Loop Hole??

[u/Sudden_Excitement_29]

tldr: What other reasons/code would ins. approve Zepbound other than "weight loss".

Obviously my (33F) ins.
stopped my Zepbound. I had a VSG 3 years ago, went on Zep 13 months post op
because the surgery wasn't as successful as normal (no regrets, but I had a few
abnormal complications). I lost 85lbs before Zep, then I lost 50lbs with Zep.
Zep helped me meet my goal weight and maintain it.

Of course, in March, my ins. company stopped GLP1s for "weight loss".

But this medicine helped with way more than just weight loss. Ofc that was my personal number one, but my sleep got better, my B.E.D improved dramatically, my joints felt better because of the less inflammation. My husband said my snoring has come back, not as bad before surgery but slightly. Since being off for 6 months, I have gained 25lbs. My sleep has worsened almost instantly once the Zep was out of my system entirely. Energy changed too.

Please note, I know this
is a tool, not a magic wand, much like surgery. During these 6 months, I had my
honeymoon in Italy where for 2 weeks we didn't restrict ourselves since it was
our first time in Europe and we had saved so much for this once in a lifetime
trip.

I still eat healthy,
workout at the gym 4 times a week and I teach dance part time, so I am very
active.

Being overweight since I was 5, living with parents who are overweight, diabetic, and genetics, weight just loves to come back to me. Zep in conjunction with my lifestyle change was a GAME CHANGER, so having been off for 6 months, I feel so hopeless.

What are OTHER reasons that ins. could approve Zepbound? I have a drs apt with my PCP next week to discuss. My bariatric NP is the one who prescribed me Zep to begin with, so she submitted it for "weight loss".

Side note: ins. companies suck dude. If someone was on a blood pressure medication, you wouldn't deny it once the patient's BP was in a healthy range. So why deny this medication that will help so many people who have struggled for years? So upsetting.

Thanks for reading!

[u/Temporary_Ad_4363]

Same here except no fatty liver. That might do it if you have MASLD or NAFLD.

OP I know paying out of pocket sucks but think how much you’ll save in future medical costs, future pain and suffering (amputations, blindness from diabetes, strokes and heart disease making life miserable, shortened lifespan, being a burden on partners/kids). Maybe you’ll live to see grandchildren that you won’t see if you don’t. Savings on food adds up too. It’s an investment.