With a little help from my friends

I’ll open this with huge apologies to Lennon & McCartney.
“What would you think if I (wrote) out of tune?
Would you stand up and walk out on me?
Lend me your (eyes) and I’ll (tell you a story),
And I’ll try not to sing out of key.”

I have been chubby all of my life. With the exception of two years toward the end of high school, weight has been a constant up-and-down battle. Atkins, Weight Watchers, nutritionist visits, running, swimming, strength training, rowing machines, elliptical machines — you name it, I’ve tried it. Usually it was successful … until it wasn’t. There are a lot of reasons — metabolism, focus and many others — but this is not a piece about that. It’s about what has happened because of it.

We will skip many of the decades of the ups and downs and land firmly in late 2015. I had become so heavy that, years earlier, I had developed a serious case of obstructive sleep apnea and had, for years, used a CPAP machine. I had high blood pressure and, even with my hips being replaced in 2009 and 2010, I was, due to the weight, almost completely inactive. I decided, after seeing how successful a friend was, to investigate bariatric sleeve surgery. I had just turned 63 and was looking at a very short timeline if things remained the same.

It was a long process, just trying to check all the necessary boxes for my medical insurance, but I got it done and, in July of 2016, had a very successful surgery. Within a year, I no longer had sleep apnea, my hypertension was gone and I completed the SoNo Half Marathon.

We both fully retired in June of ’21 and checked off one more box on my wish list and moved to Bluffton to escape the winters I hated so much. The “new life” had one downside: the weight started to creep back up — slowly, but noticeably — and lo and behold, my sleep apnea and hypertension returned. While the original surgery resulted in a loss of over 190 lbs., and that did not come back, enough did — about 50 — that all the medical conditions started to rear their very ugly heads and, along with continued aging, became more troublesome.

I had some friends who had very successfully used the new GLP-1 shots to help their weight loss, so I investigated that as well. What I found immediately was that, while I have excellent medical coverage, because it is part of a Medicare plan, those drugs are currently not covered and are far too expensive to pay for out of pocket (I will avoid a discussion of the idiocy of that here). However, under the coverage I had back in 2025, a diagnosis of sleep apnea was one of the conditions that did allow it to be covered. So, with the required sleep test and confirmation of what my wife already knew, after jumping through some paperwork hoops, it was covered and, while there was still a large annual deductible, it was manageable.

Six months later, I am happy to say that, without a single side effect, it has been a very positive experience and things were moving along very well … until it wasn’t.

When they tell you it’s not about the money, it’s always about the money. The retirement coverage that I have was changed from one company to another as of Jan. 1, 2026, and the very first attempt to refill my Zepbound was immediately denied, with the new company simply saying, “It’s not covered.” My medical team submitted the same paperwork and preauthorization with the same sleep apnea diagnosis, only to be turned down twice more. The insurance company, of course, simply assumed that multiple denials would end the request … until it didn’t.

I called the medical arm of the coverage and a very pleasant representative confirmed what I already knew from reading the materials myself: It was covered under the same conditions as in the prior plan (and also, the new plan was promoted as “equal or better” than the old one — that’s how it was “sold” to us, not that the grunts in the trenches were given a choice). Then the Rx arm still maintained that it was not, again with the supposition that would end discussion and filing … but it didn’t.

There is nothing more powerful than tenacity coupled with competence. I was lucky enough to have had a direct contact with someone who oversaw the plan, who immediately contacted the administrative team of the new plan to ask for an explanation as to (a) the denial and (b) the inconsistent information that was being given. Within 48 hours, she received the proper response based upon the actual written documentation: Yes, it was covered and it would be filled immediately. I also received multiple calls from the company’s administrative team to explain their take on what had happened and, ultimately, to apologize for the denials and the inconsistent information. None of that would have happened without everyone pulling from the same end of the wagon in what is frequently a broken system.

Let’s close with the only appropriate outro:
“Yes, I get by with a little help from my friends,
With a little help from my friends.”

Kevin Fitzpatrick is a retired teacher who, along with his wife Sue (also a retired teacher) is enjoying exploring life in the lowcountry and all it has to offer.