Klarity Health providers streamline the process of obtaining insurance coverage for medications like Ozempic, Wegovy, Mounjaro, and Zepbound by verifying eligibility, submitting documentation, and managing appeals efficiently.
Many insurance plans require prior authorization before covering medications such as semaglutide (Ozempic, Wegovy) and tirzepatide (Mounjaro, Zepbound). This process involves a review of your medical necessity, eligibility criteria, and supporting documentation.
FDA approval determines the eligibility for these medications. Generally, you need a body mass index (BMI) of 30 or higher, or 27+ with related health conditions like type 2 diabetes, hypertension, or high cholesterol. Off-label prescribing is less likely to be approved by insurers.
A healthcare provider on Klarity Health can evaluate whether you meet these criteria and document your health status accordingly.
Providers on the Klarity platform help ensure all necessary documentation—such as diagnosis codes, BMI measurements, and treatment history—is correctly prepared and submitted. They also handle the submission of PA requests, reducing errors and delays.
In case of initial denial, Klarity providers assist in filing appeals or requesting formulary exceptions, increasing the chance of coverage approval.
Your provider assesses your BMI and comorbidities to determine medical necessity.
All relevant health information, including prior treatments and related health issues, will be compiled and submitted.
The provider files the request with accurate diagnosis codes and supporting evidence.
If denied, Klarity professionals help gather additional documents and appeal decisions to improve approval chances.
Handling insurance approvals on your own can be complex and time-consuming. Klarity providers understand insurance requirements and guide you through every step, aiming to make your weight loss or diabetes treatment journey as smooth as possible.
Appointments are often available within 24 hours, with some offering free initial consultations. They also assist with prescriptions, including controlled substances, based on federal and state regulations.
Ready to begin? Schedule a session with a Klarity provider today. They will evaluate your medical needs, confirm your eligibility, and manage the prior authorization process to help you access medications promptly.
Note: All services are provided by independent practitioners, and prescriptions depend on individual assessment and state regulations.
This educational content is not medical advice. Always consult a healthcare professional for personalized guidance. If experiencing a psychiatric emergency, seek immediate help from mental health professionals or call emergency services.
Report any adverse medication effects to the FDA via MedWatch or call 1-800-FDA-1088.
Appointments are available within 24 hours. Book now to get personalized assistance in navigating insurance and obtaining your weight loss or diabetes medications.
Medical Disclaimer: This content is for educational purposes only and does not replace professional medical advice. Always consult a healthcare provider for diagnosis and treatment options.