Is it just me, or is my insurance company asking for some pretty unusual and unreasonable things from me for approval?
Hi everyone, So, some unusual things have been happening in my and my doctor's attempts to get approved for Wegovy. First one being that I have been approved TWICE, and had received my first 0.25 starting dosage. During that first month, I experienced all positives and no side effects..
Then, suddenly, I was denied in month 2. However, I was apparently never approved to begin with. We resubmitted the pre-auth, and it was approved a SECOND time. I was even sent a copy of the approval notice straight from my clinic. And yet again, when I go to get my refill, I'm suddenly denied again.
There's only one theory I have. My insurance ID# was changed approx 3'ish years ago. Same insurance, no lapsed coverage, no breaks. All information has been updated with clinics. But why would the insurance company run the old ID# and my new ID# just to approve one and not the other?
Now, as far as the denial letter and the prerequisites they are asking of me. You can read a copy of it Here. It's just an Imgur link.
Just to quickly run down a few things.
I have a BMI of 37
Suffer from heart failure. (Diagnosed during the pandemic shutdown)
Limited mobility due to degenerative disks/bulging disks (20+ years of pain meds)
High Cholesterol A panel of results you can see here. And this was after being on Fenofibrate for a few months.
The gallbladder was removed in 2009ish, So I've had to automatically watch what I eat since then. I don't eat poorly, at least as much as what my extremely limited budget can afford. You won't find any junk food in my kitchen. Hell, I'll even show anyone pictures of my pantry/fridge, and I don't eat crazy proportions (most of the time). It's just too expensive to truly eat healthy, while at the same time, the so-called "budget-friendly" healthy choices are still processed like crazy and ultimately not very healthy at all. I do NOT eat out or get fast food more than once or twice a year. I cook 99% of my meals myself. I don't eat candy, I don't drink coffee, I don't smoke, and I don't drink alcohol. I'll drink Sleepy time tea once in a while. I stay away from boxed meals as much as possible. I like one pot meals and always make sure to include protein, veggies, and some grains. Snacks in my fridge are often oranges, apples, and bananas. I love snacking on nuts (Worst thing in the world for me). I have a weakness for cheese/crackers/summer sausage. You get the picture. I'm not a pig. I've spent years trying to make the best food choices I can afford.
With that said, what the rejection letter is asking of me seems almost out of line. Like having to be 45 years old (I'm close enough), and basically telling me I have to pretty much die or come close to it before being approved, such as having a fkn heart attack! It's like, that's what we're trying to prevent! And I can barely bring my own groceries into my home, or wash my own hair without my arms feeling like they weigh a million pounds. Then add on the disk issues, how TF do you expect me to do much moving around? Now, before the pandemic and before K.O. (My dog) passed away. I would walk with K.O. 1-2 miles every day or every other day. It was about all my back could handle. But I made it work because K.O. was my everything. Even then, I never lost a pound. The thing is. I also never gain weight easily, either. And yet the insurance company is asking for some pretty ridiculous specifics...And then of course I have to have something amputated for "reasons"...
I know this is a long post, and I'm sorry. I could actually go on, but whoever gets this far has read the links I posted and is free to ask me more specific questions and offer any advice on how to continue my battle with getting approved. But any thoughts, opinons, or advice is extremely welcome. Thank you. Sorry for any typos or bad sentence structure.