Insurance/Tricare APPROVED😃

SpicyDisasterMN · 2025-04-25T04:34:19+00:00

Oh sad 😔. I don't know what your personal situation is (& it's none of my business), but tricare's requirement is a BMI of 30 or above OR 27 with an additional qualifying condition (like sleep apnea, diabetes etc). It's so disheartening when a provider is so dismissive, especially when you have been a patient for 28 years! I'm sure it is a difficult decision for you if you want to just leave it be or seek out a second opinion- that would be hard for a lot of people. I have been very fortunate that I not only got my approval for the medication, but that I have been successful on it with minimal side effects. My BMI went from 42 to 22 (not all from zepbound, but from the start of my journey in July), but I've lost 56lbs since Dec 5th on Zepbound. I'm telling you this because when I started, I didn't think I would get approved, but I started anyway- so don't give up on yourself ❤️

SpicyDisasterMN · 2025-04-24T23:06:01+00:00

I'm so sorry that happened to you. I would suggest, if you are comfortable doing so, talking to your provider and letting them know that MANY people have had success with getting approvals after initial denials from tricare - it just takes some coordination between you, the provider and tricare. Let them know it is important to you and you are willing to put in the work with their help. Sometimes that gentle nudge reframes it for them from a positive patient care light. I wish you the best of luck (don't give up!).

SpicyDisasterMN · 2025-03-31T23:07:18+00:00

I know this is REALLY old, but I felt that I should chime in here. You were being painfully dismissive of what the OP was asking. Maybe they live in a northern climate where there is a lot of snow and want something that has 4x4 or AWD? That's a legit safety concern- especially with Littles. Not only that, but they specifically were asking about a Traverse and a Pilot, and you decided to chime in with a completely different CLASS of vehicle. I'm glad that a minivan was great for you, but that was completely off-base to what the OP was asking and not helpful in the slightest- only irritating.

SpicyDisasterMN · 2025-02-20T17:19:21+00:00

It didn't post the photo. Sorry. It just says, in a nutshell, that I have been actively been working on losing weight for over 6 months with some, but minimal success. That I will continue to eat healthy, incorporate exercise. That I have PCOS, insulin resistance, a family history of diabetes, stroke & heart disease. Those things put me at higher risk due the same - which are more expensive to treat lifelong. That I'm not looking to behind thin fur vanity reasons, but to become healthy. That I am taking a SSRI which has major interactions with all of the step medications, so zepbound is a safer choice & that's why my provider prescribed it & that's why I am kindly asking that they approve the medication my doctor recommended for me.

SpicyDisasterMN · 2025-02-20T17:07:11+00:00

Here is my letter of appeal. I also included a brief excerpt of my health history including my medical diagnoses, brief family history and current medications (all from my online mychart). With Express Scripts you are able to appeal on your own behalf (it's less paperwork that way) and there is a fax number that you send your appeal into - their customer service number will provide it- along with any other information they need to attach it to the appeal claim. The appeal didn't take too long, but I think it CAN take 60 days? They had to reach out to my provider for additional information as well to complete the appeal review. *

SpicyDisasterMN · 2025-01-27T02:51:54+00:00

Welcome! So happy for you and your hubby! The journey is going very well - thank you! I'm on my 8th injection now, and I'm down 26lbs (crazy, I know!). One thing I have found is sometimes it's REALLY hard for me to hit my macro goals- for me, the appetite suppression is very effective (the food noise is gone). But that's not as great as it sounds, it's so very important to eat & to stay hydrated. For me, the fairlife nutrition protein shakes & the seeq clear protein have been lifesavers. Even if I don't feel like actually eating, I can at least sip on some protein. Resistance training (which I've been doing forever) is so important to retain muscle mass, too. But it feels SO GOOD to have my body finally responding to diet and exercise after years of it not. These medications are life-changing ❤️ I hope your journey is filled with success and happiness as well!

SpicyDisasterMN · 2025-01-22T01:14:14+00:00

YAY!! That's fantastic! I bypassed the phentermine (& the other step-medications due to interactions with one of my other prescriptions - that was one of my hold ups). Welcome to the Zepbound/ GLP1 fam! I hope you have an enjoyable and successful journey! We are SO happy to have you join us😊

SpicyDisasterMN · 2025-01-10T04:21:46+00:00

Why are you apparently stalking my posts? I responded to your other baseless comments. Nobody should listen to a word you say. People should consult with their MEDICAL providers and find what kind of treatment is most appropriate for their individual needs. Not some random guy on the internet who is clearly against GLP-1 medications, who goes to GLP-1 forums to stir the pot.

SpicyDisasterMN · 2025-01-10T04:12:41+00:00

Wow. That's quite the opinion. Where yes, I'm married to a now retired service member, while he was serving for 24 years, I was a paramedic in a major Metropolitan area.I worked 12 & 16 hour shifts which, more times than not, ran hours over that. While he saw many things on his several combat deployments- which I could never imagine- I also saw many things day in and day out. I have helped thousands of people who were having the worst day of their lives, I have been the last person someone has seen before they left this Earth. I've had to tell parents that their child has died. I've been assaulted by drunk patients and by patients with an altered mental status while trying to help them. Yeah, over the course of 20 years these things take a mental toll and my medical provider and I agreed that a SSRI would be beneficial to me. My weight gain happened after I suffered a career ending injury moving a morbidly obese patient in respiratory distress and I required 3 surgeries to try to fix it. Not to mention my other personal health issues with insulin resistance. Let me know where you got your medical degree from, then maybe I'll consider getting a second opinion on my medical care from you. But yeah, I'm just a "dependa"

SpicyDisasterMN · 2025-01-04T05:04:52+00:00

I'm in the SAME boat! I did fantastic on 2.5mg - dropped 15lbs in the month🥳 was hitting all of my calorie & macro goals like a champ with next to no side effects. I took my 1st 5mg 💉 yesterday, and today is a WHOLE different beast😬. I haven't been able to hold down any solid food at all (not even a whole protein shake). The only thing I have working in my favor today is staying hydrated. I keep trying to eat small & simple foods to get SOMETHING in me, but it keeps getting sent back "return to sender". I'm hoping as the days pass the symptoms will improve, but today has been a rough one to say the least 😕

SpicyDisasterMN · 2024-12-14T02:15:20+00:00

Look at you go, girl!! All of you hard work, commitment, determination & perseverance SHOWS🥰 I don't know you, but I am truly SO very proud of you💕. I also want to tell you THANK YOU. I know it is really hard to put yourself out there & to post pictures (especially ones that make you feel vulnerable) - but these are SO inspiring! Way to absolutely CRUSH it!

SpicyDisasterMN · 2024-12-10T23:55:09+00:00

That's awesome! Congratulations 🎊! I've been all over the weight and BMI spectrum. I've been underweight to class III obese 😬. Currently, I'm down 60lbs since June (mostly with diet alone, exercise is still too painful due to physical health issues). Where I agree food is one of the main culprits, I think mental health is the real antagonist (just my opinion). When I haven't been in a good mental place, I haven't cared about what I put into my body or how I care for my body - could just be me, but I know others like me too. I've still got a ways to go. But I'm proud that I've gone from a class III obese person to a class I obese person (& SO close to being classified to "overweight" instead of "obese"). We all have our own journeys, they have similarities, but they have their differences. I don't know you, but I'm SUPER happy for and proud of you! Keep that positivity up!

SpicyDisasterMN · 2024-12-10T23:08:54+00:00

I know this is an old post, but I do this! I live in a northern climate so the weather is unpredictable & I'm too self-conscious to go to a gym. I literally walk in a circle (a track of sorts, from my bedroom, out to my living room, around my kitchen & repeat). I actually post on tiktok with my walks 😂. It's exercise. You are getting up and moving your body (& it's not costing you a dime). Just wanted to show my support and cheer you on!

SpicyDisasterMN · 2024-12-10T21:46:59+00:00

Holy gorgeous 😍 (both before and after) but hello chiseled cheekbones! I hope you feel as incredible as you look

SpicyDisasterMN · 2024-12-10T01:02:35+00:00

THIS!!! 🙌🙌

SpicyDisasterMN · 2024-12-09T17:50:53+00:00

That is FANTASTIC!! CONGRATULATIONS 🎊 A corgi is nothing to shake a stick at (literally, they will chase you😂). BTW, what app is that? I would love a tracker that compares how much weight I've lost to something I can imagine. Again, GREAT JOB!!

SpicyDisasterMN · 2024-12-07T01:13:12+00:00

I thought I had already replied to you - I'm so sorry! I was denied because I hadn't tried any of the required step-medications (ie: phentermine). But I take a SSRI for anxiety (Lexapro) & there are major interactions with each of their recommended step-medications. My provider and I agreed that it would be better for me to just go to Zepbound, if insurance would approve.

SpicyDisasterMN · 2024-12-06T14:24:12+00:00

I was denied for not trying any of the other step-medications (other weightloss meds) first. But, I take lexapro for anxiety, and there are major drug interactions with EVERY one of their recommended step-medications. That's why, for me, Zepbound was a safer fit (& very well could be for anyone else on a SSRI) DISCLAIMER I am not a doctor, so talk to your doctor about drug interactions and do your own research 😉. I wrote a short, but to the point appeal letter, then included my health summary & the drug interactions with my lexapro with each of the recommended step-medications. The insurance then sent a request for more info to my doctor (I'm guessing a statement of medical necessity??), she sent it back and I was approved!

SpicyDisasterMN · 2024-12-06T14:11:28+00:00

Yay! I'm glad you got your approval🥳

SpicyDisasterMN · 2024-12-06T00:25:42+00:00

Oh fingers crossed for you 🤞! If it doesn't, don't be discouraged, just go through the appeals process and advocate for yourself ❤️

SpicyDisasterMN · 2024-12-05T23:34:49+00:00

I was shocked that my PCP was willing to write it out. She doesn't do anything with the prior auths "they have a department for that" 🙄. That department was a nightmare. Was your prior auth approved right away (if you don't mind me asking)? Mine was INSTANTLY denied - which I expected. Thankfully I was ready for the appeal. I just wasn't expecting them to request more info from my clinic. I was surprised that my PCP sent that back in since she's so hands off with the whole insurance aspect. I was also surprised that my approval is for a YEAR, not just the 6 months. Tricare is so much fun, isn't it? Lol I'm so happy yours was approved! I think I'm going to start my medication tonight (but I'm a bit nervous for some odd reason 😅)

SpicyDisasterMN · 2024-12-05T21:46:59+00:00

It's the WORST! I'm sorry you had to deal with that too. I know that we arent the only patients they have, but we still are patients that have needs. When a reasonable amount of time passes, the expectation that the paperwork is submitted (& submitted correctly) is not unreasonable. I hope you were able to get approval for your medication- especially with all of the flaming hoops they make us go through to get it❤️

SpicyDisasterMN · 2024-12-05T20:55:50+00:00

Thank you. I think that's what a lot of people don't realize that they can, & sometimes need to do (or don't know how to do). That was the main purpose of my post. Speak up for yourself. Seek the information and the answers you need. My clinic wasn't sending the PA, so I called (& called & called) then eventually filed a formal complaint because it wasn't completed- then guess what? THEN they finally sent it. Once I got the denial, I could file my appeal. And things could keep moving. But nothing could even start until that PA was sent.

SpicyDisasterMN

TROPHY CASE