Medical weight loss programs available online

Weight loss medication is not necessarily for everyone. Book a visit with one of our board-certified doctors to determine the optimal weight management plan for your specific needs. This plan may or may not include medication. However, if you are not eligible for medication, our doctors can still help with diet and exercise as part of a customized weight management plan.

To help you prepare for your first doctor's visit, it is helpful to gather the following information:  

• List any other medications (if any) you previously tried for your specific condition, along with the corresponding dates of use and why you feel the medications did not work for you.  

• If you have specific lab results that support your need for the medication, you can upload it to your chart before your first doctor’s visit or email it to info@plushcare.com.    

• If you are seeking weight loss medication, please provide documentation and/or receipts from any earlier diet/exercise programs. 

Yes! We are one of the few in-network providers with most major insurances. You'll have the option to search for and select your insurance provider when you book an online appointment in order to determine if your insurance is in network.

It is important to know that not every insurance plan will cover the cost of medications.  Prior to seeing your medical provider, we recommend checking your plan’s benefits to see if weight loss medicine is covered, and if so, for what particular diagnoses. Most branded weight loss medications require prior authorization in order for insurance to cover the cost. Your doctor and care team can reach out to your insurer on your behalf, which can take several business days. If you are denied the prior authorization, you can still purchase the medication at the full cash price.

Prices vary depending on the medication type, and whether or not you use insurance to pay for it. Most branded weight loss medications require prior authorization in order for insurance to cover the cost. We recommend checking with your insurance to see if these weight loss medications are covered as they usually cost about $1000 per month out of pocket. With our in-app Rx Discount Card, patients have saved from 7-20% on these medications.

When weight loss medications are stopped, many people gain the weight back. Drugs like Wegovy® and Ozempic® lower a person's appetite to help with weight loss, but experts suggest that once people stop taking these drugs, they can experience weight gain. The rates of weight gain after stopping Wegovy® vary depending on the individual, and available data suggests that with some individuals, weight gain will come back earlier, and with others, it may come later.

It's important to note that getting a Wegovy® or Ozempic® (semaglutide) prescription online without proper advice from your doctor can pose risks. It's recommended to consult your doctor for guidance on how to take these medications.  Whether you're exploring options for an Ozempic® or a Wegovy® prescription online, your doctor is crucial in ensuring a safe and effective weight loss journey.

While you are scheduling your second weight loss visit, you will be asked for your insurance information. This includes your insurance RX number, BIN number, PCN number, insurance identification number, and your address listed with your insurance provider.  This information is often listed on your insurance card. If you have any trouble finding this information or need to confirm information on file with your insurance, please contact your insurance before filling out our PA form. 

Our information will need to match your insurance provider’s information. If the information does not match their records, there may be delays in processing your prior authorization. If we need more information, we will reach out to you for clarification. Please make sure you check your email regularly in case we reach out to you. If you were not asked for this information or there are changes to this information since you submitted it, please email info@plushcare.com so that we can process your prior authorization. 

If applicable, please list the other medications you previously tried for your specific condition. You will want to list the dates you took these medications and why these medications did not work for you. If you have specific lab results that support your need for the medication, you can also send that to our prior authorization department when filling out your prior authorization Form.  If you are applying for weight loss medication, please provide documentation / receipts from any earlier diet/exercise programs.

The information that we need to submit your prior authorization is collected in your doctor appointments, by getting your lab work done, and by entering your insurance information before your second visit. 

Our prior authorization process starts automatically once your doctor prescribes medications to treat weight loss or  type 2 diabetes. You will receive a confirmation email that your information was received and in the queue. It usually takes 3-7 business days for our team to compile the necessary information to submit your PA, but this can vary. If we need more information from you, we will reach out via email.  Please make sure that you check your email regularly.  The prior authorization can be delayed if we do not have all the information that we need to submit a complete PA.    If you were prescribed a medication that needs a prior authorization and you did not receive a confirmation email from us, please reach out to our support team. 

If you have a change in your demographics or insurance information, please contact info@plushcare.com so that we can submit your PA with the correct information and avoid unnecessary PA denials. 

If you’ve been prescribed a different type of medication and your pharmacy has told you a PA is needed, you can let us know by calling 1-888-729-0438 or by emailing info@plushcare.com. You may be asked to fill out a short intake form with information about your insurance and prescription history. 

Once your PA is submitted, you’ll receive an email titled “PRIOR AUTH SUBMISSION”. Your insurance will now review the documentation provided and issue a determination. The insurance processing times vary; the average is 7-14 days. We’ll notify you once we receive an outcome. Sometimes your insurance will send you an PA outcome without sending it to us. If you receive a PA outcome and have not heard from us, please send a photo of your letter to us. 

If you have any questions during this time, you can reach the Prior Authorizations team directly by responding to the message titled “PRIOR AUTH SUBMISSION”. You can also contact your pharmacy benefit plan directly. If you contact your plan, please call your pharmacy benefit manager (PBM) as they will handle the prior authorization for your prescription and not your medical insurance network. The contact information for your PBM should be on your insurance card but may be on a separate card- common PBMs are ExpressScripts, CVS Caremark, and OptumRx.  

If you did call your PBM and they do not have your prior authorization, even though you received communication from us that we submitted the prior authorization, please give us a call at 1-888-729-0438. 

On average, prior authorizations can take 7-14 business days to process, however, decision times vary based on your insurance provider and other factors. We check for updates from your insurance company every 7 days. You will receive an email when there is an update with your prior authorization.  You may also get an email that more information is needed if your insurance information has changed, address has changed, or other information is needed to process your PA. 

Knowing what your insurance plan covers will help you decide on a treatment plan with your doctor. You should look online or call your insurance company to find out if your pharmacy benefits plan (PBM) covers FDA-approved weight loss medications, including Contrave®, Saxenda®, Wegovy®, or Zepbound™.  Ozempic®, Mounjaro®, and Rybelsus® are FDA-approved diabetes medications that are covered only for patients who have type 2 diabetes; these medications are not covered for weight loss. 

The status of your prior authorization depends on what step you are at within the process: 

If you’ve been prescribed an injectable medication for weight loss or type 2 diabetes, our team will automatically start compiling the necessary information. This usually takes 3-7 business days but can vary. If you’ve been prescribed a different type of medication and your pharmacy has told you a PA is needed, you can let us know by calling 1-888-729-0438 or by emailing info@plushcare.com. You may be asked to fill out a short intake form with information about your insurance and prescription history.  

Once your PA is submitted, you’ll receive an email titled “PRIOR AUTH SUBMISSION”. Your insurance will now review the documentation provided and issue a determination. On average, prior authorizations can take 7-14 business days to process, however, processing times vary. We’ll notify you once we receive an outcome. Sometimes your insurance will send you a PA determination without sending it to us. If you receive a PA determination and have not heard from us, please send a photo of your letter to us. 

If you have any questions during this time, you can reach the Prior Authorizations team directly by responding to the message titled “PRIOR AUTH SUBMISSION” or contact your pharmacy benefit plan directly. Please make sure you call your pharmacy benefit manager (PBM) as they are responsible for managing the prior authorization for your prescription, rather than your medical insurance network. The contact information for your PBM should be on your insurance card but may be on a separate card- common PBMs are ExpressScripts, CVS Caremark, and OptumRx. 

If you have contacted your PBM and they do not have your prior authorization on file, even though you received communication from us confirming its submission, please give us a call at 1-888-729-0438.