Obesity is a medical condition that elevates the risk of serious health problems. PlushCare offers a telehealth platform with weight loss programs as part of its healthcare services, alongside mental health support and prescription refills. This article delves into the specifics of PlushCare's weight loss program, its components, costs, and potential benefits, providing a comprehensive overview for those considering this option.
Understanding PlushCare
PlushCare is a membership-based telehealth platform designed to provide convenient healthcare services. It offers access to board-certified doctors and therapists for various needs, including weight management. The platform aims to deliver accessible and comprehensive care through online consultations, prescription services, and ongoing support.
Initial Impressions and Sign-Up Process
Setting up an account with PlushCare begins with a user-friendly home page that is calming, clean, and uncluttered. The platform readily indicates that it accepts insurance. Appointments are prominently featured to encourage users to start an account.
While the home page is straightforward, some users may find the tabs too general. For instance, there's no dropdown menu for the types of online prescriptions offered, which can be intimidating for those hesitant about online prescriptions. PlushCare does provide a list of health conditions it treats further down the home page.
Transparency in Pricing
PlushCare offers transparent pricing information throughout its platform. However, specific medication costs are not always clear. The closest indication of product pricing can be found in the FAQ section on each condition page, which includes the question, "How much does this medication typically cost?"
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Weight Loss Program Details
PlushCare’s weight loss program is designed to help individuals achieve and maintain a healthy weight through a combination of lifestyle modifications, medication (if appropriate), and ongoing support from healthcare professionals.
Qualification for Medication
If you have type 2 diabetes, a BMI of 30, or a BMI of 27 with one weight-related medical condition, you may be a candidate for medications such as Wegovy®, Saxenda®, Topiramate, Wellbutrin, or Contrave® for weight loss, or diabetes medications such as Ozempic® and Mounjaro®. However, PlushCare does not treat patients with symptoms of an active eating disorder with weight loss medication, including bulimia nervosa, anorexia nervosa, or binge eating disorder.
Weight loss should begin with healthy lifestyle modifications, including incorporating a healthy diet and regular exercise plan. Weight loss medication is not necessarily for everyone. Book a visit with one of our board-certified doctors to determine the optimal weight management plan for your specific needs. This plan may or may not include medication.
The Role of Semaglutide
Semaglutide, the active ingredient in Ozempic® and Wegovy®, is a key component in some PlushCare weight loss programs. Compounded semaglutide, an exact copy authorized for production by certain pharmacies during national shortages of brand-name medicines, may be prescribed. PlushCare ensures that its preferred compounding pharmacy produces an exact molecular copy of the semaglutide base, verified for authenticity and potency by an outside lab. It is important to note that the compounded semaglutide is not a salt form of semaglutide. Compounded semaglutide is only available as an alternative to branded Ozempic® and Wegovy® as long as it remains on the FDA drug shortages list.
Labs and Evaluations
Your doctor will order labs for you before prescribing semaglutide to determine if semaglutide is an appropriate medication for you. These labs typically include an obesity lab panel, which measures CBC (blood count), CMP (metabolic function), lipids (cholesterol levels), A1C (diabetes), TSH (thyroid function), and insulin.
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Treatment Approach
The best method for weight management incorporates lifestyle modifications that are sustainable long term. Medication can help manage weight effectively, but only when combined with a healthy diet and exercise. After losing weight, you will need to continue many of the diet and lifestyle modifications you initially made to lose the weight, to keep the weight off. You can expect to lose about 5-10% of your weight over a 6 month time period, or at a rate of up to 1-2 pounds per week.
Doctor Consultations and Prescriptions
PlushCare’s board-certified doctors can prescribe weight loss medications after an initial online consultation and necessary lab evaluations. After testing, your doctor will discuss the best medication options for you. If your telehealth or local doctor prescribes the medication, you can have it sent to the local pharmacy of your choice.
Prior Authorization
Most branded weight loss medications require a prior authorization in order for insurance to cover the cost. Your PlushCare physician and care team will reach out to your insurer on your behalf, and this process can take several business days.
Importance of Lifestyle Changes
Medical weight loss programs are effective because they incorporate dietary and lifestyle changes in addition to effective medication, under supervision of a board-certified doctor. Weight loss medications are most effective when part of a holistic treatment plan, including long term lifestyle changes. When weight loss medications are stopped, many people gain the weight back. Drugs like Wegovy® and Ozempic® lower a person's appetite to help with weight loss, but experts suggest that once people stop taking these drugs, they can experience weight gain. The rates of weight gain after stopping Wegovy® vary depending on the individual, and available data suggests that with some individuals, weight gain will come back earlier, and with others, it may come later.
It's important to note that getting a Wegovy® or Ozempic® (semaglutide) prescription online without proper advice from your doctor can pose risks.
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Insurance and Cost Considerations
PlushCare is in network with most major insurance providers. However, it is important to know that not every insurance plan will cover the cost of medications. Prior to seeing your medical provider, we recommend checking your plan’s benefits to see if weight loss medicine is covered, and if so, for what particular diagnoses. Most branded weight loss medications require prior authorization in order for insurance to cover the cost. Your doctor and care team can reach out to your insurer on your behalf, which can take several business days.
Prices vary depending on the medication type, and whether or not you use insurance to pay for it. Most branded weight loss medications require prior authorization in order for insurance to cover the cost. We recommend checking with your insurance to see if these weight loss medications are covered as they usually cost about $1000 per month out of pocket.
Navigating Insurance Coverage
During your second weight loss visit, you will be asked for your insurance information. This includes your insurance RX number, BIN number, PCN number, insurance identification number, and your address listed with your insurance provider. This information is often listed on your insurance card. Our information will need to match your insurance provider’s information. If the information does not match their records, there may be delays in processing your prior authorization. If we need more information, we will reach out to you for clarification. If applicable, please list the other medications you previously tried for your specific condition. You will want to list the dates you took these medications and why these medications did not work for you.
Our prior authorization process starts automatically once your doctor prescribes medications to treat weight loss or type 2 diabetes. It usually takes 3-7 business days for our team to compile the necessary information to submit your PA, but this can vary. Your insurance will now review the documentation provided and issue a determination. The insurance processing times vary; the average is 7-14 days. We’ll notify you once we receive an outcome. Sometimes your insurance will send you an PA outcome without sending it to us. If you receive a PA outcome and have not heard from us, please send a photo of your letter to us. If you have any questions during this time, you can reach the Prior Authorizations team directly by responding to the message titled “PRIOR AUTH SUBMISSION”. You can also contact your pharmacy benefit plan directly. If you contact your plan, please call your pharmacy benefit manager (PBM) as they will handle the prior authorization for your prescription and not your medical insurance network. The contact information for your PBM should be on your insurance card but may be on a separate card- common PBMs are ExpressScripts, CVS Caremark, and OptumRx. On average, prior authorizations can take 7-14 business days to process, however, decision times vary based on your insurance provider and other factors. We check for updates from your insurance company every 7 days. Knowing what your insurance plan covers will help you decide on a treatment plan with your doctor.
Addressing High Medication Costs
Contact your insurance about other weight loss medications: If your medication is not covered, we advise that you contact your insurance to verify what medications are covered, including details on dosages and if coverage is only for patients with specific diagnoses. Once you know what medications are covered by your plan, book a follow-up with your provider to discuss an alternate medication. As always, prescriptions are up to your doctor’s discretion. Please contact us if you need assistance. Try a cash pay medication: Some medications are not covered by insurance, but may be cheaper overall. If you are interested in exploring one of these options, please book an appointment to discuss with your doctor.
If you’ve been prescribed an injectable medication for weight loss or type 2 diabetes, our team will automatically start compiling the necessary information. This usually takes 3-7 business days but can vary. Your insurance will now review the documentation provided and issue a determination. On average, prior authorizations can take 7-14 business days to process, however, processing times vary. We’ll notify you once we receive an outcome. Sometimes your insurance will send you a PA determination without sending it to us. If you receive a PA determination and have not heard from us, please send a photo of your letter to us. If you have any questions during this time, you can reach the Prior Authorizations team directly by responding to the message titled “PRIOR AUTH SUBMISSION” or contact your pharmacy benefit plan directly. Please make sure you call your pharmacy benefit manager (PBM) as they are responsible for managing the prior authorization for your prescription, rather than your medical insurance network. Please make sure you called your pharmacy benefit manager (PBM) as they will handle the prior authorization for your prescription and not your insurance network.
Membership Plans
PlushCare currently offers two types of membership plans: annual and monthly. Both will give you the same membership benefits! Your membership starts when you first book an appointment with us. After your 30-day free trial, the card on your profile will be charged. Your membership continues until canceled. You may cancel anytime if you do not wish to pay for a membership.
Paying with Insurance
This visit, when paying with insurance, varies depending upon your plan. How is the cost estimated? The estimate is calculated in good faith based on the information known at the time the estimate was created. This amount is an estimate only and in no way a quote or guarantee of the amount you will owe or what the charges for the service will be. Your final cost(s) could be higher or lower. We try our best to give you an accurate estimate. However, many factors include the final cost, like services performed and your unique insurance benefits (deductible, copay, coinsurance, out-of-pocket maxes, and network coverage). Benefits and eligibility are subject to change and are not a guarantee of payment.
Therapy Pricing
PlushCare therapy appointments are $169 for each appointment and are FSA/ HSA eligible. The membership fee allows us to offer you the innovative digital health tools and value-added services that make PlushCare unique. proprietary technology platform, including but not limited to benefits such as online appointment booking, online prescription renewal requests, free online messaging with your care team, online care coordination services, and more. The membership fee also covers costs associated with high-touch and value-added non-medical services, including lifestyle and wellness offerings and value-added personal assistance services. Payment of the membership fee is not a prerequisite for receiving medical care.
Other Services
Our doctors can provide either a refill or initiation on most medications except for controlled substances. Please discuss your need for a work note with your PlushCare physician at the time of the appointment. Not all back-dated notes (notes requested after the fact) may be completed, please speak with your provider for details. In some instances, PlushCare can provide more substantial documents like FMLA forms, Disability forms, or Handicap/DMV card documents. These evaluations require more than one appointment before completing the forms. Our doctors need learn more about your condition, review any prior medical records, and offer any treatment options available. Sometimes, additional tests or an in-person evaluation may be necessary. Want to learn more about online doctor's notes? If that does not work and your doctor is still not on the call, please call us immediately at 1(855) 913-0255. Please note that not all issues can be treated best by telehealth, and your doctor may let you know that an in-person visit is necessary instead.
Each adult family member will get a private account with access to all the same features-including same-day bookings and prescriptions and unlimited in-app messaging-so they can get complete, convenient care whenever needed. Family members pay no extra charges for membership as long as the principal account holder remains a member of PlushCare. Each adult account is independent and private, so it will not be visible to anyone other than the account owner.
No-Show and Cancellation Policies
Patients who cannot attend their appointment must cancel or reschedule or contact PlushCare support to cancel or reschedule the appointment. If the patient does not show up for their appointment, it is considered a no-show, and the patient will be charged a $75 no-show fee. In some cases, PlushCare may need to cancel or reschedule an appointment to ensure patients get the appropriate care they need.
Payment Options
You do not have to use health insurance to pay for a PlushCare visit. If you have health insurance from a payer we accept, we will charge you an estimated visit price at the time of booking. After your visit, we will file a claim with your insurance. Typically we receive a response within 4 weeks and at that point, we will let you know whether you owe more or less. You can pay for your visits using a credit card, debit card, or your HSA/FSA funds.
Labs and Weight Management
First, a screening calculation called the body mass index (BMI) will be done by your doctor to determine if your weight may put you at risk for other diseases. It is important to understand that the BMI is only a screening tool, and an approximation of risk. For example, even if your BMI falls in what is known as the healthy range, it is still possible for you to be affected by weight-related metabolic disease. This is why your doctor will also use lab tests and perhaps even other measurements to guide your weight management treatment plan.
Labs are used to check certain items that pinpoint possible sources of weight gain. Checking labs will screen for underlying conditions, and can help determine if weight loss medications can be used safely. Labs can also determine what type of medication and lifestyle change may work best for your body. Blood tests which are typically done measure general blood chemistry, liver and kidney function, blood count, insulin sensitivity, thyroid hormone levels, and cholesterol. Other tests that are done for managing weight loss treatment include your blood pressure and pulse measurements. Carrying excess weight can increase your risk for high blood pressure and heart problems.
Because weight regulation is complex, there is no one blood test to check your metabolism. Blood tests are checked to determine if there may be imbalances that can contribute to a slower metabolism. Thyroid hormone is also generally checked, especially the TSH (thyroid stimulating hormone). The TSH is the master regulator of the entire thyroid system. Low thyroid hormone levels can contribute to small amounts of weight gain over time. However, when the TSH level is abnormal, this is more likely to be a result of the weight gain than a cause. If you're experiencing unexplained weight gain and fatigue, it's important to get lab tests that assess your thyroid function, vitamin D levels, blood sugar, and hormone balance. Common tests include TSH (for thyroid), A1C and fasting glucose (for blood sugar), and a comprehensive metabolic panel.
On average, labs should be done after your initial visit with your doctor, and then at least once a year for weight management. Depending on your initial results though, and your treatment plan and care goals, your doctor may order labs more frequently. Labs for weight loss management are affordable. Labs for weight loss are considered to be prevention medicine, which is generally covered by health insurance plans. If you are concerned about your weight or wish to discuss your body mass index, talk with one of our trusted doctors to get an order for lab tests. Labs can highlight important information that is used to guide weight loss treatment plans.
Membership Benefits
PlushCare offers a membership model with two options:
- Monthly: \$19.99 per month
- Annual: \$99 per year
Both memberships include:
- Same-day appointments
- Prescription discount cards
- Discounted lab referrals
- Ongoing, in-app messaging with a care team
- Wellness check-ins
A 30-day free trial is available upon signing up, and members can cancel anytime. Without a membership, scheduling appointments requires a phone call. The membership fee covers the platform's services, technology, wellness offerings, and support.
Family Plan
PlushCare memberships can be shared with up to five adult family members at no extra cost. Each family member has their own private account and is responsible for their own visit and copay fees.
Cost and Insurance
PlushCare accepts most insurance plans, with users typically only paying the copay and membership fee (which is not covered by insurance). Without insurance, the cost is \$129 per appointment plus the membership fee. Online therapy appointments are \$169 each, in addition to the membership fee. PlushCare currently does not accept Medicare or Medicaid but does accept HSA and FSA payments.
Refund Policy
PlushCare offers a full refund for the appointment cost (excluding the membership fee) but does not accept returns of prescriptions.
Reviews and Ratings
PlushCare has a B rating from the Better Business Bureau (BBB) with 369 complaints and a 2.09 out of 5-star customer rating. On the Google Play store, it has 4.7 stars based on 7,130 reviews, with positive feedback on care and wait times but some reports of technical issues and billing problems. The Apple Store shows a 4.9-star rating based on 123,800 reviews, with positive reviews offset by complaints about customer service and technical issues.
Pros and Cons of PlushCare
Pros:
- 30-day free trial
- Ongoing support
- Variety of treatment options
- Accepts insurance
- Refund guarantee
- Choice of healthcare professional
- Membership perks
- Prescription discount card
Cons:
- Membership required
- Expensive without insurance
- No automatic refills
- Unclear treatment pricing
- Navigation can be confusing
- Reports of communication and cancellation issues
- Cannot prescribe controlled substances
Who is PlushCare For?
PlushCare is suitable for individuals needing ongoing care with regular check-ins, such as those in weight loss programs. It is also beneficial for insured individuals due to lower copay costs and those needing convenient medication refills. For urgent care needs like colds or checkups, PlushCare offers a convenient at-home alternative.
Limitations
PlushCare is not suitable for emergencies; immediate assistance should be sought from local emergency services or by calling 911. Individuals requiring controlled substances need in-person checkups for proper monitoring and dosage adjustments. While PlushCare offers general health services for those over 3 years old, online therapy is limited to individuals 18 and older.
Nutritional Guidance and Tips
PlushCare emphasizes the importance of nutrition in weight management. March is National Nutrition Month, and PlushCare provides tips and information to optimize weight through nutrition:
- Tracking Food Intake: Use apps or notebooks to increase awareness of eating habits.
- Focus on Proteins and Greens: Prioritize these foods with healthy fats to increase fullness and reduce overeating.
- Meal Planning: Prepare meals in advance to stay on track and avoid unhealthy fast food options.
Meal Prep Strategies
- Make Meals Ahead of Time: Cook full meals in advance, refrigerate, and reheat as needed.
- Cook in Batches: Prepare large quantities of a specific recipe, portion, freeze, and eat over several months.
- Individually Portioned Meals: Prepare fresh meals and portion them into individual grab-and-go portions to be refrigerated and eaten over the next few days.
- Ready-to-Cook Ingredients: Prep ingredients for specific meals ahead of time to reduce cooking time.
When planning meals, start with familiar recipes to ease the transition and avoid monotony. Pay attention to food safety guidelines when prepping and storing food. PlushCare doctors can help create customized nutrition plans for weight management needs.
Calorie Considerations
Not all calories are created equal; some foods are more nutritious and filling than others. Fruits with low energy density and high fiber content help prevent rapid sugar release into the bloodstream.
Avoiding Fad Diets and Myths
Fad diets that remove food groups or severely restrict calories can be problematic. Common weight loss myths include:
- All Calories Are Equal: The body's weight regulation is more complex than "calories in, calories out."
- Losing Weight is Linear: Weight loss is often irregular, with initial rapid loss followed by plateaus or small gains.
- Fat Makes You Fat: Fat is an essential macronutrient.
- Weight Loss Diets Work: Most dieters regain the weight within a year.
PlushCare doctors can help create sustainable weight-loss plans.