This refers to the unique combination of specialty training that your physician has in both Internal medicine and Pediatrics. Doctors Womble, Outlaw, and Capps are board-certified in both specialties. Essentially, this means that you have the advantages of two doctors in one— a physician who provides in-depth, comprehensive care for patients of all ages.

Q1: What are GLP-1 medications?

A: GLP-1 medications are drugs that can help manage diabetes (like Mounjaro) or support weight loss (like Wegovy). They work by helping control blood sugar and, in some cases, appetite.

Q2: Does insurance cover GLP-1 medications?

A: Coverage depends on your diagnosis and insurance plan:

• Diabetes: Most insurance plans cover GLP-1 medications.
• Weight Loss: Coverage is less consistent. Approval may depend on factors such as obesity, moderate or severe sleep apnea, prediabetes, or heart disease risk factors.

Q3: How do I know if my plan covers GLP-1 for weight loss?

A: Check your insurance policy carefully. Ask:

• Does my plan cover GLP-1 therapy for weight loss?
• Is prior authorization required? If yes, what are the requirements?
• Is weight loss an "excluded benefit" under my plan? If so, this medication will not be covered.
• Do I need to use a specific pharmacy?
• Does my preferred pharmacy have the medication in stock?

Q4: What should I do once I confirm coverage?

A: Schedule an appointment with your provider through our front desk. During your visit, your provider will:

• Discuss how to take the medication
• Outline appropriate follow-up steps

Q5: Can the office submit a prior authorization?

A: We cannot submit prior authorizations until you have:

• Confirmed coverage with your insurance
• Discussed the medication with your provider

Note: We cannot process prior authorizations until this has been completed and discussed with your provider. Generally, if a medication requires prior authorization and is not covered or excluded, we will not submit an appeal.

Q6: What is a Prior Authorization, and what is the process?

A prior authorization (PA) is a requirement from your insurance company that your healthcare provider get approval before the insurance will pay all or a portion for a specific medication, test, or procedure.

 The PA Process

• Your provider will send your medication to your pharmacy for processing. Once they run the prescription through your insurance, they will notify the Pharmacist if it needs prior authorization. 
•  The pharmacy will send our office a prior authorization request notice, and we will submit a PA request to your insurance company, including your medical history and reasons for the prescription.
•  The insurance company will review the request, which can take a few days to weeks, depending on the insurance. 
•  Insurance will either approve or deny the medication.

          - If Approved: You can pick up your medication at the pharmacy.

          - If Denied: We will inform you and discuss alternative options.

Q7: How do I stay on my GLP-1 medication once insurance approves it?

A. Most insurance plans only approve GLP-1 medications for a set time (usually 3–6 months). To keep coverage, your provider will need to renew the authorization before it expires. Each dose increase may require a prior authorization, depending on the insurance carrier

Insurance may ask for:

• Proof it’s working – For example, improved A1C if you have diabetes or weight loss if you’re using it for weight management.
• Updated information – Recent weight, BMI, or lab results.
• Safety check – Confirmation that you’re tolerating the medication without serious side effects.
• Healthy lifestyle efforts – Some plans require proof that you’re continuing diet, exercise, or a structured weight program.

Every plan is different, so it’s important to keep follow-up appointments and complete lab work on time to avoid a gap in coverage.