this post was submitted on 05 Mar 2026
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No Stupid Questions

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Let me explain with my current situation. I am 22 F and I currently weigh 305lbs.

I am obese. Morbidly obese.

Even though I have been trying for 5 years at this point to lose the weight on my own. Eat healthier, eat more fruits and veggies, cut out excess sugar, walk more, exercise more, the whole kit and caboodle.

But I still am not losing the weight. I am still very fat. And I am worried that it will cause very serious health problems.

So I talked with my doctor and she told me "We need to get you on a weight loss medication. Let's try Ozempic".

But my insurance told us that they don't think I need the Ozempic so they won't pay for it.

So we tried Wegovy and Mounjaro. But my insurance still rejected our requests.

They're saying because I am young, and I am a diabetic with good numbers, I dont need the weight loss meds and I can just lose the weight naturally.

But ive been trying to and it hasn't been working. So that's why my doctor prescribed me the weight loss med.

Why is this allowed? Why is it that your insurance can deny you a medication, even if your doctor says you need it?

(page 2) 50 comments
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[–] DarrinBrunner@lemmy.world 6 points 2 weeks ago (1 children)

Because the filthy rich don't care if anyone dies.

[–] OwOarchist@pawb.social 5 points 1 week ago (1 children)

They care if a rich person dies. My friend Luigi proved that.

[–] pinball_wizard@lemmy.zip 3 points 1 week ago* (last edited 1 week ago)

Allegedly. Could have been anyone. More people had a motive than would fit into a police database.

[–] sp3ctr4l@lemmy.dbzer0.com 5 points 1 week ago

The health insurance industry is an objectively evil but very profitable business model, that sustains itself directly on human misery.

This is allowed because our government is corrupt, paid off, and broadly dysfunctional, and/or controlled by ideological/religious extremists who hold bigotry of one kind or another as a fundamental principle.

This is allowed because exploiting your suffering makes a small number of people very wealthy.

And that small number of people runs everything by way of paying off nearly everyone involved in potentially regulating them, nearly every elected representative at the level of State government or higher.

You live in a failing, rogue, totalitarian, extremist state, run by pedophile rapist murderers who lie openly and brazenly every day.

You do not live in a well-run, representative democracy, that sees to the needs of its citizens.

You live it's corpse.

[–] Heyla@quokk.au 5 points 1 week ago

Because capitalism and culture of inequality

[–] disregardable@lemmy.zip 4 points 2 weeks ago

The reason is that doctors and pharmaceutical companies are also for profit, meaning they make money selling you treatments. This puts them in a position to use your condition to exploit both you and the company. The insurance company is balancing the cost of your preferred treatment versus the cost of other treatment and the benefits. You can work with your doctor to build a documented record of attempting to lose weight- see a nutritionist, start seeing a therapist for your food addiction, start going to weight loss meetings, exercise therapy for the morbidly obese, etc. These will also be helpful by themselves, because those drugs are only temporary. Like weight loss surgery, people regain the weight when they don't do the work to address the underlying issue.

[–] DaMummy@hilariouschaos.com 4 points 2 weeks ago

Because Fuck You, that's why.

[–] minorkeys@lemmy.world 3 points 2 weeks ago* (last edited 2 weeks ago)

Because the humans making money off health insurance don't care that we suffer. Our wellbeing is absolutely irrelevant. That is why the Luigi is a folk hero right now. Get Saint Luigi a meeting with your health insurance CEO.

[–] Tollana1234567@lemmy.today 3 points 1 week ago* (last edited 1 week ago)

it simple, they wont pay for expensive ones at all. brand names, they prefer you to take generics over it, even if its a different type of generic.

they dont like paying for expensive services.

Also insurance may have tiered system for certain drugs, the lowest being generics, the 2nd one being brand name of generics, and then expensive generics would be the next tier, or brand names that dont have generics.

its when you get to things like biologics, or speciality drugs things get super expensive. think drugs for psorisis, chrons disease, or severe eczema.

Ozempic addicts ruined it for people who need the drugs.

[–] HubertManne@piefed.social 3 points 1 week ago

Im going to go out on a limb and assume you are from the us. us healthcare is nuts. Here is the funny thing. My wife has thyroid issues. Her bloodtests shows it within normal but on the low end. Doctor refuses to raise her cheap thyroid medicine and instead insists on a gpl. Even though she has other symptoms for low thyroid. insurance we had did pay for it. it makes no fucking sense. at times we can't get stuff we need and at others we are given options we don't want. A similar thing is there is this pretty cheap procedure called prp where they draw blood and centrifuge it down and dake the serum and inject it in a joint and it seems to relieve pain and does so for awhile. Like she could just get it once a year. They would not cover that but they did at one time. It kinda was based around what medicare was doing. They will pay for surgery that from our experinece may or may not make it better and may make it worse (we have more experience with surgery than anyone would want to have). That surgery is so expensive that if you were to stick the cost into a savings account it would easily make interest enough to do the prp. So even economics wise the insurance company should do the prp. Why don't they. Because its like a game of chicken. people may get surgery but it does not always go well so many people will not get it. Also prp is done in the doctors office and does not require anything. They will pay for things from drug companies injected into the joint. We have just the worst system. Also you know why your insurance covers some things but not others? Some high muckity muck at your company want something. We had one that did unlimited chiro. Im like 100% the president or one of his family must get chiro adjustments every week or something. Either that or someone between the president and the hr level that decides on what insurance to use.

[–] sin_free_for_00_days@sopuli.xyz 3 points 2 weeks ago

Had the same experience. I ended up having my doctor write a prescription for wegovy pills and am just paying $200 out of pocket. I figure I'm at least breaking even by eating less. Only been a month so far.

[–] gukleszl4hs48ughgxhr5xgd@fedia.io 3 points 2 weeks ago (11 children)

Eat healthier, eat more fruits and veggies, cut out excess sugar, walk more, exercise more, the whole kit and caboodle.

Not to say you should be denied prescription coverage, but that is not the whole kit and caboodle. Weight loss results from consuming less calories; specifically, less than you are burning. You can lose weight on a completely unhealthy diet and without any extra effort to exercise.

[–] SirSamuel@lemmy.world 3 points 1 week ago (1 children)

While CICO is universally true, it doesn't account for a few other factors. For instance, gut microbiome. Gut flora has a strong affect on cravings. Also mental and emotional health also affect self control and regulation. Food "science" has created craving ~~monstrosities~~ snacks that are as addictive as cigarettes. Personal health issues like PCOS and thyroid dysfunction will affect how many calories are consumed by the body and how those calories are used within the body.

So yes, eat less and lose weight. Sure. Some people can lose weight eating junk. For others it creates a reward cascade in the brain that leads to overeating. Just eat less. For some that's as practical as telling a lifelong smoker to give up the habit. And that's why medical alternatives to self control exist, but aren't successful without addressing the root cause of the obesity.

[–] Clent@lemmy.dbzer0.com 3 points 1 week ago (1 children)

All those behavior cycles and feedback mechanisms are also literally what these GPL drugs suppress.

It's like anxiety meds for someone who has diabilitating anxiety to just relax. Or more commonly telling the clinically depressed to just smile more.

Telling someone it's a personal failing only fuels the feedback mechanism.

Medications exist because they stop the biological feedback loops.

[–] SirSamuel@lemmy.world 2 points 1 week ago
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