Podcast feed drop: A tool everyone needs to hear about

In your Arm and a Leg feed this morning: an episode of Paper Trail, a new podcast from the investigative journalism powerhouse, ProPublica.

This episode taught us about an insurance industry term that we just had to share: external review. Knowing it could one day be the key to reversing an unfair insurance denial.

An external review allows you to tap an expert from outside your insurance company to review your case and potentially force your insurance to cover what you need.

Reporter Duaa Eldeib and host Jessica Lussenhop tell the story of one woman’s journey of discovering this tool and putting it to work. We’re very pleased to share it with you this week.

This story doesn’t just have a great lesson: It’s got a gritty, determined protagonist, and — not too big a spoiler — a good outcome.

And, a heads up: The medical side of this story also deals with some potentially upsetting stuff — including detailed descriptions of suicide attempts. As Paper Trail host Jessica Lussenhop says at the top: please take care when listening.

Could an external review help you?

Short answer: It depends on why they say they’re denying you and what else you tried.

ProPublica reporter Duaa Eldeib breaks it down.

Want more stories and tips about appealing insurance denials? We’ve got a Starter Pack for you.

Getting GLP-1s covered

GLP-1s like Wegovy, Ozempic, and Mounjaro cost hundreds of dollars out of pocket if your insurance doesn’t cover them.

But getting them covered just got easier for lots of people on Medicare — and for everybody else, we’ve got tips to share from our colleagues at KFF Health News.

Medicare kicked off a pilot program yesterday, July 1, to cover GLP-1s for millions of enrollees for the first time. Not everyone on Medicare is eligible — you have to meet certain health requirements. And only three products are covered: Wegovy tablets and shots, Zepbound KwikPens, and Foundayo tablets.

It’s big news, and lots of outlets are covering the details — but I’d recommend this CNN story for, if nothing else, the pictures of unbelievably cute dogs.

And for those of us not on Medicare and struggling to get a GLP-1 covered, check out these tips from KFF Health News.

For instance: While many plans don’t cover GLP-1s for weight loss alone, they make exceptions for people with a range of other fairly common conditions — like sleep apnea.

And they’ve got tips if you decide to buy GLP-1s online from a compound pharmacy, like how to make sure the pharmacy is licensed and legit.

That’s it for this week. We’ll be back in two weeks — yep, we’re taking a week off. Stay cool, and happy Fourth!

— Emily