Question about coding

So I’m trying to get my insurance to cover Ozempic, which I meet all of the requirements except I am not diabetic, yet. I do have high range pre-diabetes along with a variety of other health problems due to weight. The first time I tried to get the medication, my insurance denied me. I called and the insurance company told me to tell my doctor to just code it as “diabetes” and not “pre-diabetes”. She had concerns so she ultimately did not change the code, which I understand. I recently started a new job and switched insurances (still with the same insurance company though) and once again called to see if maybe my better insurance could cover the medication. Yes, I realize it’s the same company but a different representative when I asked how I could get the medication told me the same thing – to tell my doctor to just code it as diabetes, because otherwise the insurance wasn’t going to cover it, but I did meet all of the other requirements.

Sooo, what to do? Do I tell my doctor that again, they told me to just have her code it as the insurance company is telling me?

submitted by /u/kays129
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