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Insurance & Prior Authorization

Insurance & Prior Authorization · Michigan

Insurance Accepted at
Michigan Weight Loss Institute

Led by Dr. Rita Kathawa, M.D. — Double Board-Certified Physician in Obesity Medicine & Internal Medicine

Michigan Weight Loss Institute accepts many Medicaid, Medicare, and commercial insurance plans for eligible medical visits. Our team also helps patients navigate prior authorization requirements for covered medications, testing, and obesity medicine services.

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20+
Insurance Plans Accepted
10k+
Patients Treated
2
Convenient Michigan Locations
1
Dedicated PA Specialist on Staff
Double Board-Certified Physician & PA-C Insurance Verification Included Prior Authorization Support Sterling Heights & Bingham Farms
Insurance Coverage

Insurance Help for Physician-Supervised Weight Loss Care

At Michigan Weight Loss Institute, obesity medicine is medical care. Many patients come to us with weight-related health conditions such as type 2 diabetes, hypertension, sleep apnea, or joint disease that may make their visits eligible for insurance coverage.

Led by Dr. Rita Kathawa, M.D., our team helps you understand what your plan may cover before you begin treatment. First, we review your benefits and referral requirements. Then, when appropriate, we handle prior authorization requests for medications and medication benefits so you can begin care with clearer expectations.

What We Can Help With
  • Insurance plan review before scheduling
  • Referral guidance when required
  • Prior authorization documentation
  • Denial reviews and appeal support
  • Coordination with your primary care provider
  • Medication benefit verification
Plans We Accept

Insurance Plans We Accept

Michigan Weight Loss Institute accepts the following insurance plans for eligible medical services. Please call our office to confirm your current benefits, referral requirements, and plan-specific coverage before your visit.

Medicaid Plans
  • Straight Medicaid
  • Meridian Health Plan of Michigan
  • Blue Cross Complete of Michigan
  • Molina Healthcare of Michigan
  • HAP Midwest Health Plan
  • United Healthcare Community Plan
  • Aetna Better Health of Michigan
Commercial, Medicare & Medicare Advantage
  • UnitedHealthcare
  • Blue Cross Blue Shield of Michigan (BCBSM)
  • Blue Care Network (BCN)
  • Priority Health & Priority Health Medicare
  • Wellcare Medicare
  • Medicare A/B
  • ASR
Blue Care Network patients: BCN plans may require a Global Referral before specialty care is covered. Please contact your primary care provider for a referral before scheduling.
How It Works

The Prior Authorization Process, Step by Step

1
Medical Evaluation
Your provider reviews your health history, current weight, BMI, weight-related diagnoses, medications tried, and lifestyle history.
2
Insurance Review
Our team reviews what your plan may require — chart notes, diagnosis codes, lab results, medication history, and clinical criteria.
3
Submission
When clinically appropriate, we submit the prior authorization request with the documentation requested by your insurance plan.
4
Insurance Decision
Your insurance company reviews the request and issues an approval, denial, or request for more information. This typically takes 3–14 business days.
5
Next Steps
If approved, your care plan moves forward. If denied, we can review the denial and discuss whether additional documentation or an appeal is appropriate.
Nicole LaFave, Prior Authorization Specialist at Michigan Weight Loss Institute
Dedicated Support

Meet Nicole

Medical Assistant · Prior Authorization Specialist

Nicole is Michigan Weight Loss Institute’s dedicated prior authorization specialist. She works directly with insurance companies to pursue coverage approvals for GLP-1 medications, weight loss treatments, and related diagnostic testing.

For each request, she manages the documentation, submission, and follow-up process so patients can focus on their health, not paperwork. In addition, she coordinates with our clinical team, led by Dr. Rita Kathawa, M.D., to help submissions meet current payer criteria and clinical guidelines.

If your medication or service requires prior authorization, Nicole will guide you through each step and keep you informed of decisions or next steps along the way. As a result, the process feels more organized and less burdensome.

Medication Coverage

GLP-1 Medication Coverage: Wegovy, Zepbound, Ozempic, and Mounjaro

Coverage for GLP-1 medications can be complicated. However, understanding how each drug is classified can make the process easier. Some plans cover FDA-approved weight loss medications like Wegovy or Zepbound with prior authorization. Other plans exclude weight loss medications entirely, even when a patient meets clinical criteria. Meanwhile, diabetes medications like Ozempic and Mounjaro may be covered separately under pharmacy benefits when a qualifying diagnosis is present.

Medication examples and coverage notes

Wegovy®

Semaglutide · FDA-Approved for Weight Loss
Wegovy is FDA-approved for chronic weight management. For many plans, coverage requires prior authorization with documented BMI criteria and comorbidities. Not all commercial or Medicaid plans include this medication in their formulary.

Zepbound®

Tirzepatide · FDA-Approved for Weight Loss
Zepbound (tirzepatide) is FDA-approved for weight management. Eligibility varies by plan and generally requires prior authorization. However, plans that cover Mounjaro for diabetes may not yet cover Zepbound for obesity.

Ozempic®

Semaglutide · FDA-Approved for Type 2 Diabetes
Ozempic is FDA-approved for type 2 diabetes management. It may be covered under pharmacy benefits when a qualifying diabetes diagnosis is documented. Off-label use for weight loss is generally not covered by insurance.

Mounjaro®

Tirzepatide · FDA-Approved for Type 2 Diabetes
Mounjaro is FDA-approved for type 2 diabetes. In most cases, coverage is available when a diabetes diagnosis is documented. Like Ozempic, off-label use for weight loss alone may not be covered, but each plan varies.
Be Prepared

What to Have Ready Before We Check Your Benefits

To help our team review your insurance and prior authorization options efficiently, please have the following ready when you contact us or come in for your appointment:

Your insurance card
Your photo ID
Your pharmacy benefit card, if separate
Your primary care provider name, if referral is required
A current medication list
Recent lab results, if available
Any prior authorization reference numbers from other providers
Your member ID number from your insurance card
Common Questions

Frequently Asked Questions

Does insurance cover medical weight loss visits?

Many insurance plans cover office visits for obesity medicine when there is a documented medical diagnosis such as obesity, type 2 diabetes, hypertension, or sleep apnea. Because each policy is different, coverage varies significantly by plan. Our team will verify your specific benefits before your first visit.

Does insurance cover Wegovy or Zepbound?

For example, some commercial insurance plans cover Wegovy and Zepbound for weight management with prior authorization. However, many plans still exclude these medications entirely. Medicaid coverage also varies by state and managed care plan. Then, we will check your specific plan and guide you through the process.

Do you guarantee prior authorization approval?

No. Prior authorization decisions are made by your insurance company, not by our office. Although approval is not guaranteed, we can help you compile the strongest possible documentation and submit the request correctly. When a request is denied, we can help you understand your options for appeal.

How long does prior authorization take?

Most insurance companies respond to prior authorization requests within 3 to 14 business days, though urgent requests may be processed faster. The timeline depends on your specific plan and whether additional documentation is required.

What if my medication is denied?

When your prior authorization is denied, we will review the denial letter with you and discuss whether an appeal is appropriate. In some cases, an alternative medication or additional documentation can support a successful appeal. Finally, we will explain all available options so you can make an informed decision.

Do I need a referral?

It depends on your insurance plan. In addition, some plans, particularly HMOs like Blue Care Network, require a referral from your primary care provider before seeing a specialist. Before your first visit, we recommend calling the member services number on the back of your insurance card to confirm your requirements.

Can you check my insurance before I schedule?

Yes. We can verify your insurance benefits before your first appointment. Please call our office or submit a consultation request online and our team will review your plan and let you know what to expect before you come in.

Ready to Check Your Insurance Coverage?

First, our team will verify your benefits and explain what your plan covers. Then, we will guide you through every step of the prior authorization process. Let us handle the paperwork so you can focus on your health.

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