So my husband is obese, at 6' he's 350+lbs. I have been trying to get him to eat healthy & exercise but being in the oil field & gone for 2 weeks at a time there's no way I can get him to exercise or control what he's eating when he's gone. He wasn't always over weight.
As a teenager he was in shape & as an adult he was too. But when we got together we developed bad eating habits which got worse when I got pregnant. We both gained over 100lbs. I lost the weight after I had our son, he however hasn't stopped. Of course it's easier for me since I'm a stay at home mom. But he still eats garbage & drinks his calories. Plus he doesn't exercise when he comes home.
So I finally got my husband to see a doctor & to no one's surprise he is pre-diabetic & has high blood pressure. I guess that shocked him because he changed his eating habits, starting walking when he could when he was at work & said he would exercise with me when he came home.
Then the doctor put him on weight loss meds. First came Contrave, it worked GREAT! He ate so much less & lost weight. But he slept all the time and at a price tag of $200-$300 a bottle. It was expensive! But to me, I felt it was worth it. But my husband started to hate feeling tired all the time, I don't blame him. So he went back to the doctor & asked for new medication.
That's when she prescribed Saxenda and the insurance didn't even cover that! So at an even higher price tag of $1,000 a pop I said no way! So with another appointment coming up I'm hoping maybe there is another medication he can get that might be covered. But at this rate I'm not too hopeful.
I just have to wonder, why? Why doesn't the insurance company cover weight loss meds? He needs it, he is clinically obese. It's not like he's taking it to lose 20-30lbs. If he loses the weight his blood pressure will go down & he won't be pre-diabetic. I'm also thinking it would be cheaper for him to get gastric bypass ($1,200) than spend $200-$300/month on pills. Isn't that ridiculous? Thanks insurance companies & your horrible, backwards thinking!
Shouldn't we be trying to keep people *out* of the hospital? Prevent people from having surgeries? Lower the rates of comorbities? How is having to pay extremes for weight loss medications helping that?
Saxenda is the same drug as Victoza. Just repackaged for different indications. (Think Zyban and Wellbutrin) Since he is "pre-diabetic" maybe the doc can write him Victoza at equivalent dose as Saxenda and that probably will be covered.
You're insurance company will pay for anything your employer elects to include on coverage.
1 person can have BCBS and get Viagra covered and another person covered by BCBS can't. The guy that can, works for a company that has included things for a higher premium.
A person's employer can make a insurance plan look good and not offer lot's of things.
Smoking cessation is another huge one. BCBS covers it for some employers but not other, all depends on the employer.
I won't even get into self insured companies. But a little education. Big companies are self insured. They just pay someone like BCBS to use the network. So if you work for IBM and think your insurance plan is BCBS, it's not. It's IBM and they pay BCBS to administer.
There are things the public does not understand about insurance and if they did, they would blame their employer a lot more than these "evil insurance companies."
For my last comment, I am not meaning to offend the wonderful BSN's out there, this is a stab at the joke of an organization ANA that is destroying nursing........
In case you're wondering why I'm defending insurance companies a little, No, I don't work for one, but I chose to get a real degree instead of a paper writing BSN.
(Hey ANA, an ADN with a BS in management or accounting or something is better equipped, sorry about that. How many Magnet's you losing now?"
I'm fighting with my insurance company right now because they don't want to cover my last office visit to talk to my doctor about weight loss. It's crazy. I'm insulin resistant. I have PCOS. I always try hard to watch what I eat and exercise, but the last couple of months of nursing school my weight went up and I wasn't comfortable with it. I was feeling sluggish and tired. My family doctor did labs first to make sure nothing wonky was going on with my thyroid and stuff. He looked at my sugars and everything. Everything came back normal. I asked if I would be able to do Adipex to kind of jump start my system and he was like sure. So I have been taking it for 3 months. The insurance will cover a small amount of the drug, but what is frustrating me is that they don't want to cover the office visit. I wanted to do it the safe way and keep myself healthy. With PCOS the fat will accumulate around me stomach. I've lost about 18 pounds since being on it. And while I don't eat unhealthy, I do drink too much Coke which I have cut out and I'm using an app to help me keep track of my steps and it keeps me aware of things. I know if I need to go out and maybe walk several miles that day. I'm not nearly as hungry with the Adipex and I have more energy to exercise and such.
It's frustrating that anything deemed as preventative care the insurance companies won't pay for. I know that 80% of people with PCOS will end up with Type II diabetes. So, I'm not supposed to prevent that? The insurance company wants to wait until I get diabetes to pay much more money for me down the road? That makes absolutely no sense to me at all.
Just like my OB would like me to get a baseline mammogram before I hit 40. My insurance won't pay until I turn 40. Since I have a history of breast cancer in my family I feel like it's a good idea. They say because it's on my paternal side they won't pay. I cannot understand who makes these decisions in insurance companies. I would honestly like to sit down with one of these yahoos some day and I would like for it to be spelled out to me why you would not save probably billions of dollars by doing preventative care.
Specializes in M/S, LTC, Corrections, PDN & drug rehab.
I'm fighting with my insurance company right now because they don't want to cover my last office visit to talk to my doctor about weight loss. It's crazy. I'm insulin resistant. I have PCOS. I always try hard to watch what I eat and exercise, but the last couple of months of nursing school my weight went up and I wasn't comfortable with it. I was feeling sluggish and tired. My family doctor did labs first to make sure nothing wonky was going on with my thyroid and stuff. He looked at my sugars and everything. Everything came back normal. I asked if I would be able to do Adipex to kind of jump start my system and he was like sure. So I have been taking it for 3 months. The insurance will cover a small amount of the drug, but what is frustrating me is that they don't want to cover the office visit. I wanted to do it the safe way and keep myself healthy. With PCOS the fat will accumulate around me stomach. I've lost about 18 pounds since being on it. And while I don't eat unhealthy, I do drink too much Coke which I have cut out and I'm using an app to help me keep track of my steps and it keeps me aware of things. I know if I need to go out and maybe walk several miles that day. I'm not nearly as hungry with the Adipex and I have more energy to exercise and such.
It's frustrating that anything deemed as preventative care the insurance companies won't pay for. I know that 80% of people with PCOS will end up with Type II diabetes. So, I'm not supposed to prevent that? The insurance company wants to wait until I get diabetes to pay much more money for me down the road? That makes absolutely no sense to me at all.
Just like my OB would like me to get a baseline mammogram before I hit 40. My insurance won't pay until I turn 40. Since I have a history of breast cancer in my family I feel like it's a good idea. They say because it's on my paternal side they won't pay. I cannot understand who makes these decisions in insurance companies. I would honestly like to sit down with one of these yahoos some day and I would like for it to be spelled out to me why you would not save probably billions of dollars by doing preventative care.
I'm so sorry you're going through this. It is extremely frustrating & I don't know what the insurance companies are thinking. Health insurance should be preventative! But it isn't, by the time we need to use it we're in the hospital. It makes no sense!
I'm fighting with my insurance company right now because they don't want to cover my last office visit to talk to my doctor about weight loss. It's crazy. I'm insulin resistant. I have PCOS. I always try hard to watch what I eat and exercise, but the last couple of months of nursing school my weight went up and I wasn't comfortable with it. I was feeling sluggish and tired. My family doctor did labs first to make sure nothing wonky was going on with my thyroid and stuff. He looked at my sugars and everything. Everything came back normal. I asked if I would be able to do Adipex to kind of jump start my system and he was like sure. So I have been taking it for 3 months. The insurance will cover a small amount of the drug, but what is frustrating me is that they don't want to cover the office visit. I wanted to do it the safe way and keep myself healthy. With PCOS the fat will accumulate around me stomach. I've lost about 18 pounds since being on it. And while I don't eat unhealthy, I do drink too much Coke which I have cut out and I'm using an app to help me keep track of my steps and it keeps me aware of things. I know if I need to go out and maybe walk several miles that day. I'm not nearly as hungry with the Adipex and I have more energy to exercise and such.
It's frustrating that anything deemed as preventative care the insurance companies won't pay for. I know that 80% of people with PCOS will end up with Type II diabetes. So, I'm not supposed to prevent that? The insurance company wants to wait until I get diabetes to pay much more money for me down the road? That makes absolutely no sense to me at all.
Just like my OB would like me to get a baseline mammogram before I hit 40. My insurance won't pay until I turn 40. Since I have a history of breast cancer in my family I feel like it's a good idea. They say because it's on my paternal side they won't pay. I cannot understand who makes these decisions in insurance companies. I would honestly like to sit down with one of these yahoos some day and I would like for it to be spelled out to me why you would not save probably billions of dollars by doing preventative care.
Insurance companies are actually now required to cover legitimate preventive care. A "baseline mammogram" has no evidence to support it and is actually more likely to cause cancer than it is to prevent it or detect it.
Insurance companies are actually now required to cover legitimate preventive care. A "baseline mammogram" has no evidence to support it and is actually more likely to cause cancer than it is to prevent it or detect it.
I know that, and like I stated, if the history of breast cancer had been on the maternal side of my family they would have covered it. My paternal grandmother had it twice. A baseline mammogram has been recommended by my OB and Family physician. They wanted it to be able to detect any early changes for me. It was first brought to my attention when I was 36. Most of my genes seem to come from that side of the family so far. Looks and health issues. Mainly from the grandmother that had to have both of her breast removed and ended up dying when it spread to the pancreas. You can't tell me having a baseline mammogram is not helpful in the early detection of breast cancer. I have several risk factors for it. I find that the insurance companies will do whatever they can to justify not covering preventative care. I don't want to turn into a diabetic someday so I approach my physician about it and he does the proper thing by checking me out thoroughly and now my insurance company doesn't want to cover the follow-up visit to get the results of that blood work and discuss my weight loss with him? That is absolutely crazy in my opinion. It was my first bloodwork since 2012. In the past, I usually would just change my diet and up my exercise routine and would knock out the extra few pounds. I always try to catch it so it doesn't get out of hand. I'm not in the obese category with my BMI, it's under 30, I just don't want it to get there and I think me being proactive is good. This time though, changing my eating habits and exercise wasn't helping for some reason. I think it was probably the stress of the end of the semester and not hardly sleeping. And I needed to back off the coke a lot. I'm down 18lbs so it's working, but I shouldn't have to pay an extra hundred dollars for saving my insurance company a lot of extra money.
I turn 40 at the end of this year so I will get my mammogram next year. I'm on top of my monthly breast checks myself. So there won't be a baseline and they won't detect small abnormal changes in me, which I think is crazy. At some point these companies need to realize that people lives do matter. We may only be a number to them, but I am a daughter, a sister, a niece, a mother, a girlfriend. I'm important to many people, just like all of you are. We all matter to someone. And playing Russian Roulette with lives is not ethical to me. It's not ethical to see people dying from stuff that could have easily been prevented to me. Organized Chaos loves her husband. She wants to see him get better and keep him here for her and her children. By losing weight it's going to save him from diabetes and most likely fix his hypertension. Paying for this medication now will save this insurance company hundreds of thousands of dollars down the road by not having to treat diabetes and hypertension down the road and keep him here with his family. He won't become disabled and will be able to keep working and paying their premiums. It makes no sense to not cover this stuff. And they find lots of reasons to deny claims and skirt around the law.
I know that, and like I stated, if the history of breast cancer had been on the maternal side of my family they would have covered it. My paternal grandmother had it twice. A baseline mammogram has been recommended by my OB and Family physician. They wanted it to be able to detect any early changes for me. It was first brought to my attention when I was 36. Most of my genes seem to come from that side of the family so far. Looks and health issues. Mainly from the grandmother that had to have both of her breast removed and ended up dying when it spread to the pancreas. You can't tell me having a baseline mammogram is not helpful in the early detection of breast cancer. I have several risk factors for it. I find that the insurance companies will do whatever they can to justify not covering preventative care. I don't want to turn into a diabetic someday so I approach my physician about it and he does the proper thing by checking me out thoroughly and now my insurance company doesn't want to cover the follow-up visit to get the results of that blood work and discuss my weight loss with him? That is absolutely crazy in my opinion. It was my first bloodwork since 2012. In the past, I usually would just change my diet and up my exercise routine and would knock out the extra few pounds. I always try to catch it so it doesn't get out of hand. I'm not in the obese category with my BMI, it's under 30, I just don't want it to get there and I think me being proactive is good. This time though, changing my eating habits and exercise wasn't helping for some reason. I think it was probably the stress of the end of the semester and not hardly sleeping. And I needed to back off the coke a lot. I'm down 18lbs so it's working, but I shouldn't have to pay an extra hundred dollars for saving my insurance company a lot of extra money.
I turn 40 at the end of this year so I will get my mammogram next year. I'm on top of my monthly breast checks myself. So there won't be a baseline and they won't detect small abnormal changes in me, which I think is crazy. At some point these companies need to realize that people lives do matter. We may only be a number to them, but I am a daughter, a sister, a niece, a mother, a girlfriend. I'm important to many people, just like all of you are. We all matter to someone. And playing Russian Roulette with lives is not ethical to me. It's not ethical to see people dying from stuff that could have easily been prevented to me. Organized Chaos loves her husband. She wants to see him get better and keep him here for her and her children. By losing weight it's going to save him from diabetes and most likely fix his hypertension. Paying for this medication now will save this insurance company hundreds of thousands of dollars down the road by not having to treat diabetes and hypertension down the road and keep him here with his family. He won't become disabled and will be able to keep working and paying their premiums. It makes no sense to not cover this stuff. And they find lots of reasons to deny claims and skirt around the law.
No, a "baseline" mammogram is of absolutely no use to a radiologist reading your future mammograms. Your negative mammogram will not look clinically different from anyone else's negative mammogram. The problem with mammograms is that they can be a self-fulfilling prophecy, if you get enough of them they will eventually detect the cancer that your previous unnecessary mammograms caused.
If you have a BRCA mutation then the recommendations do include testing before the age of 40, otherwise the recommendations from multiple practice groups all say that routine mammogram screening should not be used until after the age of 50, or after the age of 40 if a family history exists. I suppose if you want to pay for testing that has clearly been shown to be non-beneficial yourself that's one thing, but the purpose of insurance is to share the costs of reasonably appropriate care, not to get others to help pay for wasteful tests and treatments.
When blood tests are done, a follow up appointment is usually only covered if the results are abnormal, otherwise there isn't anything to discuss. Primary care physicians have limited time, and there are plenty of people who never get in to see a PCP and they actually have these conditions, so it's not really for some to take up that time discussing how they don't have this condition or that.
And insurance will tell him to eat less and move more! Our healthplan pays NOTHING for weight loss. No pills, diets, surgeries, NOTHING. And we have "good" insurance---others with our same carrier have coverage for such things, but my DH's employer's contract with any insurance carrier doesn't allow for coverage. (DH works for an entity that has employees over a tremendous geographical area, so there are several health plan options to choose from. Whether you choose BC/BS, Humana, United Healthcare or any other plan, you will NOT have weightloss coverage)
Well with him being in the oil field, he doesn't have time to do WW. We need to do what works for him.
EXACTLY!! IBM and BCBS sit down and decide what will be covered by BCBS for IMB employees. It is not always the big bad insurance companies that do or don't allow a procedure/medication to be covered. I was trying to say this in my other post. BCBS (not our plan) may cover gastric bypass for many of it's insured, but it will NOT cover GB if you have BCBS through my DH's employer.
2 things.
Saxenda is the same drug as Victoza. Just repackaged for different indications. (Think Zyban and Wellbutrin) Since he is "pre-diabetic" maybe the doc can write him Victoza at equivalent dose as Saxenda and that probably will be covered.
You're insurance company will pay for anything your employer elects to include on coverage.
1 person can have BCBS and get Viagra covered and another person covered by BCBS can't. The guy that can, works for a company that has included things for a higher premium.
A person's employer can make a insurance plan look good and not offer lot's of things.
Smoking cessation is another huge one. BCBS covers it for some employers but not other, all depends on the employer.
I won't even get into self insured companies. But a little education. Big companies are self insured. They just pay someone like BCBS to use the network. So if you work for IBM and think your insurance plan is BCBS, it's not. It's IBM and they pay BCBS to administer.
There are things the public does not understand about insurance and if they did, they would blame their employer a lot more than these "evil insurance companies."
For my last comment, I am not meaning to offend the wonderful BSN's out there, this is a stab at the joke of an organization ANA that is destroying nursing........
In case you're wondering why I'm defending insurance companies a little, No, I don't work for one, but I chose to get a real degree instead of a paper writing BSN.
(Hey ANA, an ADN with a BS in management or accounting or something is better equipped, sorry about that. How many Magnet's you losing now?"
Another frustrating thing about people not understanding how insurance works: Insurance isn't saying you CAN'T have a mammogram. It's saying they won't PAY for it. You are welcome to get the test, it's just that YOU will have to pay for it. Insurance isn't as in control of your healthcare as you're letting it be.
I know that, and like I stated, if the history of breast cancer had been on the maternal side of my family they would have covered it. My paternal grandmother had it twice. A baseline mammogram has been recommended by my OB and Family physician. They wanted it to be able to detect any early changes for me. It was first brought to my attention when I was 36. Most of my genes seem to come from that side of the family so far. Looks and health issues. Mainly from the grandmother that had to have both of her breast removed and ended up dying when it spread to the pancreas. You can't tell me having a baseline mammogram is not helpful in the early detection of breast cancer. I have several risk factors for it. I find that the insurance companies will do whatever they can to justify not covering preventative care. I don't want to turn into a diabetic someday so I approach my physician about it and he does the proper thing by checking me out thoroughly and now my insurance company doesn't want to cover the follow-up visit to get the results of that blood work and discuss my weight loss with him? That is absolutely crazy in my opinion. It was my first bloodwork since 2012. In the past, I usually would just change my diet and up my exercise routine and would knock out the extra few pounds. I always try to catch it so it doesn't get out of hand. I'm not in the obese category with my BMI, it's under 30, I just don't want it to get there and I think me being proactive is good. This time though, changing my eating habits and exercise wasn't helping for some reason. I think it was probably the stress of the end of the semester and not hardly sleeping. And I needed to back off the coke a lot. I'm down 18lbs so it's working, but I shouldn't have to pay an extra hundred dollars for saving my insurance company a lot of extra money.
I turn 40 at the end of this year so I will get my mammogram next year. I'm on top of my monthly breast checks myself. So there won't be a baseline and they won't detect small abnormal changes in me, which I think is crazy. At some point these companies need to realize that people lives do matter. We may only be a number to them, but I am a daughter, a sister, a niece, a mother, a girlfriend. I'm important to many people, just like all of you are. We all matter to someone. And playing Russian Roulette with lives is not ethical to me. It's not ethical to see people dying from stuff that could have easily been prevented to me. Organized Chaos loves her husband. She wants to see him get better and keep him here for her and her children. By losing weight it's going to save him from diabetes and most likely fix his hypertension. Paying for this medication now will save this insurance company hundreds of thousands of dollars down the road by not having to treat diabetes and hypertension down the road and keep him here with his family. He won't become disabled and will be able to keep working and paying their premiums. It makes no sense to not cover this stuff. And they find lots of reasons to deny claims and skirt around the law.
And honestly, you cant necessarily fault the employer either. There are things that can legally be excluded from coverage by insurance, and things that cant. It is all a balance of dollars- the more they cover, the more it costs (and that increases costs for both the employer and employee) Yes, in some cases covering the "preventative" treatment would overall save dollars in the long run, but many of these treatments also dont have long term data showing proven high success rates. Gastric bypass is an excellent example- for some it works great, for others, it is done in the absence of a a proven ability to alter lifestyle, and ends up leading to a whole host of complications that aren't good for the patient and cost a ton of extra money.
Pretty much all coverages/deductibles/copays etc are selected by the employer when negotiating with the insurance company. The differences in insurance companies are not in those areas, but in the quality of service they provide (ie claims processing, ease of pre-approval process etc.), and the extent of their provider network agreements and how much choice they give in the service area.
EXACTLY!! IBM and BCBS sit down and decide what will be covered by BCBS for IMB employees. It is not always the big bad insurance companies that do or don't allow a procedure/medication to be covered. I was trying to say this in my other post. BCBS (not our plan) may cover gastric bypass for many of it's insured, but it will NOT cover GB if you have BCBS through my DH's employer.
adnrnstudent, ASN, RN
353 Posts
2 things.
Saxenda is the same drug as Victoza. Just repackaged for different indications. (Think Zyban and Wellbutrin) Since he is "pre-diabetic" maybe the doc can write him Victoza at equivalent dose as Saxenda and that probably will be covered.
You're insurance company will pay for anything your employer elects to include on coverage.
1 person can have BCBS and get Viagra covered and another person covered by BCBS can't. The guy that can, works for a company that has included things for a higher premium.
A person's employer can make a insurance plan look good and not offer lot's of things.
Smoking cessation is another huge one. BCBS covers it for some employers but not other, all depends on the employer.
I won't even get into self insured companies. But a little education. Big companies are self insured. They just pay someone like BCBS to use the network. So if you work for IBM and think your insurance plan is BCBS, it's not. It's IBM and they pay BCBS to administer.
There are things the public does not understand about insurance and if they did, they would blame their employer a lot more than these "evil insurance companies."
For my last comment, I am not meaning to offend the wonderful BSN's out there, this is a stab at the joke of an organization ANA that is destroying nursing........
In case you're wondering why I'm defending insurance companies a little, No, I don't work for one, but I chose to get a real degree instead of a paper writing BSN.
(Hey ANA, an ADN with a BS in management or accounting or something is better equipped, sorry about that. How many Magnet's you losing now?"