How is Healthy You Endocrinology and Weight Loss different from a traditional endocrinology practice?

Healthy You operates on a Direct Care model without the constraints of insurance billing. This allows Dr. Borensztein to take on a smaller patient panel, offering same-week appointments, longer visits (60–90 minutes for new patients), transparent pricing, and direct access to the doctor between visits. There are no surprise bills — all costs are listed upfront and HSA/FSA payments are accepted.

Does Healthy You accept Medicare or Medicaid?

Healthy You accepts select Medicare and Medicare Advantage plans on a limited basis. Medicaid is not accepted. Medicare and Medicaid patients cannot enroll in the membership program. Please call the office at 856-559-7616 for current availability.

How quickly can a new patient get an appointment?

New patients can typically be seen within the same week, often the same day or the next day. Patients are encouraged to gather their health records before their appointment to make the most of their visit.

Can I be reimbursed by my insurance for visits at Healthy You?

If your insurance plan includes out-of-network coverage, you may be able to submit a superbill (which the practice will provide) for reimbursement. Reimbursement is not guaranteed. HSA and FSA funds can also be used to pay for visits. Contact your insurance company to confirm your out-of-network benefits.

Can I still use my insurance for labs, imaging, and prescriptions?

Yes, in most cases you can use your insurance for labs, imaging, and prescriptions ordered by Dr. Borensztein. In rare instances, insurance may deny payment for testing ordered by an out-of-network provider. If you are concerned, it is best to check with your insurance company directly.

What is included in the Healthy You membership?

The Weight Loss and Endocrine Memberships include unlimited in-person and telemedicine visits, direct text access to Dr. Borensztein, prior authorization support, letters and forms, and communication with other medical offices. Weight Loss members also receive monthly body composition analysis and access to a members-only site with recipes, workouts, and blog posts. Memberships start at $125/month for Endocrine and $200/month for Weight Loss.

What ages does Healthy You treat?

Healthy You typically sees patients age 16 and older. For patients under 18, it is recommended to call the office first at 856-559-7616 to confirm that the appropriate care can be provided.

What conditions does Dr. Borensztein treat?

Dr. Borensztein treats the full spectrum of endocrine conditions including hypothyroidism, hyperthyroidism, Hashimoto's thyroiditis, Graves' disease, thyroid nodules, Type 1 and Type 2 diabetes, prediabetes, insulin resistance, PCOS, menopause and perimenopause, hormone replacement therapy (HRT), adrenal disorders (Cushing's syndrome, adrenal insufficiency), pituitary disorders, osteoporosis, hyperparathyroidism, and medical weight loss with GLP-1 medications such as Wegovy, Zepbound, and Ozempic.

Does Healthy You offer telemedicine appointments?

Yes. Telemedicine visits are available for established patients located in New Jersey or Pennsylvania. New patient first visits are required to be in person at the Collingswood, NJ office.

Where is Healthy You Endocrinology located?

Healthy You Endocrinology and Weight Loss is located at 900 Haddon Avenue, Suite 409, Collingswood, NJ 08108 — just outside of Philadelphia. There is onsite parking and the PATCO station is nearby. Call 856-559-7616 or email info@healthyyouendo.com.

Who Qualifies for GLP-1 Medications? The Criteria, the Insurance Fine Print, and What's Off-Label

Jul 29

Written By Alejandra Borensztein

By Dr. Alejandra Borensztein, MD, DABOM, MSCP — Founder, Healthy You Endocrinology & Weight Loss

One of the most common questions I hear in my office is some version of: "Do I actually qualify for a GLP-1?" It's a fair question, and the honest answer is that it depends on which question you're really asking. There are two very different gatekeepers here — the science, and your insurance company — and they often disagree. Let me walk you through both, plus the medications themselves and the areas where these drugs are being used beyond weight loss.

First, what "obesity" actually means clinically

Most eligibility criteria start with body mass index (BMI), so it helps to know the categories:

Overweight: BMI 25–29.9
Obesity, Class I: BMI 30–34.9
Obesity, Class II: BMI 35–39.9
Obesity, Class III (severe): BMI 40 and above

Here's my honest caveat, and it's an important one: BMI is a screening tool, not a diagnosis of health. It doesn't distinguish muscle from fat, it doesn't account for where you carry weight, and it says nothing about your metabolic health. Two people at the same BMI can be in completely different places medically. That's why leading obesity-medicine and endocrinology groups increasingly pair BMI with other measures — waist circumference, body composition, and whether weight is actually driving disease. In my practice, I use an InBody scan to look at muscle and fat directly, because the number on the scale rarely tells the whole story.

I say all this because I don't want you to disqualify yourself based on a single number, in either direction.

The FDA's weight-management criteria

For the medications specifically approved to treat obesity, the FDA labeling is refreshingly clear. You may be a candidate for chronic weight management if you have:

A BMI of 30 or higher, or
A BMI of 27 or higherplus at least one weight-related medical condition — such as high blood pressure, prediabetes or type 2 diabetes, high cholesterol, obstructive sleep apnea, fatty liver disease, or cardiovascular disease.

Notice what's not required: you do not need diabetes to qualify. This is the single biggest misconception I correct. These criteria apply to the drugs carrying an obesity indication regardless of your blood sugar.

Why your insurance may say something completely different

This is where "qualifying on paper" and "getting it covered" split apart — and where a lot of my patients feel blindsided. Insurers routinely stack their own requirements on top of the FDA criteria. Depending on your plan, you may run into:

A higher BMI threshold. Some plans won't approve a GLP-1 for weight loss unless your BMI is 35 or even 40, rather than the FDA's 30.
Two conditions instead of one. Where the FDA asks for a single weight-related comorbidity at BMI 27+, some plans require two or more documented conditions.
Mandatory lifestyle or coaching enrollment. Many plans require documentation of a supervised weight-management program — often 3 to 6 months of it — before they'll approve medication. Some employer plans go further and route GLP-1 access only through a specific digital coaching or telehealth program you must sign up for.
Step therapy. You may be required to try (and fail) lower-cost options first.
Documented weight history and reauthorization. Plans commonly want BMI readings over time, then proof of continued weight loss every 6 to 12 months to keep coverage active.

I want to be direct about something: a prior-authorization denial is a coverage decision, not a medical one. It reflects your plan's budget and formulary — not whether treatment is appropriate for your body. In my direct-care practice, I don't answer to a formulary, so eligibility is a clinical conversation between us. (And if you're paying cash, none of these insurance hoops apply at all — manufacturer direct-pay programs have brought brand-name pricing down dramatically from where it was a couple of years ago.)

The GLP-1 medications and what they're actually FDA-approved for

"GLP-1" is a category, not a single drug, and the specifics matter — especially because the same molecule is often sold under one brand for diabetes and another for weight loss, which is a big part of why insurers treat them so differently.

Semaglutide

Ozempic — approved for type 2 diabetes. It also carries approvals to reduce the risk of major cardiovascular events in adults with type 2 diabetes and heart disease, and (following the FLOW trial) to slow kidney disease progression in type 2 diabetes with chronic kidney disease.
Wegovy — approved for chronic weight management (adults, and adolescents 12+). It's also approved to reduce cardiovascular risk in adults with established heart disease plus obesity or overweight (the SELECT trial), and, more recently, to treat noncirrhotic MASH — a serious form of fatty liver disease with fibrosis (the ESSENCE trial). Wegovy is now available as both an injection and an oral tablet.
Rybelsus — the oral semaglutide tablet approved for type 2 diabetes.

Tirzepatide (a dual GIP/GLP-1 agonist — it acts on two receptors, which is part of why it tends to be so effective)

Mounjaro — approved for type 2 diabetes.
Zepbound — approved for chronic weight management, and additionally for moderate-to-severe obstructive sleep apnea in adults with obesity (the SURMOUNT-OSA trial).

Orforglipron

Foundayo — the first oral non-peptide GLP-1, approved for chronic weight management and launched in 2026. Because it isn't a peptide, it doesn't carry the strict food-and-water timing rules that oral semaglutide does.

Liraglutide (older, daily injection)

Victoza — type 2 diabetes. Saxenda — chronic weight management (adults and adolescents 12+).

Dulaglutide

Trulicity — type 2 diabetes, with an approval to reduce cardiovascular events in higher-risk patients.

Older agents like exenatide (Byetta, Bydureon) have largely been phased out. And on the horizon, several next-generation drugs — including the triple agonist retatrutide and the combination CagriSema — are in trials but are not yet FDA-approved; I mention them because patients ask, but they aren't options today.

One more note: compounded semaglutide and tirzepatide are not FDA-approved products, and the shortage-related window that made large-scale compounding permissible has closed. I'm cautious about them for good reason, and I'm happy to explain why in person.

Off-label uses: where the evidence is genuinely interesting

"Off-label" sometimes sounds alarming, but it simply means a medication is being used for something other than its FDA-approved indication. It's legal, common, and appropriate when supported by good evidence and sound clinical judgment. Here's where GLP-1s are being used beyond their labels — with an honest read on how strong the evidence is in each case.

Insulin resistance and prediabetes. This is close to the core of what these drugs do. GLP-1s improve insulin sensitivity and glucose handling directly, on top of the benefit that comes from weight loss. For patients with prediabetes or clear insulin resistance who don't yet meet a diabetes diagnosis, this can be a meaningful, evidence-based reason to consider therapy.

PCOS (which I prefer to call PMOS — polyendocrine metabolic ovarian syndrome, because insulin resistance sits at its center). No GLP-1 is FDA-approved for PCOS, but the evidence has become substantial. Multiple randomized trials, and a 2026 systematic review in the European Journal of Endocrinology, show that semaglutide produces meaningful weight loss in women with PCOS and overweight or obesity, along with improvements in insulin resistance, androgen levels, and — importantly — menstrual regularity and ovulation. Semaglutide is currently the best-studied option here; tirzepatide data in PCOS is still limited, and the evidence in lean PCOS is thinner. Two practical cautions: benefits tend to reverse when the medication is stopped, and because these drugs are not safe in pregnancy, they must be discontinued well before trying to conceive.

Inflammation. This one is the most preliminary, so I'll be careful. GLP-1s do appear to lower markers of systemic inflammation — a 2024 meta-analysis in the European Heart Journal found semaglutide reduced C-reactive protein (CRP) across dozens of trials, and studies like PIONEER-2 suggest part of that effect is independent of weight loss. This is a plausible piece of why these drugs protect the heart. But there is no FDA-approved anti-inflammatory indication, and no one should start a GLP-1 to "treat inflammation" as a standalone goal. It's a promising mechanism, not an established use.

The bottom line

Whether a GLP-1 is right for you isn't a number on a chart, and it certainly isn't a decision your insurance company should be making for you. It's a clinical question — one that takes your full history, your metabolic picture, your goals, and the real evidence into account.

That's exactly the kind of conversation I built my practice to have: unhurried, specialist-level, and free of prior-authorization gatekeeping. If you've been wondering whether you qualify, let's find out together.

Dr. Alejandra Borensztein is a triple board-certified endocrinologist, obesity medicine and menopause specialist at Healthy You Endocrinology & Weight Loss in Collingswood, NJ, serving patients across South Jersey and Pennsylvania. If you're weighing your options for weight-loss treatment, book a consultation to talk through what fits your life and your health.

📞 [Call us] | 💬 [Send a message] | 🗓️ [Book an appointment]

Healthy You Endocrinology & Weight Loss | Dr. Alejandra Borensztein, MD, DABOM, MSCP
900 Haddon Ave, Suite 409, Collingswood, NJ 08108 | 856-559-7616 | healthyyouendo.com

GLP1medical weight lossweight loss doctor

Alejandra Borensztein