Denied by One Telehealth Platform, Approved by Another: Why Criteria Differ

Not All Platforms Use the Same Rulebook

Each GLP-1 telehealth platform develops its own clinical protocols — the rules their prescribers follow when evaluating patients. While all platforms operate within the FDA's approved indication framework, there's significant variation in how they interpret and apply those criteria.

Common differences include: BMI thresholds (some platforms require BMI ≥ 30, others accept BMI ≥ 27 with comorbidities, and a few will prescribe at lower BMIs with clinical justification), contraindication lists (some exclude conditions that others evaluate case-by-case), required labs or screenings (some platforms require recent bloodwork, others don't), and the depth of medical evaluation (from comprehensive telehealth visits to brief questionnaire-only approvals).

Why Stricter Isn't Always Better

It's tempting to assume that stricter platforms are more responsible, but the Yale JAMA study revealed the opposite end of the spectrum — platforms that approve almost everyone with minimal clinical evaluation. The reality is that responsible prescribing isn't about being maximally strict or maximally permissive. It's about matching treatment decisions to individual patient circumstances.

A platform that denies you because your BMI is 28.5 instead of 30, despite documented comorbidities, isn't being responsible — it's being rigid. A platform that approves you in 5 minutes without asking about your thyroid history isn't being accessible — it's being careless.

What to Do After a Denial

Ask for the specific reason. "Your application was denied" isn't helpful. Ask which criteria you didn't meet. The answer tells you whether to try another platform or address a clinical issue first.

Try another platform with your records. If Platform A denied you for BMI (borderline) but you have significant comorbidities, Platform B's protocol may weigh comorbidities more heavily. Bring your denial letter and medical records to give the new prescriber full context.

Consider a non-platform prescriber. Your PCP or an obesity medicine specialist isn't bound by any platform's protocol. They evaluate you as an individual patient and make clinical decisions accordingly.

Red Flags on Both Sides

Red flags in a denial: No explanation given. Denial is clearly based on a blanket policy rather than clinical evaluation. No appeal or reconsideration process available.

Red flags in an approval: Approved without asking about thyroid history, eating disorder screening, or current medications. No medical professional identified by name. Approval took less than 5 minutes with no clinical interaction.

The right platform evaluates you individually, explains its reasoning, and makes a clinical decision that accounts for your specific health profile — whether that decision is to approve or deny.