I moved to the US in September for work and I’m struggling to understand the healthcare system here. My company provides Cigna insurance with an HDHP plan called Open Access Plus. I’m aware that each employer customizes these plans, so what I have may differ from others.
I have high blood pressure and am at risk of diabetes. Before moving, my doctor in Mexico was about to start me on Ozempic to help manage my weight and prevent diabetes, but I left before starting treatment. I still have all my medical records, including tests like ECGs, ultrasounds, and bloodwork.
What steps should I take to start this process in the US? Should I look for a primary care physician (PCP), or is there a more direct approach? I’d prefer to handle everything here since I’m living in the US now, but I feel completely lost. Any advice would be greatly appreciated.
Call Cigna and ask for a list of in-network Primary Care Physicians (PCPs) in your area who are accepting new patients. Schedule an appointment, bring your medical records, and explain your situation. The PCP can guide you on next steps, including referrals to specialists if needed. You can change your PCP later if you’re not satisfied, but starting with one is crucial.
You’re on the right track. Start by calling your insurance company to confirm what’s covered under your plan and to find in-network doctors. Establishing care with a PCP is a good first step since they can help coordinate your care and provide referrals if needed. Be sure to confirm in-network status for any specialists or facilities they recommend. For prescriptions like Ozempic, your doctor may need to submit a prior authorization to your insurance.
With a high-deductible health plan (HDHP), many weight-loss medications aren’t covered unless there’s a diabetes diagnosis. Since you’re not technically diabetic, you may need to explore out-of-pocket options through services like HERS or Weight Watchers’ medical programs. These can sometimes be more affordable than going through insurance.
I’ve had Cigna Open Access Plus for years and have found it to have a wide network. Your biggest challenge might be getting coverage for medications like Ozempic unless you meet specific criteria. Still, starting with a PCP to build your medical history in the US is a solid move.
Insurance in the US rarely covers Ozempic for non-diabetic patients. If your insurance denies it, look into compounded medications through online or local clinics. These can be significantly cheaper and don’t require insurance approval.
Cigna’s Open Access Plus plan is generally good for access, but the pharmacy benefits (handled by CVS Caremark) will determine what’s covered. You’ll likely need your doctor to submit a prior authorization for Ozempic, and even then, approval might depend on strict criteria.