Common Humana Denial Reasons "Plan exclusion" Weight loss is not a covered indication (most common) "Missing diagnosis code" Pharmacy didn't submit ICD-10 code (resubmit, don't appeal) "Prior auth not obtained" Medicaid plans require PA before filling "Step therapy required" Must try other meds first (Saxenda, Contrave) When an Appeal Makes Sense Medicaid PA denial you meet criteria but were denied anyway OSA coverage dispute Medicare denied despite valid sleep apnea diagnosis Wrong diagnosis code your doctor listed the wrong indication Renewal denial you showed 5% weight loss but were still denied If your situation fits one of these, appeals can work
New members starting a GLP-1 for weight loss must have a BMI of 40 or higher to qualify for coverage
That being said, if I wanted to get the best care and quality, I would probably look to a more trusted provider like Willow, Josie (especially if I were a woman over 40!), or Remedy Meds
Drawing on both clinical expertise and personal insights, McCall outlines the potential consequences of under-treatment, including mental health decline, metabolic issues, and autoimmune progression