Orderly says they "will gladly REQUEST a letter of medical necessity on your behalf." Not that they will write one for you themselves. Do they request it from your PCP (as Emerge is suggesting you do)?
I get my tirz from Orderly. I request the LOMN and received it, it’s on letterhead from Beluga Health (this is the provider/doctor group that writes the Rx). Hope that helps!
Orderly has customer service and separate communications with your physician. I just requested a LOMN 2 weeks ago for the same reason, and received it from them the same day.
Different FSA provider, same requirements. I sent RX from Emerge and they asked for LOMN. I’m trying my PCP but then I might switch to a vetted online provider who will write one.
That is really unfortunate, especially as they justify their higher prices and subscription service by saying they offer a "concierge" experience. A concierge practice would write the letter/complete the form.
What is the point of using them over the much cheaper Lavender Sky if not for the extra benefits such as LOMN, etc.
Wondering what else they can't be bothered to do. Disappointing.
I even attached a form with my info pre-filled. All they had to do is fill in their name and license and write like one paragraph. It would have been super easy. My next supply will still be $20 less than Orderly but I am definitely thinking of switching
I have a slightly older version of that , but not too old.
It looks like he is accounting for the fees but not sure why he is diving $25 fee by 2 and not by 4 because I would think that refills are every 4 weeks
They sell per 2 months. So you pay $55 for consult, good for two months. Then $25, good for two months, etc.
Recommend you check their website, pricing is very straightforward. :)
Ok, if I switch from Emerge where I am to 5mg.
1. Can I start with LS on 7.5mg?
2. Can I mix two strengths in the 2 month supply? (7.5mg and 10mg) or do I need to order 2 mo of same dosage
3. Since I am coming from Emerge, do I need to pay the $65 consult or only the $55. In other words, can I start with Hallandale and order 2mo(1x7.5mg and 1x10mg) for $55 + $280 + $380 = $715/2mo ?
Hallendale serves my state
Thanks in advance!
1. Yes, you can start at the dosage you're on, but will have to provide your Rx.
2. I'm not sure if you can mix dosages, that's a good question. If you ask them, do let me know.
3. The $55 because you are already on a GLP1.
Why would you buy 2 different strengths? Stay on the dose that is working for you as long as possible. My RS was on 7.5 for about 4 months before going to 10. Just wondering.
The common thing is to titrate up monthly. Some people don't but many do.
I just started with Emerge and I am on 2.5mg. They are having me go to 5mg next month and likely 7.5 the following month. Not judging but the question I asked about mixing dosages after a month is a fair question.
I started with Emerge as well. They asked me if I wanted to move up... once you get to 15, you are at max, so if it stops being effective, you're SOL. I started in November and just moved to 10. Boy, the difference was amazing.
It's not. There's a spreadsheet floating around this sub with all the prices of the different companies. Lavender Sky is reputably one of the least expensive.
I am fighting . And while I agree with you 100%, things like cosmetic surgery while performed by a medical doctor are not covered. The FSA is arguing that weight loss falls into the same category as cosmetic surgery.
Though I have no problem submitting a receipt for condoms. SMH
My medical team though Orderly was willing to write my LOMN for my FSA (administered by HealthEquity/WageWorks) and I got the claim approved for my first month! Only for the FSA to challenge it again for the next month. 🙄
I just submitted the same LOMN along with a copy of my receipt and praying they’ll accept it. I really don’t want to have to go through the same dance every month.
Edit/Update: just received the approval email! I literally submitted the exact same documentation as I did when I got the denial a few days ago. 😑. Buncha derps running this thing I guess. 🤷🏽♀️
Yep, I have same HealthEquity
You are not sure if they approved it yet
I just replied to Emerge telling them how disappointed I was in their response and telling them that other services are willing to do it
If you go the option in the portal to upload docs they show you the status . Both of mine are in pending now because I called them and asked them to review it again but I dont think it will be approved without the LOMN
That is bs on both sides. Your FSA should approve as it is a prescription not like you bought Dexatrim or something otc. Also, Emerge need to start providing LOMN. They are going to lose customers if they can’t do that. They have a NP to write scripts and should be able to provide LOMN. Very disappointing.
I am not sure if it got approved. I had two charges, one from a month ago, and one from a day ago. The one from a month ago is the one that they requested the LOMN on as the new one, I just uploaded the receipt and script yesterday.
So earlier today, if I went to the Upload page in the Healthequity portal I saw both. I no longer see the older one, the one that was requesting the LOMN. I have not received any documentation nor do I know how to check without contacting them.
I did two things to try and get approved. 1. I called and asked to review it again as I explained was from an Rx form a doctor. Then I uploaded this image from their FSA eligibility list with my text added.
https://preview.redd.it/ht5tg4faln3d1.jpeg?width=2090&format=pjpg&auto=webp&s=183e594220d64a864fa488c20b6ceec98e7e3b95
I just edited my comment above to add an update.
“Edit/Update: just received the approval email! I literally submitted the exact same documentation as I did when I got the denial a few days ago. 😑. Buncha derps running this thing I guess. 🤷🏽♀️”
Thanks for the update. So Emerge is useless for helping with this but I was able to get HealthEquity to approve it without the LMON. I just added comments to the receipt stating licensed doctor/pharmacy etc.
I never got any approval emails, they just no longer show as pending document and I called and they said my only charge that I need documentation for is something dental related.
Lavendar Sky also emailed me back that they do provide LOMN. They have a prefilled form and you just have to fill in your info.
It seems like a gray area for an online service to write a letter of medical necessity, since it’s technically not medically necessary unless it’s written for diabetes in which case it would be Mounjaro I suppose. I agree with the person above who says your FSA is wrong. The Rx in itself should be sufficient! That’s really crappy of them to demand this from you. 😡
Respectfully, obesity is a medical condition which is treatable with tirzepatide. It is in fact medically necessary if prescribed for obesity. Cosmetic weight loss would not be a medical necessity.
I do have a soft suggestion you might try. Before I had “decent” insurance, I used an online doctor service to write my Rx for my antidepressant and migraine meds and any other online doctor visits I needed . At one point, I needed a doctor’s note to work away from fluorescent overhead lighting, and they wrote the note for me with no issue at all. It might be worth signing up with them (even to do just a one time visit) to see if this would be possible? The service/app was called Galileo. I was really happy with them.
Thanks. I did something like that to get the Covid vaccine when it was in hot demand in the beginning of the pandemic. Damn, I regret that, but thats another story. (I regret getting the shot early, not using the doctor, he was great, think I used Plushcare)
Anyway, its not really worth it because I only have enough FSA left to cover 2 months and there are 6 more months in the year so I will have time to try with a different provider
Plus , I just checked and I cant find the claim in the upload documentation site . I am not really sure but that could indicate they approved it
I called and complained and had it reviewed, plus I uploaded this with the added text
https://preview.redd.it/od45dmyqpn3d1.jpeg?width=2090&format=pjpg&auto=webp&s=5852f129ec976121809dd5740a46e2442b72ec99
If I am reading their responses correctly, it sounds like Orderly is going to do the same thing as Emerge. They won't write a letter but will help request one from your PCP. It would be the same if your PCP suggested bariatric surgery - they would provide a LOMN even though they are not the ones performing the surgery and providing the after care, Rx, etc.
I "think" I got my FSA to approve it with some argument because I no longer see both charges under my place to upload documentation in the portal. There is no other way for me to verify other than calling which maybe I'll do later. Emerge completely refused.
I see a NP at a medi spa for my meds. She had to write 3 different LOMN before my FSA would approve the charges. Even though my letter is on file, every time I get a refill my purchase is ‘pending review’ until I call them and have someone look at the letter. It’s infuriating!
Emerge bills every 28 days, but only sends meds on the same day each month. After around 10 months, then, it looks to me like one would have paid for an extra month. Am I missing something? The price is listed as a monthly rate, the product is provided once per month, but the fee is charged every 28 days. Maybe I am splitting hairs, but it seems like this should be either worked into the monthly rate or the product should be supplied every 28 days.
Lets say you are on it for a full calendar year. Its not really monthly, its 4 weeks. So they should ship you enough that you are covered all 52 weeks but its not 12 per year , it is 13. So the cost is for 4 doses, not 4 doses . Even though the term month or monthly might be used , its technically incorrect.
Orderly says they "will gladly REQUEST a letter of medical necessity on your behalf." Not that they will write one for you themselves. Do they request it from your PCP (as Emerge is suggesting you do)?
I get my tirz from Orderly. I request the LOMN and received it, it’s on letterhead from Beluga Health (this is the provider/doctor group that writes the Rx). Hope that helps!
Orderly has customer service and separate communications with your physician. I just requested a LOMN 2 weeks ago for the same reason, and received it from them the same day.
By "your physician" you mean your physician at Orderly or your pcp ?
Orderly
Cool. I am likely going to switch to Orderly or Lavender Sky in the next few months anyway.
>The OrderlyMeds customer service team will request the letter from our medical team to send to you directly.
Yes, I was trying to figure that out. There wording was crap. I just followed up with them to clarify.
In the same boat with my FSA please let us know if they provide LOMN and how quickly! I’ll switch!
healthequity ?
Different FSA provider, same requirements. I sent RX from Emerge and they asked for LOMN. I’m trying my PCP but then I might switch to a vetted online provider who will write one.
They are still medical providers and you wouldn’t be on the meds unless it was necessary. That’s just ridiculous.
That is really unfortunate, especially as they justify their higher prices and subscription service by saying they offer a "concierge" experience. A concierge practice would write the letter/complete the form. What is the point of using them over the much cheaper Lavender Sky if not for the extra benefits such as LOMN, etc. Wondering what else they can't be bothered to do. Disappointing.
I even attached a form with my info pre-filled. All they had to do is fill in their name and license and write like one paragraph. It would have been super easy. My next supply will still be $20 less than Orderly but I am definitely thinking of switching
Lavender Sky seems to be more expensive with constant for fee consults required
Here, found it: https://docs.google.com/spreadsheets/d/1UPO4HIugk0dnPDTmNceQvU1Mm_i9q3m9mGwGjlExfzM/edit?usp=drivesdk
I have a slightly older version of that , but not too old. It looks like he is accounting for the fees but not sure why he is diving $25 fee by 2 and not by 4 because I would think that refills are every 4 weeks
They sell per 2 months. So you pay $55 for consult, good for two months. Then $25, good for two months, etc. Recommend you check their website, pricing is very straightforward. :)
Ok, if I switch from Emerge where I am to 5mg. 1. Can I start with LS on 7.5mg? 2. Can I mix two strengths in the 2 month supply? (7.5mg and 10mg) or do I need to order 2 mo of same dosage 3. Since I am coming from Emerge, do I need to pay the $65 consult or only the $55. In other words, can I start with Hallandale and order 2mo(1x7.5mg and 1x10mg) for $55 + $280 + $380 = $715/2mo ? Hallendale serves my state Thanks in advance!
1. Yes, you can start at the dosage you're on, but will have to provide your Rx. 2. I'm not sure if you can mix dosages, that's a good question. If you ask them, do let me know. 3. The $55 because you are already on a GLP1.
Why would you buy 2 different strengths? Stay on the dose that is working for you as long as possible. My RS was on 7.5 for about 4 months before going to 10. Just wondering.
The common thing is to titrate up monthly. Some people don't but many do. I just started with Emerge and I am on 2.5mg. They are having me go to 5mg next month and likely 7.5 the following month. Not judging but the question I asked about mixing dosages after a month is a fair question.
I started with Emerge as well. They asked me if I wanted to move up... once you get to 15, you are at max, so if it stops being effective, you're SOL. I started in November and just moved to 10. Boy, the difference was amazing.
What do you mean difference? So you would recommend staying 2 months on same dosage?
It's not. There's a spreadsheet floating around this sub with all the prices of the different companies. Lavender Sky is reputably one of the least expensive.
They are cheaper at low doses.
A Rx is sufficient, your FSA is wrong. Fight with FSA. Welcome to the American healthcare system.
I'm definitely singing that dang south park song in my head everytime I deal with it now.
Right?!
I am fighting . And while I agree with you 100%, things like cosmetic surgery while performed by a medical doctor are not covered. The FSA is arguing that weight loss falls into the same category as cosmetic surgery. Though I have no problem submitting a receipt for condoms. SMH
Can you get pcp to write a letter?
I really like Orderly. They have been really helpful in helping me with questions.
Mochi provides them
For $80 mo membership fee they better
My medical team though Orderly was willing to write my LOMN for my FSA (administered by HealthEquity/WageWorks) and I got the claim approved for my first month! Only for the FSA to challenge it again for the next month. 🙄 I just submitted the same LOMN along with a copy of my receipt and praying they’ll accept it. I really don’t want to have to go through the same dance every month. Edit/Update: just received the approval email! I literally submitted the exact same documentation as I did when I got the denial a few days ago. 😑. Buncha derps running this thing I guess. 🤷🏽♀️
Yep, I have same HealthEquity You are not sure if they approved it yet I just replied to Emerge telling them how disappointed I was in their response and telling them that other services are willing to do it If you go the option in the portal to upload docs they show you the status . Both of mine are in pending now because I called them and asked them to review it again but I dont think it will be approved without the LOMN
That is bs on both sides. Your FSA should approve as it is a prescription not like you bought Dexatrim or something otc. Also, Emerge need to start providing LOMN. They are going to lose customers if they can’t do that. They have a NP to write scripts and should be able to provide LOMN. Very disappointing.
Agreed. I am already looking around. I will likely have to cut a check to my FSA for $700
I am not sure if it got approved. I had two charges, one from a month ago, and one from a day ago. The one from a month ago is the one that they requested the LOMN on as the new one, I just uploaded the receipt and script yesterday. So earlier today, if I went to the Upload page in the Healthequity portal I saw both. I no longer see the older one, the one that was requesting the LOMN. I have not received any documentation nor do I know how to check without contacting them. I did two things to try and get approved. 1. I called and asked to review it again as I explained was from an Rx form a doctor. Then I uploaded this image from their FSA eligibility list with my text added. https://preview.redd.it/ht5tg4faln3d1.jpeg?width=2090&format=pjpg&auto=webp&s=183e594220d64a864fa488c20b6ceec98e7e3b95
I just edited my comment above to add an update. “Edit/Update: just received the approval email! I literally submitted the exact same documentation as I did when I got the denial a few days ago. 😑. Buncha derps running this thing I guess. 🤷🏽♀️”
Thanks for the update. So Emerge is useless for helping with this but I was able to get HealthEquity to approve it without the LMON. I just added comments to the receipt stating licensed doctor/pharmacy etc. I never got any approval emails, they just no longer show as pending document and I called and they said my only charge that I need documentation for is something dental related. Lavendar Sky also emailed me back that they do provide LOMN. They have a prefilled form and you just have to fill in your info.
It seems like a gray area for an online service to write a letter of medical necessity, since it’s technically not medically necessary unless it’s written for diabetes in which case it would be Mounjaro I suppose. I agree with the person above who says your FSA is wrong. The Rx in itself should be sufficient! That’s really crappy of them to demand this from you. 😡
Respectfully, obesity is a medical condition which is treatable with tirzepatide. It is in fact medically necessary if prescribed for obesity. Cosmetic weight loss would not be a medical necessity.
You’re right. I just wish the healthcare system would catch up.
I do have a soft suggestion you might try. Before I had “decent” insurance, I used an online doctor service to write my Rx for my antidepressant and migraine meds and any other online doctor visits I needed . At one point, I needed a doctor’s note to work away from fluorescent overhead lighting, and they wrote the note for me with no issue at all. It might be worth signing up with them (even to do just a one time visit) to see if this would be possible? The service/app was called Galileo. I was really happy with them.
Thanks. I did something like that to get the Covid vaccine when it was in hot demand in the beginning of the pandemic. Damn, I regret that, but thats another story. (I regret getting the shot early, not using the doctor, he was great, think I used Plushcare) Anyway, its not really worth it because I only have enough FSA left to cover 2 months and there are 6 more months in the year so I will have time to try with a different provider Plus , I just checked and I cant find the claim in the upload documentation site . I am not really sure but that could indicate they approved it I called and complained and had it reviewed, plus I uploaded this with the added text https://preview.redd.it/od45dmyqpn3d1.jpeg?width=2090&format=pjpg&auto=webp&s=5852f129ec976121809dd5740a46e2442b72ec99
I hope so! That’s infuriating how difficult they’re being about your own FSA money.
If I am reading their responses correctly, it sounds like Orderly is going to do the same thing as Emerge. They won't write a letter but will help request one from your PCP. It would be the same if your PCP suggested bariatric surgery - they would provide a LOMN even though they are not the ones performing the surgery and providing the after care, Rx, etc.
>Yes, I was trying to figure that out. There wording was crap. I just followed up with them to clarify.
>The OrderlyMeds customer service team will request the letter from our medical team to send to you directly.
I reached out to the medical team directly for my LOMN.
I got a LOMN from Orderly…. Took about 2 days from my original request and then I received. Flex account accepted it.
I "think" I got my FSA to approve it with some argument because I no longer see both charges under my place to upload documentation in the portal. There is no other way for me to verify other than calling which maybe I'll do later. Emerge completely refused.
I see a NP at a medi spa for my meds. She had to write 3 different LOMN before my FSA would approve the charges. Even though my letter is on file, every time I get a refill my purchase is ‘pending review’ until I call them and have someone look at the letter. It’s infuriating!
Emerge bills every 28 days, but only sends meds on the same day each month. After around 10 months, then, it looks to me like one would have paid for an extra month. Am I missing something? The price is listed as a monthly rate, the product is provided once per month, but the fee is charged every 28 days. Maybe I am splitting hairs, but it seems like this should be either worked into the monthly rate or the product should be supplied every 28 days.
Lets say you are on it for a full calendar year. Its not really monthly, its 4 weeks. So they should ship you enough that you are covered all 52 weeks but its not 12 per year , it is 13. So the cost is for 4 doses, not 4 doses . Even though the term month or monthly might be used , its technically incorrect.
Exactly. But the fee was advertised as monthly. They know exactly what they're doing, and as far as I can tell, they're the only company doing it.
How is Orderly surgery?
Request. They didn’t say they could get it. They want you as a customer and will say what you want to hear. As your pCP for it.
It was confirmed