this post was submitted on 05 Mar 2026
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No Stupid Questions

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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?

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[–] FartMaster69@lemmy.dbzer0.com 6 points 44 minutes ago

The answer is evil greed.

[–] Bristlecone@lemmy.world 10 points 2 hours ago (1 children)

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

[–] Tollana1234567@lemmy.today 1 points 1 hour ago* (last edited 1 hour ago)

isnt also because alcohol industry is lobbying against it, because omezpic also reduces your "desire" for addictions.

[–] Tollana1234567@lemmy.today 3 points 1 hour ago* (last edited 1 hour ago)

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.

[–] mech@feddit.org 10 points 3 hours ago

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

Money and the power of "fuck you".

:(

[–] jtrek@startrek.website 34 points 5 hours ago

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.

[–] whotookkarl@lemmy.dbzer0.com 60 points 6 hours ago (2 children)

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.

a list of things to request from your insurer that may cause them to charge their determination

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

[–] AmbitiousProcess@piefed.social 7 points 2 hours ago (1 children)

The insurance company is going to have a doctor who said you don’t need it.

To add on to this, my psychologist told me that he's had antipsychotic meds denied by a urologist before, because the insurance companies often don't actually care what field the doctor is in. All they care about is getting to say "a doctor" reviewed it.

[–] Tollana1234567@lemmy.today 2 points 1 hour ago

then they have teams to review the first insurance agent approved your medications, and sometimes a team to review that teams decision of said medication. they will do this til you give up.

[–] yakko@feddit.uk 2 points 2 hours ago

This is the lore. I haven't heard from anybody trying it, I hope OP will make the attempt and report back.

[–] obelisk_complex@piefed.ca 49 points 7 hours ago

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.

[–] actionjbone@sh.itjust.works 84 points 8 hours ago

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.

[–] stephen@lazysoci.al 39 points 8 hours ago (1 children)

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.

[–] inari@piefed.zip 3 points 2 hours ago (1 children)

This guy is so photogenic, it's insane

[–] Tollana1234567@lemmy.today 2 points 1 hour ago

he bulked up in jail apparently too.

[–] Witchfire@lemmy.world 30 points 7 hours ago* (last edited 7 hours ago) (2 children)

This is what pushed Luigi to allegedly merc one of them

[–] lemmyng@piefed.ca 46 points 7 hours ago (1 children)

What do you mean, Luigi was at my place playing xbox games when that guy got killed.

[–] neidu3@sh.itjust.works 22 points 7 hours ago* (last edited 7 hours ago) (1 children)

Can confirm. I was playing with both of them online, and Luigi and I were making lewd comments about lemmyng's mom.

[–] pinball_wizard@lemmy.zip 6 points 4 hours ago (1 children)

That was so rude, but also hilarious. It was a big lobby that night, but Luigi was really keeping everyone chill.

[–] gilokee@lemmy.world 4 points 3 hours ago

yep, I was there too.

Allegedly ☝️

[–] Fubarberry@sopuli.xyz 12 points 7 hours ago (1 children)

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.

[–] Tollana1234567@lemmy.today 2 points 1 hour ago

apparently you can use coupons for the pharmacy in amazon to lower the price evenmore. i wonder of goodrx works on it.

[–] Rhynoplaz@lemmy.world 14 points 8 hours ago (2 children)

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.

[–] starlinguk@lemmy.world 2 points 1 hour ago

Three months for 350 is pretty good, here it's 500 a month.

[–] KuromiGirl04@lemmy.world 10 points 7 hours ago (2 children)

And see, that's what my problem was

Yes, I am technically a type-2 diabetic, but i am a diabetic with good numbers, so my insurance is saying "oh we wont pay for those meds. You don't need it."🙄😒

[–] mech@feddit.org 1 points 42 minutes ago

Then you gotta pump those numbers up, those are rookie numbers!

(pls don't)

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