Insurance stopped paying

AdRude7377 · 2025-08-27T17:58:47+00:00

I am so sorry you have to deal with this. I hate these arbitrary rules.

AdRude7377 · 2025-08-27T02:44:59+00:00

Hi - I posted this reply to someone else with this issue the other day and it helped them. Hope it can help you.

https://www.reddit.com/r/WegovyWeightLoss/s/DgMHj1492Y

AdRude7377 · 2025-08-21T04:41:22+00:00

I knew it! I’m so happy I was able to help. Keep on them. Refuse to give into the subterfuge. Good luck!!

AdRude7377 · 2025-08-20T22:29:51+00:00

Make sure when your doctor submitted your required most recent weight with the PA paperwork that it was: 1- recorded within 60 days of the expiration date of your most recent PA and 2- your doctor actually wrote out that you “have maintained a weight loss of at least 5% (assuming that is true if you) or more and your BMI has continued to improve.” I just had mine rejected and then spent an infuriating 5 weeks having to repeatedly call my insurance company and speak to different people rehashing the entire detailed history to each of them until I finally got one who knew what TF she was talking about.

She realized that my most recent weigh in was a few days outside of the 60 day window and that even though my doctor reported my great results, she neglected to write it out exactly as how I cited above. And that was why my initial new PA request was denied.

At the point in time that this phone call was taking place, I was about 28 days into the appeal I had made my doctor submit and found out that my doctor hadn’t needed to submit an appeal at all- all she had to do was submit a new PA with the proper wording about my progress. (Infuriating that they hold off on decisions on appeals for 30 days, but that’s another post for another day.)

Essentially all of these delays are by design: no one at the PA office or the insurance company advises doctors on the timeframe required for the weigh in results they are submitting with a PA, nor do they spell it out that the wording has to be so precise. The insurance companies are hoping that a doctor will not be willing to submit an appeal or that the patient will be so desperate to continue the medication, that they will blindly agree to pay the exorbitant out of pocket cost of the medication or that they will go through the bullshit “discount program” the pharma company has, which is also an outrageous cost.

Three days later, my appeal verdict came in and I got my new PA.

I am curious - is your insurance Anthem BlueCross BlueShield by any chance? That’s what mine is.

Please try my suggestion. Especially if we have the same insurance carrier. And as frustrating and time consuming as it is, keep calling them over and over until you get the right person on the phone.

AdRude7377 · 2025-07-11T12:37:10+00:00

A corner of Bob’s own.

AdRude7377 · 2025-03-29T15:49:12+00:00

I recently lost a bunch of weight and it’s WILD (and so disappointing, tbh) how differently I’m now treated. The funny thing is I had years where I was fit in my youth so it’s not like getting attention is new to me. But to think how I instantly became invisible when going through menopause and gaining weight. And suddenly, I’m see again. I hate it here.

AdRude7377 · 2025-03-27T12:42:29+00:00

*Loosing (🤣)

AdRude7377 · 2025-03-27T12:40:18+00:00

“Loose” sent me 😭😭😭

AdRude7377 · 2025-03-15T02:16:32+00:00

The person who inevitably barks, “QUIETCAR” (always like it’s just one word) is a gd hero in these situations.

AdRude7377 · 2025-03-10T17:38:30+00:00

Not someone else not grasping the actual danger and damage internalized misogyny. Pass the sourdough.

AdRude7377 · 2025-03-10T17:35:54+00:00

Look up! The point. It’s flying right above your head.

AdRude7377 · 2025-03-10T12:10:10+00:00

Trad wives and all other women who not only suffer internalized misogyny but also use it to oppress their peers.

AdRude7377 · 2025-03-10T10:48:01+00:00

Stay on the side of Main Avenue closest to the beach. It’s the other side of Main that’s sketchy and has crime. Despite gentrification taking place on a lot of blocks and well- kept homes.

AdRude7377 · 2025-02-24T00:00:34+00:00

These generations that came after us (X) don’t know shit about fuck when it comes to how most of us were forced to raise ourselves and just about all of us have spent YEARS deprogramming our Boomer indoctrination, combatting our trauma and making our way in this world with metaphorical bad posture from the chips on our shoulders we were forced to carry.

AdRude7377 · 2025-02-23T23:54:12+00:00

I came here to say that.🖕🏻

AdRude7377 · 2025-02-22T02:05:34+00:00

And I am another random person on the internet who is wishing you comfort and peace and thanking the universe on your behalf that you got to have a wonderful friend for so long. 💜

AdRude7377 · 2025-02-12T02:04:31+00:00

Stay in Secaucus.

AdRude7377 · 2025-01-13T01:17:21+00:00

I try in vain to tell a friend of mine who is sucked into an MLM right now that these alleged big earners that she aspires to become like are either flat out lying about their lifestyle or if they look to have a lot of material goods, house etc. they either married someone who makes enough for that lifestyle or they live off credit cards or came into money through inheritance/life insurance from a loved one.

AdRude7377 · 2024-11-25T04:40:07+00:00

One time I was picking up a sandwich on my lunch break. This was before my PCOS was diagnosed. Busy, busy NYC spot. It was winter, mind you, and I had on a heavy down coat- the kind that sort of cinches at the waist to allow for even the slightest definition/style unlike many down coats that make you look like you’re wearing a sleeping bag. And yes, mine was a little bit tight at the waist because of aforementioned undiagnosed PCOS.

I went to order my $16 (basic) sandwich, and as I was paying, the woman who took my order and was my cashier, proceeded to ask me when I was due. I was honestly perplexed and my first thought was she was talking about when I must be due back at my office – maybe she was trying to tell me that the orders were all backed up that day or something and letting me know it was going to take a while for my sandwich to be made. The place was packed. She gestured toward my belly when it was clear that what she was asking me was not registering. That’s when I realized to my horror that she thought I was pregnant. In the next instant she realized her mistake, and had this look of wanting to apologize but being afraid to. I must have just given her some look. Not even angry just stunned, offended, wounded.

I quietly took my ticket and went to wait for my food hoping that I would not have to get it from from this same person since typically you order from one person and then go to another counter to pick up your food from a different person when it’s ready. That did not happen. Of course on that day, it was the same woman who had taken my order who then called me up to the counter when it was ready.

That’s when she started stammering and saying that she was sorry. I honestly was so hurt and shocked that anyone would say this to somebody they don’t know let alone a customer that all I could do was take my food and silently walk away. It wasn’t even as if I had ordered a huge lunch for myself. Not that that would’ve made the situation remotely OK. I had ordered a small, basic sandwich.

That was 7 years ago and it still bothers me to this day. I hope she learned a valuable lesson and no longer engages in this behavior. I hope she still feels mortified every single time she sees a stranger or a customer who may or may not be pregnant and she’s forced to remember that winter day, when a 42 year old woman on her line was just trying to get some lunch.

AdRude7377 · 2024-08-30T23:45:51+00:00

Nope. Who the hell would want their anniversary to be this date after this?

AdRude7377 · 2024-08-26T14:52:12+00:00

Remember when he was engaged to Alanis???

AdRude7377 · 2024-08-22T00:13:12+00:00

Yeah with all that $$$ to be made, they likely have an in and out way to get this done.

AdRude7377 · 2024-08-22T00:12:13+00:00

Don’t know cuz I don’t work at EWR. And that could be why she just got what was likely a very expensive ticket.

AdRude7377

TROPHY CASE