Welp, lost my final appeal....learn from my mistake
My insurance denied my PA back in February, stating that I no longer qualified as I was no longer obese. They also stated they had a new requirement that people have to participate six months of a "weight loss program, such as Weight Watchers" before they qualify. I did two levels of appeal and then put in for an external appeal.
I started these medications in July of 2021, and at that time I weighed 192 lbs with a BMI of 37.5. I've lost 70 lbs since starting anti-obesity medications, for a total of 36.2% of my body weight. 20 of those lbs were lost on Zepbound.
I saw my doctor in January of 2026, at which point I was 123 lbs. This is where I made my biggest mistake: I told my doctor that I felt I was losing too much weight and wanted to decrease my dose.
I had bariatric surgery in February of 2017, at which point I weighed 252 lbs. Because of this, I'm at increased risk of post-surgical malabsorption, which is monitored yearly through bloodwork. It should be noted that my labs are excellent and have been for years. On the lower side of average for protein but that's my norm so not a concern to my team. However, my own words were used against me in the appeal as justification that I no longer would benefit from this medication. There's no mention of maintenance, despite all the research that shows maintenance is needed, just that I no longer should be losing weight. Here's what the appeal said:
So, TLDR, never tell your doctor that you're losing too much weight, as your words will come back to bite you. I'm paying $400 a month out of pocket right now but it's not realistically sustainable for me long term (daycare costs + the rising cost of living is killing me) so I am going to start to wean myself off and hope for the best.
Would love to hear stories of people who have come off and successfully kept the weight off. I have completely changed my life, I'm much more active and eat smaller portions. But I'm terrified of the food noise and how quickly it comes back. I joke that I was literally born overweight (nearly 11 lbs as a newborn!) and I know my body will keep fighting to go back to what it considers "normal."
Posted May 12, 2026, 2:58 PM UTC