Experience Personalized Care
for Lifelong Health

We set ourselves apart from our competition as we provide individualized care. We spend time getting to know you and your past medical history to evaluate the best course of treatment for you. We also spend time focusing on a personalized diet/lifestyle for you so that you can take what you have learned to benefit you for the rest of your life.

Inclusion Criteria:

• Adults 18 Years or Older

• Body Mass Index (BMI) of 30 or Greater, or a BMI of 27 or Greater With at Least One Weight-Related Medical Condition

• Willingness to Commit to Lifestyle Changes and Program Requirements

Exclusion Criteria:

For a complete listing and specific contraindications, refer to the medication’s package insert. The most common contraindications to semaglutide and tirzepatide injections are:

• Medullary Thyroid Cancer

• Multiple Endocrine Neoplasia Type 2 (MEN 2)

• Family History of Medullary Thyroid Carcinoma

• Pregnancy (or Within 2 Months Before Planning Pregnancy)

• Breastfeeding

• Diabetic Retinopathy

• Suicidal Thoughts

• Uncontrolled Depression

• Acute Inflammation of the Pancreas

The easy answer is possibly!

• Yes—lab work is often covered by insurance.

• No—virtual appointments are not able to be billed to insurance at this time. I am able to provide a Superbill for you to submit to insurance for reimbursement, though. Virtual appointments are also FSA and HSA eligible.

• Maybe prescription GLP-1 medication might be covered by your insurance. Please read on for further details:

In general, if you want to know if your insurance covers any brand-name weight loss medications, the best thing is for me to prescribe them to your pharmacy and go from there. Alternatively, you can call your insurance and ask if they cover GLP-1 medications, but if you do not have diabetes, you should inform them that you are using these medications for weight loss, as often this changes their answer about whether this class of medications is “covered.”

After I prescribe the medication, sometimes there is paperwork to be done (called a “prior authorization”), and sometimes we get a flat-out denial. Sometimes the medications are “covered,” but the co-pay is literally still hundreds of dollars (as in $500-$1500). Occasionally, the medication is covered, and the co-pay is only $25! There are truly multiple ways this can play out with insurance. Luckily, it is my job to handle the paperwork—I just ask for your patience as I navigate this for you. I promise to keep you as updated as I am. Eventually, we will get an answer and get on with treatment!

Although Kelsey Abraham, PA-C, does not bill directly to insurance, all of our services are billable. After each visit, patients receive a “Superbill” from our office, which is a detailed receipt of the services rendered. The superbill includes diagnostic codes (ICD codes) and treatment codes (CPT or HCPCS codes) that insurance companies use to determine reimbursement. Patients can submit this superbill to their insurance company for possible out-of-network coverage. On average, insurance companies may reimburse 50-80% of the cost for out-of-network services, but this depends on your personal insurance and is not guaranteed.

* Please note that Medicare will not reimburse out-of-network services, so superbills cannot be submitted to Medicare for reimbursement.

Additionally, our electronic health system is able to accept HSA/FSA cards, as long as they are issued by one of the major card brands (examples: Visa, Discover, Mastercard, or Amex).

Why We Choose To Be Out-of-Network With Insurance: Our out-of-network operation ensures that Kelsey Abraham, PA-C, can offer individualized, evidence-based care without constraints from insurance companies. This allows us to focus wholeheartedly on your health, particularly in areas of disease prevention, nutrition and lifestyle optimization, and weight loss.

Laboratory tests, diagnostic tests, procedures, and medications: Even though Kelsey Abraham, PA-C, is out of network with your insurance, all laboratory tests, diagnostic tests, and medications prescribed will be submitted to your insurance provider as usual. This means that these services will be covered according to the terms of your insurance plan.

Your monthly payment covers your virtual visit with me, which includes medication titration and dose-tolerance assessment, as well as nutrition counseling and resources (meal plans, recipes, education materials, etc.).

If you are using your insurance to cover your medication, that cost is separate and is paid directly to your pharmacy as you normally would pay for medications.

If we are not using insurance, the cost of your medication (and any necessary supplies) is also separate but is billed through the clinic. It is a separate receipt from your virtual visit for easy record-keeping. The cost of medication varies by dose. Please feel free to send me an email if you have further questions about payment.

Yes, our weight loss program includes personalized dietary and exercise recommendations tailored to your goals and lifestyle. These plans are designed to complement the medications and support your long-term success.