• medgremlin@midwest.social
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    7 days ago

    If they have cardiovascular disease or kidney disease, those are getting added as indications for the GLP-1’s so they might be able to resubmit the authorization/claim with those diagnosis codes added to get it covered.

    • Jesus@lemmy.world
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      7 days ago

      Yeah, but the problem is, if tests / labs show the precursor indicators for those diseases, and you have a family history, they’ll still deny until you actually have the something like a heart attack or stroke.

      GLP-1s are the hot new thing, but it’s pretty common for insurance companies to deny expensive preventative care, even after all other avenues have been thoroughly explored.

      • medgremlin@midwest.social
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        5 days ago

        In my family medicine rotation a couple months ago, we got it approved for someone with pre-diabetes, high blood pressure, and stage 2/3 kidney disease (which is not very advanced. A lot of people over the age of 35-40 can technically fall into stage 1/2.)

        • Jesus@lemmy.world
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          7 days ago

          We just changed insurance and were able to get through with one provider that valued preventative care more, but our new insurance company is a complete pain in the ass. And the person in my family dealing with the insurance company actually works for the company and knows all the ins and outs.

          They even give their own employees crap policies.

          • medgremlin@midwest.social
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            7 days ago

            This is entirely unsurprising. Hopefully they can wrangle something functional out of the insurance at some point.