No Stupid Questions

it simple, they wont pay for expensive ones at all. brand names, they prefer you to take generics over it, even if its a different type of generic.

they dont like paying for expensive services.

Also insurance may have tiered system for certain drugs, the lowest being generics, the 2nd one being brand name of generics, and then expensive generics would be the next tier, or brand names that dont have generics.

its when you get to things like biologics, or speciality drugs things get super expensive. think drugs for psorisis, chrons disease, or severe eczema.

Ozempic addicts ruined it for people who need the drugs.

Nurse here. Because in America our healthcare priorities are FUCKED that way. Getting worse every year too

Because there aren't enough Nintendo video game characters advocating for a change.

Money and the power of "fuck you".

:(

The insurance companies want to make money.

There are no (enforced) laws prohibiting this behavior.

Very few insurance company decision makers are murdered in the street.

Change one or more of these, and you'll get better results.

The insurance company is going to have a doctor who said you don't need it. They will try to hide who that doctor is, specifically what their NPI is, which can be used to personally identify the doctor who made the medical judgement against your doctor's without having to provide further explanation than they've already given. Depending where you are they may have to provide more information when directly asked for specific evidences, or will suddenly change their rejection on the claim with a letter from an attorney asking for specific details in writing. They know hiring an attorney is expensive and bank on people not advocating for their rights & people with severe medical issues not being able to afford to.

And lastly a video of a surgeon being denied the NPI of the insurance's doctors who are likely breaking the law hiding behind the idea that insurance doctors are so hated they need to hide their identity even from other doctors to prevent reprisal. She was blacklisted from United claims for this video and others like it.

https://youtu.be/AZhCYisIQB8

Oh, I know the answer to this one. It's because we don't have single-payer healthcare, which Republicans don't want because they don't want bureaucratic death panels of disconnected doctors denying people access to medication.

They'd much prefer to have bureaucratic death panels entirely disconnected from any medical expertise denying people access to their medication and for spurious reasons.

It's quite simple:

They are money-grubbing assholes in an unregulated industry. Their goal is to make as much money as possible while hurting as many people as possible. Because if they hurt people, they can take their money and provide no service.

It's legal because the government won't make it illegal.

This is what pushed Luigi to allegedly merc one of them

Monied interests have crafted a legal system that benefits them, not you.

I hate that this is happening to you.

Darknet Markets are booming with semaglutides because of capitalism’s greed.

This sucks, and I'm sorry, but you missed one crucial thing.

Eat healthier, eat more fruits and veggies, cut out excess sugar, walk more, exercise more

Have you tried eating less? Fruits and veggies give you good nutrition, working out builds muscle, but the only thing you can do to actually lose weight is to eat less.

You can get wegovy 28-day of the auto injectors through Amazon pharmacy for $200 a month without insurance. It still requires a prescription, but it sounds like you have that.

Obviously it would be better if your insurance would cover it, but $200 a month is better than the $600 a month some people are paying for ozempic/etc.

When signing up for insurance, you'll want to check their approved medications. My wife was prescribed mounjaro for her diabetes, but most of the insurance plans we looked at didn't have it listed as one of their approved medicines. It was one of the largest factors in deciding which insurance we needed to go with.

Because Fuck You, that's why.

My wife was prescribed one of those for her diabetes, and the insurance company STILL wouldn't cover a dime. She was able to find a coupon for a three month supply for $350.

They can't, they can only deny coverage for it. You can still get it paying for it yourself.

Because the filthy rich don't care if anyone dies.

Capitalism and actuarial science. Their models likely show that you are still young enough for them to keep you fat for a few years while the cost of GLP1s go down.

Mounjaro and Ozempic both have savings cards you can sign up for on their respective websites, as long as you aren't on government insurance.

I had the same issue last year, my A1C was 6.9 and insurance denied coverage. I got the savings card from Lilly, had my doctor call in the script and BAM! 25USD for 12 weeks of Mounjaro.

I didn't even need a prior authorization anymore. Apparently results may vary, but I got lucky. Try them both if needed. Stay vigilant!