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ForumsMarketplace & ListingsTelehealth prescriber directory — anyone have experience? Page 2

Telehealth prescriber directory — anyone have experience?

Dr.GutHealth Fri, Mar 22, 2024 at 9:09 AM 36 replies 2,800 viewsPage 2 of 8
PharmacoVig_BOS
Senior Member
1,567
8,901
Feb 2024
Boston, MA
Mar 22, 2024 at 8:07 PM#6
Dr.GutHealth said:
Denials are usually procedural rather than clinical, and the order that works reflects that.
Dr.GutHealth said:
...regarding the discontinuation data for cost and coverage...

I want to reframe the discontinuation narrative. We don't say "insulin fails because blood sugar rises when you stop it." We don't say "antihypertensives fail because BP goes up without them."

Why do we apply different logic to anti-obesity medications? The answer is stigma. We still, unconsciously, believe obesity is about willpower rather than biology. The discontinuation data actually PROVES it's a chronic biological condition requiring ongoing treatment.

This reframing isn't semantic — it has implications for insurance coverage, treatment duration, and patient expectations.

22 17amsterdam_pete, LondonLisa, mike_nyc and 19 others
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NurseAsh_DET
Member
356
1,567
Sep 2024
Detroit, MI
Mar 23, 2024 at 12:27 AM#7

Following on from Dr.RheumBOS — and this may be the naive question:

What did you change at the same time, and can you separate the two now?

21 16ricardo_MIA, BrianDallas92, labquiet_amy and 18 others
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james_edin
Member
289
1,234
Sep 2024
Edinburgh, UK
Mar 23, 2024 at 4:48 AM#8
PharmacoVig_BOS said:
Dr.GutHealth said: ...regarding the discontinuation data for cost and coverage...
PharmacoVig_BOS said:
...my insurance denied cost and coverage coverage because...

Insurance denial is the single biggest barrier to GLP-1 access. Let me share the appeal framework that worked for me and several community members:

  1. Document medical necessity (BMI, comorbidities, failed alternatives)
  2. Reference clinical practice guidelines (AGA, AACE, Endocrine Society)
  3. Cite cost-effectiveness data (preventing diabetes/surgery saves money long-term)
  4. Request peer-to-peer review between your doctor and the plan's medical director
  5. File external appeal with your state insurance department if internal appeal fails

Don't accept the first denial. The appeal process exists for a reason.

20 15tane_welly, Dr.PathRoch, mona_PHX and 17 others
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Dr.GutHealth
Senior Member
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7,890
Mar 2024
Minnesota
Mar 23, 2024 at 9:09 AM#9

Reporting back.

Update: approved on the third attempt after a peer-to-peer. Nothing about my case changed; only who was doing the talking.

Last edited: Mar 23, 2024 at 2:09 PM
19 14Dr.RaviCardio, jennifer_SEA, tyler_CSCS and 16 others
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Dr.GastroMayo
VIP Member
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Jan 2024
Mayo Clinic, MN
Mar 24, 2024 at 6:01 AM#10
james_edin said:
PharmacoVig_BOS said: ...my insurance denied cost and coverage coverage because...

Telehealth prescriber review for cost and coverage: I've used 4 different telehealth platforms to get my GLP-1 prescription. Comparison:

FeaturePlatform APlatform BPlatform C
Initial Consult$68$88$0
Monthly Follow-up$38Included$53
Prescription SpeedSame day24-48 hoursSame day
Lab MonitoringRequiredOptionalRequired

I settled on the one that required labs — it shows they care about safety, not just prescribing volume.

Last edited: Mar 24, 2024 at 11:01 AM
15 13InsuranceTom, WendyG_ATL, SaraMom3 and 12 others
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