Friday, November 18, 2022

YSK: insurance coverage of MD appointments/medications pertaining to weight loss

Just want to warn people if you are going to talk to your MD about weight loss check with your insurance company first to make sure they cover weight loss as a benefit. Also it's up to your employer if they want to cover "weight loss" on a workplace plan.

I scheduled an appointment with a Dr for what I thought was going to be my annual physical that is supposed to fully covered by insurance per ACA. I have BCBS regence and $25/office visit copay. My previous PCP at this clinic had quit so I was seen by a new Dr. She said this was like a preliminary visit since she hadn't seen me before, not the actual physical. I had my labwork done previously so brought that in for her to look at. My A1C was slightly elevated and she said that I was prediabetic but it could be managed with carb restrictions/weight loss. She wrote a script for one of those diabetic injections that also work for weight loss (can't remember the name). I go to fill it at the pharmacy and they tell me it's not covered as my insurance does not pay for anything related to weight loss. A few weeks later I get a denial letter that they would not pay for the office visit either. I called my insurance and they said it was denied since it was related to weight loss but to call the Dr and ask her to use a different code for the visit. That was just today so I left a message and haven't heard back yet. I just can't believe it.

submitted by /u/thelma_edith
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