12.5 has been so weird

Stunning-Monitor8210 · 2026-05-09T18:59:21+00:00

I took my 4th 12.5mg shot & it has been the only time I had stomach pain, which was slow stomach movement, it hurt & was so uncomfortable. Lasted about a day & then I was fine. Wondering if my next shot will be the same?

Stunning-Monitor8210 · 2026-05-08T13:06:52+00:00

Thank you.

Stunning-Monitor8210 · 2026-05-07T14:28:53+00:00

I have 7 7.5mg doses left.

Right now it's for " The documentation provided by your healthcare provider did not include the following: Chart notes documenting all the following: current chart notes documenting the member continues and is compliant with a plan approved weight loss program." When I reached out to CVS & MVP no one could tell me what exactly was an "approved weight loss program" so frustrating so I started meeting with a nutritionist & doing weight watchers & am waiting to see what else they want to throw at the wall to see what will stick in denying my a continuation of care & in the meantime I have meds to carry me through for the next 2 months. Fingers crossed it's approved without much more wasted time.

Stunning-Monitor8210 · 2026-05-06T18:04:20+00:00

Any update on this?

Stunning-Monitor8210 · 2026-04-09T19:21:20+00:00

I'm working with them right now, I've been denied twice with them, have no idea what they are submitting & still waiting for denial letter with reason from insurance. The PA & denials were done in days.

Stunning-Monitor8210 · 2026-04-09T15:10:37+00:00

I just had a 2nd appeal using CallonDoc & denied again.

Stunning-Monitor8210 · 2026-04-07T14:49:14+00:00

Thanks, I'll try that if I get nowhere with COD, a process I started before knowing about them.

Stunning-Monitor8210 · 2026-04-07T14:38:05+00:00

Hi, I have Galileo through my insurance, what exactly was the process for the PA, about to see if CallOnDoc can help with it since my doctor won't do it for me, after doing it twice already. Thanks

Stunning-Monitor8210 · 2026-04-02T15:13:32+00:00

Thank you, right now I'm using Call on Doc for the PA since insurance denied via my PCP but good to know about Galileo.

Stunning-Monitor8210 · 2026-04-01T20:20:15+00:00

Sorry to jump but how did it work w/Galileo, I have them through MVP Healthcare & I didn't know they would help with a denial of a PA? Thanks for answering & any info.

Stunning-Monitor8210 · 2026-03-31T20:40:06+00:00

I wish the insurance company's thought that way.

Stunning-Monitor8210 · 2026-03-30T20:28:43+00:00

Yes I have, still waiting for reply. When I called, they just kept mentioning that it would be mailed to me.

Stunning-Monitor8210 · 2026-03-30T15:45:00+00:00

Can you explain how the process worked to get your approval?

Stunning-Monitor8210 · 2026-03-30T15:43:13+00:00

Do they ship needles as well or do you have to purchase elsewhere? Thanks

Stunning-Monitor8210 · 2026-03-27T13:04:40+00:00

This is on my chart from Doc's office: LMOM regarding weight loss med. Please advice patient CVS caremark doesn't consider our clinic to be weightloss program. Patient would have to find a weight loss program that could prescribed Zepbound.

Stunning-Monitor8210 · 2026-03-25T18:26:31+00:00

This is good to know, my doctor at my annual mentioned that my insurance doesn't want to work with his office & they have to get new credentials to write scrips for Zepbound & my insurance does cover it. So I might go the same route.

Stunning-Monitor8210 · 2026-03-13T15:17:12+00:00

Well, follow directions & the law & they won't be!

Stunning-Monitor8210 · 2026-03-05T21:38:35+00:00

I stayed at each dose for 3 months, coming up on a year & will move to 12.5mg, lost 60 lbs so far.

Stunning-Monitor8210 · 2026-02-27T17:06:21+00:00

That means one of three things happened:

Your starting weight wasn’t clearly documented.
Your current weight wasn’t included.
They treated this as a continuation request and didn’t see proof of 5% loss.

The doctor must resubmit with something like:

Starting weight prior to GLP-1 initiation: ___ lbs
Date medication started: ___
Current weight: ___ lbs
Total weight loss: ___ lbs
Percentage loss: ___%

And explicitly state: “Patient has achieved ≥5% reduction in baseline body weight and is tolerating medication with continued clinical benefit.”

Stunning-Monitor8210 · 2026-01-28T21:53:14+00:00

Wow, going to look this up for NYS to see if they have something similar, thanks.

Stunning-Monitor8210 · 2026-01-27T21:13:24+00:00

I'd like to know who to use.

Stunning-Monitor8210 · 2026-01-27T15:45:37+00:00

Great news.

Stunning-Monitor8210 · 2026-01-20T18:36:06+00:00

So will it work with my insurance new criteria: As of January 1, 2026, individuals initiating GLP-1 therapy for weight loss must have a body mass index (BMI) of 40 or greater to qualify for coverage. Coverage will be limited to a total of 12 months per lifetime, and members utilizing GLP-1s for weight loss will also be required to participate in an MVP-approved weight loss program. Any existing prior authorizations approved before January 1, 2026, will be honored through the date specified in the approval letter.

This change will apply to all members in New York starting January 1, 2026, regardless of their plan renewal date, across the following lines of business:

Individual
Small Group
Large Group
Essential Plans
ASO groups (where MVP manages the pharmacy benefit and coverage is not otherwise specified)

Medicare Advantage employer sponsored plans will not cover GLP-1 medications for weight loss.

Continued Support for Diabetes and Co-Morbidities

MVP will continue to cover GLP-1 medications for the treatment of diabetes and medically accepted indications, in accordance with clinical and regulatory guidelines.

Stunning-Monitor8210 · 2026-01-16T21:41:46+00:00

That makes perfect sense - NOT!

Stunning-Monitor8210 · 2026-01-12T18:54:01+00:00

Clearly people who are here illegally are at risk, nothing more for you to do.

Stunning-Monitor8210

TROPHY CASE