WEIGHTS LOSS DIET

Does Fidelis Cover Weight Loss Medication? 

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Does Fidelis Cover Weight Loss Medication
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Marlon Emmanuel Mcleod

May 3, 2023

Does Fidelis Cover Weight Loss Medication? If so, you may be wondering whether Fidelis covers weight loss medication. The answer is not specific, as it relies on several aspects. In this complete manual, we will research the ins and outs of Fidelis coverage for weight loss medication so that you can make an informed decision about your healthcare.

Understanding Fidelis Health Insurance

Before diving into Fidelis’ coverage for weight loss medication, it’s essential to understand the basics of Fidelis Health Insurance. Fidelis is a New York State-based health insurance company that offers coverage for individuals and families and Medicaid and Medicare plans. Fidelis prides itself on providing affordable and comprehensive coverage for its members.

Types of Weight Loss Medication

Before discussing Fidelis’ coverage for weight loss medication, let’s first explore the different types available. There are several FDA-approved medications for weight loss, including:

  • Phentermine: A prescription appetite suppressant that decreases hunger and helps you feel full.
  • Orlistat: A prescription medication that inhibits the absorption of dietary fat.
  • Liraglutide is a prescription medication that helps regulate blood sugar levels and decrease appetite.
  • Contrave: A combination of two medications, naltrexone, and bupropion, that work together to decrease appetite and increase metabolism.
  • Saxenda: A prescription medication mimics a hormone the gut produces that regulates appetite.

Fidelis Coverage for Weight Loss Medication

As mentioned earlier, Fidelis’ coverage for weight loss medication varies from plan to plan. Some plans may cover certain medications, while others may not. Reviewing your plan’s formulary to determine which weight loss medications are covered is crucial.

Fidelis generally covers weight loss medication when it is deemed medically necessary. It means that you must meet specific criteria, such as having a body mass index (BMI) of 30 or more elevated or a BMI of 27 or more increased with a short one weight-related fitness requirement, such as high blood pressure or type 2 diabetes.

How to Get Weight Loss Medication Covered by Fidelis

If you believe that weight loss medication is medically necessary for your condition, you’ll need to follow specific steps to get it covered by Fidelis. It relies on your exact insurance plan and the medication you’re considering. Fidelis does cover some weight loss medications, but not all of them.

Review your plan documents or contact Fidelis directly to determine if your Fidelis plan covers weight loss medication. In general, Fidelis may cover weight loss medication if deemed medically necessary. It means you must have a medical condition affected by your weight, such as diabetes or high blood pressure. Here’s what you need to do:

Speak to your doctor: 

Your doctor can support determining if weight loss medication is appropriate for you and if it is medically necessary. They can also provide documentation to support your claim.

Submit a claim:

 Once your doctor has determined that weight loss medication is necessary, they will submit a claim to Fidelis on your behalf.

Wait for approval: 

Fidelis will review the claim and determine if the medication is covered under your plan. This procedure can take several days to several weeks, depending on the complexity of the suit.

If Fidelis does not cover your weight loss medication, you may still be able to get it through other means. Some pharmacies offer discounts on certain medications, and there are also prescription discount programs that can help reduce the cost of medication.

Conclusion

In conclusion, it’s essential to understand your coverage options if you’re considering weight loss medication and have Fidelis insurance. While Fidelis does cover some weight loss medications, coverage will depend on your specific plan and medical necessity. If you believe that weight loss medication is medically necessary for your condition, talk to your healthcare provider about obtaining a prescription and submitting a claim to Fidelis.

Remember, weight loss medication is not appropriate for everyone and should only use under the guidance of a licensed healthcare provider. Always be concerned about the dangers and benefits of any treatment with your healthcare provider before deciding.

FAQS – Does Fidelis Cover Weight Loss Medication

What weight loss medications does Fidelis cover?

Fidelis covers some weight loss medications, but not all of them. The medications that are covered may vary depending on your specific insurance plan. You must review your plan documents or contact Fidelis directly to determine if a specific medication is covered.

Do all Fidelis plans to cover weight loss medication?

No, weight loss medication is not covered by all Fidelis plans. Coverage for weight loss medication varies depending on your specific plan and the medication in question.

Do I need a prescription for weight loss medication?

You will require medication from a licensed healthcare provider to obtain weight loss medication. Your healthcare provider will evaluate your medical history and determine whether weight loss medication is appropriate.

Will Fidelis cover the entire cost of weight loss medication?

No, Fidelis typically does not cover the entire cost of weight loss medication. You may be accountable for a copay or coinsurance, depending on your plan. The amount you will owe will depend on your specific plan and the medication you’re prescribing.

How long can I take weight loss medication?

The length of time that you can take weight loss medication will depend on your treatment plan. In general, weight loss medication is meant to be used with diet and exercise and is not a long-term solution. Your healthcare provider will determine how prolonged you should take the medication based on your needs.

Does Fidelis cover weight loss surgery?

Fidelis does cover weight loss surgery in some cases. However, like weight loss medication, coverage will vary depending on your specific plan and medical necessity.

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