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What else SHOULD I see but that I DO qualify for it (my BMI is barely under 30, and - even if it weren't - I have a qualifying comorbidity) and that I DO have funds I need to spend or else will lose, and that I DO need and want to lose 15-20 pounds and haven't been able to?
What, exactly, is your objection to that, except that you have a personal grudge against the OP that's very obvious here?
I'm happy to hear that it's worked for others; good for you! I wish it could work for me.
Have you tried a weight loss clinic? My semaglutide rx was around $325 a month (not thousands as some have said), and my tech who is a Nurse Practitioner was with me 100% of the time. She oversaw every
step-up in the amount I took.
I’m not saying $325 is cheap, by any means, but if you have this lump sum sitting and if you can use it for this, why not give it a try? Especially if you’re going to lose out on that money since there’s nothing else it covers that you need or want.
Have you tried a weight loss clinic? My semaglutide rx was around $325 a month (not thousands as some have said), and my tech who is a Nurse Practitioner was with me 100% of the time. She oversaw every
step-up in the amount I took.
I’m not saying $325 is cheap, by any means, but if you have this lump sum sitting and if you can use it for this, why not give it a try? Especially if you’re going to lose out on that money since there’s nothing else it covers that you need or want.
Again...I would need "a letter of medical necessity" for this HRA to approve it; do weight loss clinics issue those? But yes, that's probably what I'll end up doing, even if I have to pay for it myself.
Again...I would need "a letter of medical necessity" for this HRA to approve it; do weight loss clinics issue those? But yes, that's probably what I'll end up doing, even if I have to pay for it myself.
Not sure about that. I guess the only way to find out is to ask the clinic.
Again...I would need "a letter of medical necessity" for this HRA to approve it; do weight loss clinics issue those? But yes, that's probably what I'll end up doing, even if I have to pay for it myself.
You should confirm with the claims administrator of your HRA whether "a letter of medical necessity" is required and what documentation is acceptable.
Last edited by Maddie104; 01-30-2024 at 08:17 AM..
So was Phen/Fen in the 90s. I lost about 50 lbs on it, but as soon as I reached my goal weight, the doc stopped prescribing it, so I gained it all back. Because I never learned how to eat within my body's goal caloric/fat/carb intake.
Weight Watchers is the best weight-loss program out there, at least for my needs. I lost 50 lbs in 2020, although due to a tragedy in our family I gained back 20 lbs when I went off it and ate what I wanted for awhile. But I went back to it and have kept off the original 30 lbs.
You should confirm with the claims administrator of your HRA what is required for reimbursement.
I already did. "A letter of medical necessity" stating that I meet the prescribing protocols, which are a BMI of 30 or of 27 with a comorbidity (hypertension, diabetes, or dyslipidemia). Although I do meet those criteria, my doctor won't prescribe it or write the letter, insisting that I "don't qualify" (via his assistant; I wasn't able to actually talk to him or get an appointment on such short notice - he's booked six months out - so I left a message and got a message back). He's either misinformed or just doesn't want to do it. Actually, I don't even know for sure that he was asked!
I already did. "A letter of medical necessity" stating that I meet the prescribing protocols, which are a BMI of 30 or of 27 with a comorbidity (hypertension, diabetes, or dyslipidemia). Although I do meet those criteria, my doctor won't prescribe it or write the letter, insisting that I "don't qualify" (via his assistant; I wasn't able to actually talk to him or get an appointment on such short notice - he's booked six months out - so I left a message and got a message back). He's either misinformed or just doesn't want to do it. Actually, I don't even know for sure that he was asked!
I suppose I would be, but there's the difficulty of finding one that's accepting new patients, scheduling an initial appointment, getting the prescription (I would actually need TWO months' worth to use all the funds) and, of course, all that takes time, along with follow-up appointments. I have only a month to spend this money. Since my doctor and I HAD discussed my weight - and even Wegovy - in the past and he HAD my BMI and labs on file, I thought it would be an easy matter to get started on this. I was wrong! If I end up with outstanding expenses once I transition off my insurance, it won't be covered at all since Medicare doesn't pay for weight loss drugs (although Medicaid does, which I find interesting), and that seems risky. If I end up having to pay out of pocket, I'd rather pay $325 to a weight loss clinic than thousands to a doctor.
I already did. "A letter of medical necessity" stating that I meet the prescribing protocols, which are a BMI of 30 or of 27 with a comorbidity (hypertension, diabetes, or dyslipidemia). Although I do meet those criteria, my doctor won't prescribe it or write the letter, insisting that I "don't qualify" (via his assistant; I wasn't able to actually talk to him or get an appointment on such short notice - he's booked six months out - so I left a message and got a message back). He's either misinformed or just doesn't want to do it. Actually, I don't even know for sure that he was asked!
Or, he doesn't feel that you would be successful. I meet all the criteria necessary to successfully have a hysterectomy. Except one, very important one: I don't need a hysterectomy.
Your doctor, for whatever reason, has determined that you don't need Wegovy. Maybe he's determined you need something different. Maybe he's determined you don't need anything at all. Maybe he's already given you advice, and you've chosen to fixate on the newest fad in weight loss instead. No one here knows, and all you're trying to do here on this forum is seek validation for your own poor decisions. You won't get that from me.
I gathered that he's not a fan of Wegovy, from what little we discussed. In fact, his exact words were "if they would just shut their pieholes instead," and we laughed. That was the extent of our discussion (we had other things to discuss), but that should tell you something. And, again, that's his prerogative; just because I meet the protocol doesn't mean he HAS to prescribe it; in fact, he doesn't HAVE to treat me at all.
The fact remains that I DO "qualify" for it, so for him or his office to say I don't is false, and that irks.
I've decided to go with something that's a sure bet instead: a cap for a tooth that I've been needing but putting off. I could have gone longer without it and possibly even gotten a discount with my future Medicare Advantage Plan, but oh well! That should almost to the penny use up all the funds and not be subject to controversy or complications.
Keep the feedback coming, though! I'm interested in your Wegovy stories, particularly if anyone else meeting the criteria was denied, although it doesn't sound like that happens very often...
Last edited by otterhere; 01-30-2024 at 08:36 AM..
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