Let me explain with my current situation. I am 22 F and I currently weigh 305lbs.
I am obese. Morbidly obese.
Even though I have been trying for 5 years at this point to lose the weight on my own. Eat healthier, eat more fruits and veggies, cut out excess sugar, walk more, exercise more, the whole kit and caboodle.
But I still am not losing the weight. I am still very fat. And I am worried that it will cause very serious health problems.
So I talked with my doctor and she told me “We need to get you on a weight loss medication. Let’s try Ozempic”.
But my insurance told us that they don’t think I need the Ozempic so they won’t pay for it.
So we tried Wegovy and Mounjaro. But my insurance still rejected our requests.
They’re saying because I am young, and I am a diabetic with good numbers, I dont need the weight loss meds and I can just lose the weight naturally.
But ive been trying to and it hasn’t been working. So that’s why my doctor prescribed me the weight loss med.
Why is this allowed? Why is it that your insurance can deny you a medication, even if your doctor says you need it?
Nunber 1: Ozempic is NOT a weight loss drug.
Ozempic is a diabetes management drug that has a potential side-effect of weight loss.
The reason that you are likely being denied for Ozempic by your insurance is because you likely lack the diabetes with the additional comorbidities. You shared that you are diabetic with good numbers.
If you had worse diabetes and additional issues (comorbidities) such as high risk for stroke or heart attack by (very) high unmanaged blood pressure, then you could appeal the insurance company to cover the drug.
Number 2: the struggle is real. I highly recommend you fight this and continue your weight loss journey. Diabetes is unbelievably complicating later in life.
US healthcare will go broke covering $350/mo drugs to counteract lifestyle choices. 15M already on this drug, that’s $5.25B a month.
Damn, so five whole days of the Iran war would cover it for a whole month for everyone?
Good. Fuck em all and replace the whole thing with a system that works.
Oh no! Not the health
careinsurance industry.It doesn’t cost $350/mo/person to produce these drugs. Manufacturers brazenly price gouge knowing no goverment body would retaliate.
This is a problem that can be solved by legislation and cutting out the middle-man(insurance companies) by expanding medicare for all.
The answer is evil greed.
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.
They argue that they are preventing waste and fraud by holding doctors accountable. Like “oh if we didn’t have this power then doctors would order so many unnecessary tests and prescriptions”
(Not defending them, just sharing what they say)
If that was the case we’d have one of the most efficient medical systems in the world instead of one of the least
Yeah, and what they say is bullshit. Doctors prescribe the medicine people need.
They don’t care about fraud. They care about their profits. We shouldn’t repeat their excuses like that.
Because there aren’t enough Nintendo video game characters advocating for a change.
Because your congressperson is bought and paid for and there aren’t enough people assassinating health insurance CEOs in the street to inspire them to change their ways.
It’s not allowed, but then again, I’m not in the US.
Look into compound pharmacies, you can get it for under $50 a month that way and not have to deal with insurance at all.
Sorry you are getting such negaticve responses here, people dont realize ozempic actually helps you to eat less and make the lifestyle changes people insist anyone can do without help. Feel free to dm me if you need additional help.
This is what pushed Luigi to merc one of them
Allegedly ☝️
What do you mean, Luigi was at my place playing xbox games when that guy got killed.
Can confirm. I was playing with both of them online, and Luigi and I were making lewd comments about lemmyng’s mom.
That was so rude, but also hilarious. It was a big lobby that night, but Luigi was really keeping everyone chill.
yep, I was there too.
Nurse here. Because in America our healthcare priorities are FUCKED that way. Getting worse every year too
isnt also because alcohol industry is lobbying against it, because omezpic also reduces your “desire” for addictions.
and McDonalds.
no way this skinny CEO eats that shit.
He swallowed some of the juice, he’ll taste that for weeks.
You gotta love the wince developing on the left side of his face as he chokes down his promo nibble.
Money.
These drugs were originally diabetes drugs, that had the side effects of weight loss, but that wasn’t their original use that they got FDA approval for.
So they are going back and getting them approved for different uses, and maybe one of those will get by the insurance company. I saw one being advertised for Sleep Apnia, which is common in obese people. It works because when you lose weight, your Apnia usually improves, so while they aren’t selling it specifically for weight loss, that’s the mechanism that improves the Apnia. Maybe your doctor can get it approved for that reason, or another one.
I was 350, and I’ve lost 100 pounds, without the drugs. I quit all sugary beverages, and only drink ice water or unsweet tea. I only eat when I’m hungry, and only until I’m not hungry. It allows me to eat whatever I want, but in strict moderation. It doesn’t feel like a diet, though, because when I’m hungry I eat, but only until I’m not. I never eat more than a half sandwich. I will eat cookies, but only two, not half a package. When I have craving for chocolate, I’ll eat 4 or 5 chocolate chips, one at a time, and let them melt on my tongue, so my chocolate craving gets fulfilled, without an entire candy bar.
And importantly, I developed a distraction. My Dad quit smoking years ago, by doing a Rubik’s Cube whenever he got a craving. I took up the guitar. I keep an acoustic guitar next to my chair, and if I get a craving, instead of heading to the fridge, I pick up my guitar.
I didn’t even increase my exercise, although I have a pretty physically active job. I’ve plateaued now, so I think it’s time to increase my exercise for the last 50 I’d like to lose.
Keep at it, don’t give up. It is far easier to lose weight at your age than after about 30, so do it now. Keep making adjustments in your diet and exercise, and eventually your metabolism will shift and start working with you.
I’ll add that one huge thing is establishing a realistic plan that accepts weakness and failures without derailing. When I was actively losing weight I did the following cico based plan.
I started with a week of just counting calories, all diet changes were because I was aware of how much I was eating. While doing that I found out what my maintenance calories were and what the maintenance calories of my goal weight were.
I then did a week at my maintainance calories, though the goal is to keep doing it until it’s comfortable. While doing that I figured out general meal plans (ie how much I wanted to budget for breakfast/lunch/dinner/snacks). This stage is important because a) you’re probably used to overeating so this is you stopping gaining weight, b) you’re learning where you’re most comfortable cutting calories in your day, and c) relearning your relationship with hunger. For that last part, I was teaching myself to associate a mild hunger with losing weight and to stop seeing it as such a problem.
Then once I was comfortable at maintenance I began with a 500 calorie deficit. That’s a generally safe number that’s largely achievable and results in a pound a week loss. When I was comfortable there I moved up to 1000 a week, which is about the limit of what is safe/wise for the average person to sustain over an extended period without medical supervision. Either as the ultimate deficit is fine.
From there, don’t check the scale more than once a week, and if you hit a plateau for a few weeks reevaluate your maintenance calories and double check you aren’t missing some in your counts. I also recommend smaller portion sizes over a longer time. Keep food out of sight when it’s not eating time. Try a glass of water and a walk instead of a snack. You may need a multivitamin or to plan around your micronutrients. Fiber helps with satistion, refined sugar hurts with it, though you’ll figure out what foods leave you full and what foods just aren’t worth the calorie/fullness ratio pretty quickly. Some days you will fail, that’s ok, keep them spread out and don’t try to make up for them. You can have cheat days, but those calories do still count so keep them few and far between. Also home cooked is usually a better value for calories than premade.
Once you hit your goal keep counting while eating at maintenance for a while to ensure you’re sticking with stable maintenance habits. This isn’t supposed to be a yo yo (though if you’re active dirty bulk/cut cycles), instead it’s about building a healthy relationship with food portioning.
Exercise doesn’t make you lose weight outside maybe a hundred or two calories a day, but it does lead to a healthier lifestyle and creates reinforcement of the health and ability gains from weight loss. It also can raise your resting calorie burn (don’t calculate for changes from it until you’re done). The important thing is just like with diet, finding a way to sustain it. This means finding something involving cardio that you enjoy that you can do regularly like a sport, running, or biking. If you’re interested in strength building, bodyweight exercises are great. Slowly build up with exercise, until you’re at an activity level that you want.
Anyways yeah, I figure it’s worth putting all this out there since a lot of people out there love to act like it’s either all about willpower or all about finding tricks to not need any willpower, when really it’s all about building better habits and accepting that it took time to gain it, it’ll take time to lose it, but you lose it bit by bit with actual changes. I was never huge, but I lost 30 pounds in about half a year when I was OPs age and developed a healthy lifestyle for years out of it despite a family riddled with obesity, heart disease, and anorexia. This doesn’t take from the shittiness of what OP is going through and if her doctor feels the medical benefits outweigh the risks the insurance company needs to shut up and pay.
Losing weight is just math: Calories In vs Calories Out. Which one is bigger determines whether you gain or lose weight.
For that last part, I was teaching myself to associate a mild hunger with losing weight and to stop seeing it as such a problem
This is huge, and one of the first things that you have to overcome. Heavy people have been conditioned to not just eat when they feel the slightest hunger, but to stuff themselves. Making that psychological shift that a little hunger is not only acceptable, but it’s a signal that you are losing weight, is a sign that your diet is working. After a while, instead of motivating you to go to the refrigerator for something to eat, that hunger reminds you of your weight mission, and motivates you to stay the course.
It’s just math in the same way basketball is just a bunch of physics 101 problems. Yes, but the hard part is taking it from paper to doing it with biology. Your brain is struggling to get you to have an excess when there’s more than enough because animals whose brains didn’t do that were less likely to survive lean times. Add in complications like hypothyroidism and other endocrine and metabolic issues, some people are going to really struggle in ways others might not. For some the cravings will be far more intense than they can bear, and that’s why going in steps and waiting until that step is comfortable and sustainable before the next step is so useful.
Food can serve in many roles, some of which are healthy, such as a bonding exercise, cultural expression, and nutrition, others are unhealthy like stimulation and emotional comfort. One of the important things about my method is that the maintenance and early loss steps are going to challenge your negative relationships with food and find more healthy forms of stimulation and emotional comfort if those are reasons you overeat. A small weight is a great replacement for stimulation as is a glass of water or a walk. And learning to handle emotional distress without destructive coping mechanisms such as overeating is vital, here too I’ve found exercise to be a magnificent replacement. (Yeah basically any time anything happens or I feel anything I take a walk or bike ride)
Oh also I totally forgot to mention the self esteem elements. I’m not going to say nobody can hate themselves skinny, I’ve seen it, but the people who do it are rarely the sorts one should emulate. Much easier is to love yourself and your body enough to do this for yourself. “I deserve to have a body that I am physically and emotionally comfortable with” is just so much better of a mantra for when you’re hungry or struggling to exercise than something about hating how fat you are. You want to learn to look in the mirror with love and kindness and as time goes on with pride. Firstly because it’s not like fat people are less deserving of love and kindness. But also because you’re doing this for you, and it’s a hell of a lot easier to do something difficult for someone you love than out of spite. And that spite will fade as you lose weight anyways, and it may coincide with sagging skin.
But also, hugely important is that hating yourself is a fast track to disordered eating and overshooting weight loss as well as developing weight focused body dysmorphia (ie inability to see your healthy weight as healthy). I have a loved one who wound up hospitalized for anorexia, so it’s something I feel is important to acknowledge and avert the risks of. It’s better to be overweight and living an active and happy lifestyle than to be anorexic. General rule is a little over is better than a little under, but a lot over can be worse than a little under.
Because “business” and “dollar amounts” are more important than human life (some human life anyway).
Luigi…
Sadly that’s only (or mostly) in America. Here we get whatever meds the dr says. Most common ones are subsidized by the government (via taxes yes).
My idea of Ameroca was already wild but finding out you gotta convince an insurance company you pay that you need medicine a dr prescribes is crazy.
Oh and we get pretty much all blood tests and stays for free. GP one day, scan/test the same day (different location but some have them next door) then back at the GP by the end of the week with results and get your meds. Done.
Sorry OP.
Tgis article has some helpful tips if you haven’t tried what the article entails.
https://www.healthline.com/health/how-to-appeal-insurance-claim-denial#takeaway
Also assuming you’re American look to see if your state has a Department of Insurance. I had a positive experience with mine when Geico was trying to pay me half what my car was worth.
