Metabolic Health Insurance

Long story short, I’m taking Ozempic off-label to get to a healthier weight. A year ago I was 350 lbs. 5’10” and at my previous follow up my doctor had been talking about bariatric surgery (this is after years of trying to do better, first an exercise check, other prescription drugs and combos check pretty much i had been through the list and still unable to get it under control.

My Dr said things have changed and so I got on Ozempic (as a pre diabetic). Fast forward 1-year, I’ve lost 80 lbs. feel great (physically and mentally) and things are looking better than they have in way to long.

Yesterday, I got an email that our insurance was implementing a prior approval process on Ozempic. I discussed with my doctors office and because I’m pre diabetic and not diabetic they do not think I would be able to qualify.

A little more background, I work in the industrial sector in a white collar position.

After a lot of reading I determined that employers can opt in to metabolic coverage for their health benefits plans.

I have a hypothesis that metabolic coverage is actually cheaper long term than the alternative and I’m going to be pitching this concept to HR to argue for the benefit to be added to our coverage.

Here’s what I have come up with so far as cost mitigation:

Less obese employee pool could lead to decreased incidence of OSHA recordables which in turn can reduce expense related to employee injuries – reviewing our injuries every recordable in the previous 2 years that was ergonomic in nature was an employee that would benefit from metabolic treatments.

A less obese employee pool can reduce costs of other treatments. Examples include: bariatric surgery, CPAP, increased incidence of heart attack and stroke

Finally treating someone who is still at a point where their pre diabetes can be reversed is cheaper than me progressing to diabetes and then claiming insurance benefits at that point.

Just wanted to get your thoughts and ask if anyone is aware of where I could find actual data on costs and mitigated costs of metabolic group insurance policies.

Love to hear your thoughts.

submitted by /u/AdNo7052
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