bbq_ray_KC said:Denials are usually procedural rather than clinical, and the order that works reflects that.
Insurance update relevant to cost and coverage: I just got my prior auth approved through UnitedHealthcare after 1 attempts.
What finally worked: a letter from my endocrinologist documenting BMI history (>3 years), failed diet attempts, comorbidities (PCOS + insulin resistance), and referencing the SELECT trial data.
If your PA keeps getting denied, don't give up. Request a peer-to-peer review between your doctor and the insurance medical director. That's what finally broke through for me.
One thing that is still open after Dr.PulmRoch’s answer:
Was that from a primary source or from a summary of one?
Dr.AddMedPHL said:Insurance update relevant to cost and coverage: I just got my prior auth approved through UnitedHealthcare after 1 attempts.
My insurance denied my PA related to cost and coverage. Has anyone successfully appealed? I'm considering going compounded instead.
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Follow-up — getting the denial reason in writing was the step that mattered. It named the criterion, and the criterion was a document I already had.
Dr.MetabolicMD said:My insurance denied my PA related to cost and coverage.
Dr.MetabolicMD said:...compounded vs brand cost and coverage...
This debate comes up weekly and I think both sides have valid points:
Pro-brand: FDA-approved, manufacturing standards guaranteed, clinical trial data directly applicable
Pro-compounded: 10x cost savings, same active molecule, independent testing available, accessibility
My position: if you can afford brand or have insurance coverage, that's the gold standard. If not, properly tested compounded from a 503B pharmacy is a reasonable alternative. Neither side should shame the other.