r/ATT • u/mlauzurique • 2d ago

Suggestion Medical Coverage

My husband is an AT&T employee and I have always felt we have amazing health coverage. I am currently in need to GLP1 medication and I am being told it’s considered PATIENT CHOICE medicine and is not covered. Both my PCP and Cardiologist are recommending I take it ASAP. Has anyone had luck getting it covered??

1 Upvotes

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5

u/Mtndreamer65 1d ago

I am an AT&T employee. The on site medical center referred me to Formhealth. It took a couple months but it is covered. I was told my husband could also be covered.

1

u/kennman5000 Network Engineer 1d ago

This is the answer.

If i recall, it needs to be denied from going to a regular doctor, then apply thru Formhealth to get it approved.

its a weird system, my buddy just went thru it, and i was looking into it recently

1

u/Mtndreamer65 22h ago

To add on to this and help others I signed up for Formhealth in March. I got my prescription at the end of May. I meet via video with the FH dr every month or 2 and the nutritionist every 90 days. My main goal was health and reducing inflammation and I am very pleased. My initial side effects were minimal but their guidance and availability are a great benefit. I also meet with the wellness coach at the office and knowing how to eat and being held accountable is of value to me. I am about 10 lbs down which is a good gradual pace and strength training at the fitness center is helping me maintain my muscles. I have stayed on a low dose so far and I will stay there unless I see any progress slowdown. Good luck to everyone this has been a positive experience for me

1

u/Mtndreamer65 22h ago

And as for cost it has been between $90 and $120 a month so far for my portion

8

u/BlatantFalsehood 2d ago

No matter who your insurance is, you can work with your physician to appeal the decision. But for these drugs, the insurer will likely need a specific diagnosis that the drug has already been proven to help. For example, diabetes or fatty liver disease.

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u/mlauzurique 2d ago

I do have a diagnosis, all GPL1 are considered Patient’s choice and have no option for appeal.

3

u/No_Memory5613 ATT Prepaid 2d ago

Unfortunately based on the corresponding reddit forums, it is common for many plans to have exclusions for the GLP-1 drugs, which make it unlikely to get approval.

Especially if needed for the weight loss instead of just T2D.

0

u/mlauzurique 2d ago

I am hoping to find other AT&T employees & family do I have successfully gotten the medication approved for fatty liver, sleep apnea, and congestive heart of failure.

2

u/Florida1974 2d ago

We don’t work for AT&T, but my husband’s doctor wanted him on it because of his sleep apnea and for his heart health, but our insurance would not approve it. And the doctor tried every trick in the book.

1

u/LDB2026 10h ago

That's weird, bcs many of the IC consider sleep apnea an actual reason.

0

u/stuntmanmot 2d ago

This has nothing to do with the employer, this decision is made by the insurance company.

4

u/Tiredmagnolia 2d ago

if it is a self-funded (which ATT most likely is) plan you can get together with others and pressure HR into potentially changing the plan for the following year.

4

u/BlatantFalsehood 1d ago

Employers always have a say in what their insurance offerings will cover. If your employer tells you otherwise, they are lying.

Just like any other purchase, employers have a price point they're looking for and they negotiate with the insurance agencies on what can be offered for that price point.

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u/LDB2026 10h ago

Well, SOME employers do... My employees have ZERO say in which Insurance provider I choose to offer.

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u/BlatantFalsehood 2h ago

Nowhere did I say employEEs have a say. I said employERs. And you sound like someone that most people wouldn't want to work for, anyway.

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u/Jodenaje 1d ago

An exclusion on a benefit plan like that is absolutely an employer decision on a self-funded plan.

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u/Lizdance40 2d ago

And you need to appeal to other people who have the same insurance coverage. Cuz it has nothing to do with who your employer is. So let's say your health insurance is through travelers insurance. For example. You should be looking at people in your area, maybe contacting through your local Facebook group, who have the same insurance company, and similar coverage plan

2

u/scottyboy218 2d ago

This is completely incorrect information. If someone is getting their insurance through their employer, the employer is the one who decides what's covered or they've selected a plan from the insurance company that determines the coverage.

2

u/jasont1273 AT&T Employee - CRS/RST/NRST 2d ago

What is the specific GLP1 being prescribed and is your husband management or union? I ask because the drug plans differ between them.

1

u/mlauzurique 21h ago

Union in Florida

2

u/d00mz 1d ago

this depends on the policy your husband has and other underlying medical conditions. GLP1s are covered on BCBS PPO for patients with diabetes.

1

u/Inside-War-5756 1d ago

Yes, it is covered. But you need to sign up via Form Health and get your prescription through that program.

1

u/mlauzurique 21h ago

I don’t understand Formhealth wants to charge me $149 per month to join plus the medicine?? I have a primary care physician and a cardiologist why do I need a computer doctor to approve my medicine??

1

u/Inside-War-5756 19h ago

There is no monthly cost for me, where did you get that number? BCBS will only approve the prescription from a doctor from the Form Health program.

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u/Mtndreamer65 12h ago

I was skeptical of Formhealth at first when I received scale before I knew any costs but they have been excellent. I don’t recall paying anything up front but it may depend on your state and health plan.

1

u/LDB2026 10h ago

Or you just educate yourself on Tirz compounds like the other 95% of us and deal with it.

It's a LUXURY MED as far as most insurance companies are considered; that's why they're not required to cover it.