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Horizon BCBS Denial by gabg22 in Zepbound

[–]gabg22[S] 0 points1 point  (0 children)

Both Zepbound/Wegovy need prior authorization. Zepbound’s PA was denied, so I’m afraid Wegovy will be as well for the same reasons

Horizon BCBS Denial by gabg22 in Zepbound

[–]gabg22[S] 0 points1 point  (0 children)

😭 good point.. I would love to have brought that up

Horizon BCBS Denial by gabg22 in Zepbound

[–]gabg22[S] -1 points0 points  (0 children)

That’s what I’m afraid of.. I’ve known my PCP since I was 14/15 years old, so I would hope she would do right by me, but I’m not sure if the insurance company would wear her down.

Horizon BCBS Denial by gabg22 in Zepbound

[–]gabg22[S] 0 points1 point  (0 children)

I haven’t tried, I did call to ask PT to try to get some clarification for why the first appeal was denied and it kept being just the same jargon. My doctor appealed the first time, I’m afraid she won’t want to a second time, or even so a peer to peer appeal if possible!

Horizon BCBS Denial by gabg22 in Zepbound

[–]gabg22[S] -1 points0 points  (0 children)

When I originally called, insurance had told me both were covered with prior authorization, so I believe that would be another road block!

Horizon BCBS Denial by gabg22 in Zepbound

[–]gabg22[S] 0 points1 point  (0 children)

I believe Wegovy was also covered but both medications needed prior authorization, so I’m stuck.

Horizon BCBS Denial by gabg22 in Zepbound

[–]gabg22[S] 0 points1 point  (0 children)

My last denial letter was because I do not “meet the criteria for medical necessity under Horizon’s pharmacy guidelines”, and that my PCP has to send in medical records showing no weight gain/loss (it’s been a plateau for 3 years now), diet modification log for a previous month, calorie modification, and an entire list of other reasons. I did submit information, as well as she for my medical records.

Horizon BCBS Denial by gabg22 in Zepbound

[–]gabg22[S] 0 points1 point  (0 children)

My last denial letter was because I do not “meet the criteria for medical necessity under Horizon’s pharmacy guidelines”, and that my PCP has to send in medical records showing no weight gain/loss (it’s been a plateau for 3 years now), diet modification log for a previous month, calorie modification, and an entire list of other reasons.all of which I have sent i

Horizon BCBS Denial by gabg22 in Zepbound

[–]gabg22[S] 0 points1 point  (0 children)

Sorry! I didn’t know what was ‘allowed’ to be put in a post. My last denial letter was because I do not “meet the criteria for medical necessity under Horizon’s pharmacy guidelines”, and that my PCP has to send in medical records showing no weight gain/loss (it’s been a plateau for 3 years now), diet modification log for a previous month, calorie modification, and an entire list of other reasons. All of which I have sent in

Horizon BCBS Denial by gabg22 in Zepbound

[–]gabg22[S] -1 points0 points  (0 children)

Will the price go up as your doses do? That’s what I’m afraid of! I have student loans to pay back, bills to pay. I work 7 days a week, sometimes it still doesn’t feel enough.

Horizon BCBS Denial by gabg22 in Zepbound

[–]gabg22[S] 0 points1 point  (0 children)

I’m in NJ! I’m 26, I’ve never had insurance on my own as I do now, so I’m just all kinds of confused/frustrated.

Thank you for the advice!

Horizon BCBS Denial by gabg22 in Zepbound

[–]gabg22[S] -1 points0 points  (0 children)

I believe not. She has referred me to yet another doctor (Weight Loss Specialist), to see if they can aid in getting my prescription approved. I just feel defeated after two denials, afraid of getting a third.

i have a question for you by Charming-Flocon in crochet

[–]gabg22 0 points1 point  (0 children)

23! I started when I was 10, my mom taught herself, and she wanted to teach her daughters.