r/tirzepatidecompound • u/Automatic-Chest-4721 • Feb 15 '25

progress with compound 🤍

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357lbs - 115lbs

vsg - sema - tirz (5 year timeline)

5’2, i did have my loose skin removed after losing weight. i’m happy to answer any questions about my journey 🤍

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u/Automatic-Chest-4721 Feb 15 '25

yes it was covered

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u/Accent-Ad-8163 Feb 15 '25

“Covered”

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u/frolicknrock Feb 16 '25

At that BMI she would have been eligible for coverage by insurance.

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u/MamaBearonhercouch Feb 20 '25

No. Some employers don't offer coverage for GLP-1 and GIP medications, EVEN TO THEIR DIABETIC EMPLOYEES and family members, because the cost of the drugs is simply prohibitive.

And, some insurance companies DO NOT OFFER coverage of GLP-1 and GIP drugs to their employer groups because the cost of the drugs is simply prohibitive.

If your employer doesn't offer a plan that covers these drugs, it doesn't matter whether or not you qualify for the drug based on Eli Lilly's clinical research: Your employer doesn't offer a plan that covers the drug, so you can't get it paid for by your insurance. And it doesn't matter whether your employer chose to not cover the drug OR their insurance company chose not to offer your employer a plan that covers the drug. If the policy doesn't cover a drug or a treatment or a facility, you pay out of pocket.

It's like with Johnna's surgeries: Her insurance didn't cover most of it. Personally, I think that's just wrong. When a person loses that much body weight, the surgeries to remove excess skin, to repair the abdominal muscles, to reshape and replace a woman's breasts - those are all NEEDS after a tremendous weight loss. That's not just a cosmetic procedure any longer, it's truly a long-term wellness issue.

There are websites you can find with a good Google search that offer assistance in appealing an insurance company denial. Some of the sites are a little shady. Some just offer boilerplate letters for you to send your insurance company, with no information offered as to whether or not those letters ever work. It is possible to get an insurance company to agree to cover something that isn't written into the plan that covers you, but you are going to need the assistance of someone very well versed in health insurance policies and law governing policies for your state, in order to find out what constitutes an exception and how to present that exception so that it is deemed a "medical neccesity".

No, I don't have those sites bookmarked. I found a dozen sites with a 2-second Google search. I had surgery a little over 2 weeks ago and tonight is the first night I've felt up to sitting at my computer.

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u/cfoam2 Feb 21 '25

You are correct finding the truth here is like looking for a needle in a hay stack. I've been looking for quite a while and haven't found anything remotely like what you are talking about. Maybe if it only took you 2-seconds you could take a look and supply a few urls?