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[quote=Anonymous][quote=Anonymous]I’m thinking of switching to GEHA standard bc the Wegovy price is better. Anyone have any experience good or bad?[/quote]

Had.  I switched to BCBS because it seemed like everything— every service, every med—  needed a PA, and my PAs across multiple providers and multiple family members were getting denied, appealed, denied again, doctor got on a peer to peer call and GEHA MD was a no show.   MH reimbursement is better. But, I was also getting self submitted OON my claims kicked back regularly.  GEHA is better reimbursement. But you need to get the reimbursement.  I reached a point we were changing meds to things less effective and paying out of pocket for pain management procedures, because of ongoing Pa denials

Under BCBS standard, with Zepbound plus mental health plus pain management procedures, I have hit my out of pocket max of $6000 by June.  Once I hit mine, it’s not far for my kids and DH to hit there’s. Months 1-3 are doable because if my FSa plus the extra money they give you for entering your BP or going to preventative appointments.  Months 4-6 suck, but I’ve gotten used to budgeting $1000 a month for medical three months.  Stating in June or July, Zepbound is free— everything in network is free—because I’ve hit my max. By August Sept, OON mental health is free up to the reimbursement amount (which is about $20 less than my therapist charges). I had major surgery, a hospital stay, extensive PT and OT starting in August.  I’ve paid $0 to hospital, MD, PT, OT, meds associated with the surgery. Because I met my max. And yes, the time of the surgery was intentional.  I have never had a PA issue. And even though Zepbound is only available under an exception, I was able to easily get it by my MD saying ai had plateaued on Wegovy and Saxenda conflicted with a med I was taking. PA just renewed for Zepbound for a full year.

GEHA is probably better financially— when they pay. My MDs (multiple) hate using them though, and say it is definitely not just me. My pain management can get procedure approval in one day for BCBS. They must allow 2 weeks for GEHA. And I kept having procedures I was taking off work for cancelled the day of because GEHA was still mulling.  And I’m an administrative lawyer. So, I can fill out paperwork properly. It’s not a me issue. [/quote]

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