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[-] medgremlin@midwest.social 4 points 1 month ago

If they have cardiovascular disease or kidney disease, those are getting added as indications for the GLP-1's so they might be able to resubmit the authorization/claim with those diagnosis codes added to get it covered.

[-] simplejack@lemmy.world 4 points 1 month ago

Yeah, but the problem is, if tests / labs show the precursor indicators for those diseases, and you have a family history, they’ll still deny until you actually have the something like a heart attack or stroke.

GLP-1s are the hot new thing, but it’s pretty common for insurance companies to deny expensive preventative care, even after all other avenues have been thoroughly explored.

[-] medgremlin@midwest.social 3 points 1 month ago* (last edited 1 month ago)

In my family medicine rotation a couple months ago, we got it approved for someone with pre-diabetes, high blood pressure, and stage 2/3 kidney disease (which is not very advanced. A lot of people over the age of 35-40 can technically fall into stage 1/2.)

[-] simplejack@lemmy.world 4 points 1 month ago

We just changed insurance and were able to get through with one provider that valued preventative care more, but our new insurance company is a complete pain in the ass. And the person in my family dealing with the insurance company actually works for the company and knows all the ins and outs.

They even give their own employees crap policies.

[-] medgremlin@midwest.social 3 points 1 month ago

This is entirely unsurprising. Hopefully they can wrangle something functional out of the insurance at some point.

this post was submitted on 11 Dec 2024
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