brux
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Post by brux on Dec 7, 2023 16:22:50 GMT -6
I've come to learn that my insurance thought I had diabetes when they approved my Ozempic. No one said I did, but there was no prior auth process in place at the time, so it was approved because my doctor prescribed it. Now I had to get a prior auth for Wegovy, which I did, but I had to pay OOP for it until I hit my annual maximum. It's very very cost prohibitive. It seems unbalanced to me that health insurers would rather pay for surgery than meds. It's bc the surgeries have an established track record, so they know the potential payout risks. We don't know what the long term effects of the meds will be, and it could cost them a ton if there are negative side effects that result in people needing medical care for years. So in risk analysis, the surgery is safer for them.* *Safe, risk ,etc is in terms of cost to them, not safety of the patient that probably has a lot to do with it. I assume some of it is also just the insurers being caught unprepared for the novelty and popularity of new-to-market medical weight loss interventions. Rather than it being a proactive "we aren't going to allow these meds," it's coming from a place where they didn't even know about the meds to come to a cost/benefit conclusion about them.
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flojo
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Post by flojo on Dec 7, 2023 16:23:57 GMT -6
I don’t want to derail the Ozempic talk but apparently Selena Gomez confirmed she’s dating Benny Blanco under an IG pos. People are commenting and she’s getting really riled up. I can’t look away.
I hope she’s been hacked or else someone needs to take her phone away. It’s a lot.
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brux
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Post by brux on Dec 7, 2023 16:30:11 GMT -6
I don’t want to derail the Ozempic talk but apparently Selena Gomez confirmed she’s dating Benny Blanco under an IG pos. People are commenting and she’s getting really riled up. I can’t look away. I hope she’s been hacked or else someone needs to take her phone away. It’s a lot. why are people mad about it?
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flojo
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Post by flojo on Dec 7, 2023 16:37:19 GMT -6
I don’t want to derail the Ozempic talk but apparently Selena Gomez confirmed she’s dating Benny Blanco under an IG pos. People are commenting and she’s getting really riled up. I can’t look away. I hope she’s been hacked or else someone needs to take her phone away. It’s a lot. why are people mad about it? I guess he said some not great things about her in the past? Idk. Fans are just commenting kind of innocuous stuff and she’s going off replying to them on some post that’s not even her account lol. I don’t know what’s going on but I can’t stop watching.
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jaygee
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Post by jaygee on Dec 7, 2023 16:50:22 GMT -6
It's bc the surgeries have an established track record, so they know the potential payout risks. We don't know what the long term effects of the meds will be, and it could cost them a ton if there are negative side effects that result in people needing medical care for years. So in risk analysis, the surgery is safer for them.* *Safe, risk ,etc is in terms of cost to them, not safety of the patient that probably has a lot to do with it. I assume some of it is also just the insurers being caught unprepared for the novelty and popularity of new-to-market medical weight loss interventions. Rather than it being a proactive "we aren't going to allow these meds," it's coming from a place where they didn't even know about the meds to come to a cost/benefit conclusion about them. It’s almost always the latter. And not just with this. Most commercial insurers are slow to cover any new stuff - procedures, drugs, etc. They will make a policy that just says there is not enough research on this so it’s not covered until there is more data. That combined with the fact that medicine is moving so fast these days that there are not even codes established to support reporting and billing for some services means they get away with not paying for it. Some will wait until Medicare/CMS allows for coverage, some more aggressive insurers will establish their own medical policies with specific diagnosis codes that they cover the treatment for, and some will start to cover it once they figure out if they can without increasing their costs too much. Fun with insurance coverage!
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Post by newspapers on Dec 7, 2023 17:29:22 GMT -6
Additonally, Ozempic isn't a weight loss drug and won't be covered if you don't have diabetes--wegovy is. And Wegovy isn't covered by many insurers. It's why I went to surgery, which was basically free, instead of paying 1600 per month. Access is still very much an issue. I've come to learn that my insurance thought I had diabetes when they approved my Ozempic. No one said I did, but there was no prior auth process in place at the time, so it was approved because my doctor prescribed it. Now I had to get a prior auth for Wegovy, which I did, but I had to pay OOP for it until I hit my annual maximum. It's very very cost prohibitive. It seems unbalanced to me that health insurers would rather pay for surgery than meds. I guess because meds are indefinite and surgery is one-stop shopping (sort of). ETA: or what people already said before I posted this without reading.
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sterling
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Post by sterling on Dec 7, 2023 17:31:13 GMT -6
I have so many feelings on these drugs. I’ve been taking it since April and have lost 25 pounds. I had a BMI at just about 30 when I started so I was a candidate and covered by insurance, I pay $25 a month and I’m not at the highest dosage and have no plans on using the higher one at any time. I cannot express to you the mental wellbeing that I have 25 pounds lighter having come here by way of not having an ED or over exercising. I have never been happy with my body and mentally well, it was always one or the other. And while I know drugs come with risks, so do a great many thing in this life. I do not intend to be on this drug for life, but it’s helping me maintain a healthier weight and feel SO MUCH better about myself. I am running more and faster, I crave healthier foods, I’m drinking less, and my back is in less pain every day. I generally adore the MP podcast, but I actually had issues with some of the content they shared, less so the discourse. I 100% agree with them on the stuff about fatphobia, that these drugs will make it worse for fat people, and doctors will overprescribe to people who don’t want or need it. But some of the facts were wonky (summarized in this post I found here, but I read about it all over). It’s all so tricky. My kids are on a new ADHD medication that’s not covered by insurance yet. It’s been great for them, like life changing arguably. I have to trust that it’s doing more good than harm, and has been through processes of medical and scientific rigor. Same with things like covid vaccines. Drugs are always new at some point, and rarely harmful (though of course weight loss drugs are fraught with horror stories). IDK. It’s complicated. I’m so glad I have access to something other than an eating disorder.
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willow
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Post by willow on Dec 7, 2023 17:32:18 GMT -6
This is getting me all angsty about how fucked our health care system is in general.
I had to go through 3 anti depressants and show they didn’t work before my insurance would even entertain the idea of covering my upcoming ketamine infusions. So I dealt with months of mental torture and sleeplessness as I suffered through the side effects of the meds. And now dealing with brain zaps. Because god forbid we just let people try what they want to try for their mental health.
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sterling
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Post by sterling on Dec 7, 2023 17:37:24 GMT -6
This is getting me all angsty about how fucked out health care system is in general. I had to go through 3 anti depressants and show they didn’t work before my insurance would even entertain the idea of covering my upcoming ketamine infusions. So I dealt with months of mental torture and sleeplessness as I suffered through the side effects of the meds. And now dealing with brain zaps. Because god forbid we just let people try what they want to try for their mental health. I felt like this as I fought to get my older son anxiety medicine. Like, how much longer does this kid need to suffer before you’ll let him try some wildly proven and tested Prozac? It shouldn’t be this hard.
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Cher
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Post by Cher on Dec 7, 2023 17:39:06 GMT -6
This is getting me all angsty about how fucked out health care system is in general. I had to go through 3 anti depressants and show they didn’t work before my insurance would even entertain the idea of covering my upcoming ketamine infusions. So I dealt with months of mental torture and sleeplessness as I suffered through the side effects of the meds. And now dealing with brain zaps. Because god forbid we just let people try what they want to try for their mental health. I felt like this as I fought to get my older son anxiety medicine. Like, how much longer does this kid need to suffer before you’ll let him try some wildly proven and tested Prozac? It shouldn’t be this hard. That’s so frustrating. I’m sorry.
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flojo
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Post by flojo on Dec 7, 2023 17:52:23 GMT -6
This is getting me all angsty about how fucked our health care system is in general. I had to go through 3 anti depressants and show they didn’t work before my insurance would even entertain the idea of covering my upcoming ketamine infusions. So I dealt with months of mental torture and sleeplessness as I suffered through the side effects of the meds. And now dealing with brain zaps. Because god forbid we just let people try what they want to try for their mental health. I’m sorry that you’re dealing with all of that and especially the brain zaps. I went through that and it freaked me out but eventually led me to my fourth (and hopefully final) antidepressant. I’m super interested in the ketamine infusions if you wouldn’t mind sharing once you do it.
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willow
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Post by willow on Dec 7, 2023 18:17:13 GMT -6
This is getting me all angsty about how fucked our health care system is in general. I had to go through 3 anti depressants and show they didn’t work before my insurance would even entertain the idea of covering my upcoming ketamine infusions. So I dealt with months of mental torture and sleeplessness as I suffered through the side effects of the meds. And now dealing with brain zaps. Because god forbid we just let people try what they want to try for their mental health. I’m sorry that you’re dealing with all of that and especially the brain zaps. I went through that and it freaked me out but eventually led me to my fourth (and hopefully final) antidepressant. I’m super interested in the ketamine infusions if you wouldn’t mind sharing once you do it. I thought I was in the clear because it’s been 3 days post last pill but nope. I woke up and I was like what the actual fuck is happening to my brain. I’ll follow up on the ketamine for sure. I’m really looking forward to it. I have C-PTSD and after my last dog died this summer, I felt like I became even more mentally untethered. My therapist is also really anxious to hear about my experience because she hasnt had a patient try it yet. Everything I’ve been reading seems really encouraging though. Also it means I get to dissociate/hallucinate under a blanket with an eye mask and calming playlist, so basically a parent’s dream alone time.
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jorkzy
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Post by jorkzy on Dec 7, 2023 20:06:17 GMT -6
Why must my work be busy on the days we talk about one of my fav issues?? 😩 Actually just had a discussion at work today with some nurses about Ozempic. I think a lot of the “hand wringing” so to speak is from looking at the history of drugs marketed for weight loss and how many of patients who took them ended up actually being harmed. Maybe this one will be different. Agree 10000% with STP on basically all points. Obesity isnt a disease.
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jorkzy
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Post by jorkzy on Dec 7, 2023 20:06:35 GMT -6
Anyways, back to celeb gossip 😅
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Post by shamycooler on Dec 7, 2023 20:09:39 GMT -6
willow, one of my clients is a therapist and her teenage son was murdered. No traditional therapy methods were working for her so she tried ketamine therapy and she stated it helped her so much. She’s a huge proponent of it now. Just one anecdote for you.
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willow
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Post by willow on Dec 7, 2023 20:15:38 GMT -6
willow, one of my clients is a therapist and her teenage son was murdered. No traditional therapy methods were working for her so she tried ketamine therapy and she stated it helped her so much. She’s a huge proponent of it now. Just one anecdote for you. Oh fuck that is so awful. I’m happy it helped her! I’m a little nervous for the inevitable unpleasant trips that will occur but that’s kind of the whole point is confronting those deep buried emotions and memories. But the prospect of living a life where I feel like a human and an active member of my life is worth getting uncomfortable.
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Post by shamycooler on Dec 7, 2023 20:18:07 GMT -6
willow, one of my clients is a therapist and her teenage son was murdered. No traditional therapy methods were working for her so she tried ketamine therapy and she stated it helped her so much. She’s a huge proponent of it now. Just one anecdote for you. Oh fuck that is so awful. I’m happy it helped her! I’m a little nervous for the inevitable unpleasant trips that will occur but that’s kind of the whole point is confronting those deep buried emotions and memories. But the prospect of living a life where I feel like a human and an active member of my life is worth getting uncomfortable. I really hope it works for you too! I can tell you I notice a big difference in her as well.
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Post by SweetPotato on Dec 7, 2023 22:41:34 GMT -6
Maintenance Phase podcast recently did an episode on Ozempic that echos similar points made here - about the shaming for using that method of weight loss, the data so far (and limitations of it), and the fucked up healthcare system we have and how it will surely mess this up too. Recommend it as a listen. One other thing they mentioned is how they predict that there will be shaming of obese people who do not use it and “remain obese”. Like society will be like “we found a cure, don’t you want to be cured?” When the reality is that some people don’t need to take it, some people can’t take it, and some people choose not to. So look forward to that level of fuckery coming soon. I’ve had this reaction about not doing Botox. One of my friends joke yelled at my (plastic surgeon) bff about why doesn’t she do my Botox and she was like…I would but she doesn’t want it. I’m not anti Botox at all. Mostly just lazy. But it’s weird that it’s a thing that I have wrinkles at 44 😅
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jaygee
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Post by jaygee on Dec 7, 2023 22:52:36 GMT -6
Maintenance Phase podcast recently did an episode on Ozempic that echos similar points made here - about the shaming for using that method of weight loss, the data so far (and limitations of it), and the fucked up healthcare system we have and how it will surely mess this up too. Recommend it as a listen. One other thing they mentioned is how they predict that there will be shaming of obese people who do not use it and “remain obese”. Like society will be like “we found a cure, don’t you want to be cured?” When the reality is that some people don’t need to take it, some people can’t take it, and some people choose not to. So look forward to that level of fuckery coming soon. I’ve had this reaction about not doing Botox. One of my friends joke yelled at my (plastic surgeon) bff about why doesn’t she do my Botox and she was like…I would but she doesn’t want it. I’m not anti Botox at all. Mostly just lazy. But it’s weird that it’s a thing that I have wrinkles at 44 😅 Same. Where I live it’s unheard of to get to 44 and not have a Botox routine. And I just…don’t. I’ve had some friends look at me like I have a third eye ball. I’ll probably get it at some point and I know it’s better if you start early but I’m just ready yet.
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jaygee
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Post by jaygee on Dec 7, 2023 23:53:57 GMT -6
I don’t want to derail the Ozempic talk but apparently Selena Gomez confirmed she’s dating Benny Blanco under an IG pos. People are commenting and she’s getting really riled up. I can’t look away. I hope she’s been hacked or else someone needs to take her phone away. It’s a lot. I just caught up on this on Reddit and yikes. I have the embarrassment for her. She needs one of those lock boxes for her phone.
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maybe
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Post by maybe on Dec 8, 2023 9:52:49 GMT -6
People have nicknamed her Ozemprah and I am all for it for her. To finally be free of your lifelong bugaboo must feel amazing at her age. Good for her! But also…hello…where have you been? How are you??? sorry so late. Work and kids have me going 24/7. I try to lurk when I can but all is well with me. I just don’t have enough hours in a day to keep up with many things.
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maybe
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Post by maybe on Dec 8, 2023 9:58:17 GMT -6
I have been on Ozempic since February and have lost the 70lbs I had gained since taking my job 3 years ago. I have a food issue and obsess and binge and the magic of the drug has been my mental freedom from even thinking about it, similar to what sterling shared. MP made it sound like ppl don’t lose that much weight and I am one of the cases where it works that well. Oddly enough, my insurance covered Ozempic for a while until a few months ago because I am not diabetic. My doctor than switched me to WeGovy, which is still Ozempic and more expensive, and my insurance has covered it. So, it’s kind of BS. On top of that, because my family is a heavy user of the medical care system, I have gotten it for free for past 3 months because we hit our out of pocket max.
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maybe
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Post by maybe on Dec 8, 2023 10:02:11 GMT -6
angelashly did you see TJ Holmes insta post of him and Amy with the Bible verse? I have so much German embarrassment for them. No off to look I call one more year before they crash and burn and will burn hard The romance that their exes have will go the distance and theirs will not. Totally agree with you!
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brux
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Post by brux on Dec 8, 2023 11:43:00 GMT -6
Life twin maybe! I also was on insurance-covered Ozempic until my insurance kicked me off, but then I was approved for Wegovy and all is right in the world. Over the last 18 months, I've lost 60+ pounds on it, which is way more than the studies say, but is really in line with real life experience of people who stick with it. The meds have given me a mental freedom from food that I've never had before. I'm really thankful for it.
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klong11
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Post by klong11 on Dec 8, 2023 11:47:04 GMT -6
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jaygee
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Post by jaygee on Dec 8, 2023 11:52:24 GMT -6
Good for her! But also…hello…where have you been? How are you??? sorry so late. Work and kids have me going 24/7. I try to lurk when I can but all is well with me. I just don’t have enough hours in a day to keep up with many things. So good to hear that. And definitely understand the life demands. But don’t be a stranger. We miss you.
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tinyjoys
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Post by tinyjoys on Dec 8, 2023 12:27:46 GMT -6
Wasn't he just linked to Reese Witherspoon last month? I swear I posted it.
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Post by angelashly on Dec 8, 2023 13:21:47 GMT -6
Wasn't he just linked to Reese Witherspoon last month? I swear I posted it. Yes
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klong11
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Post by klong11 on Dec 8, 2023 13:31:31 GMT -6
Wasn't he just linked to Reese Witherspoon last month? I swear I posted it. Yes Her reps said it was fabricated. So now he has moved on to Jewel.
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Post by angelashly on Dec 8, 2023 13:32:56 GMT -6
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