Wegovy covered by my insurance until it worked as intended? Now rejected because I’ve lost weight.

I'm absolutely appalled by my insurance right now. I was prescribed Wegovy for weight loss at a BMI of 28.2. I lost 30 pounds. Now my insurance won't cover it because my BMI is below 24.0. This is their "policy".

It's well documented that people who go off Wegovy gain 70% of the weight back on average. My cholesterol and other biomarkers are vastly improved, as are my energy and overall mental health.

Approving coverage for a drug to treat chronic obesity via weight loss. Then denying coverage once it has been successful at treating chronic obesity via weight loss.

Isn't this the same as approving coverage for antidepressants, then denying coverage once the person is feeling better due to the antidepressants. How is this legal? It seems so evil I can't even believe it.

My only recourse is to have my doctor appeal the decision. This is a big time commitment on my doctor's side of things, it's been hard to motivate them to do even the prior authorization request in the first place since the insurance already makes the doctor jump through as many hoops as possible to get the PA approved (I suspect this is by design too).

I'm wondering what else I can do here? Is there some place I can file a complaint? Sue? This just seems so unjust.

Anthem Blue Cross PPO in California. The prior authorization stuff is managed via Rightway Rx.

submitted by /u/clothesface
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