insurance and hrt

[stern]

Has anyone had a problem getting insurance to pay for HRT tests, rx's etc?
Is HRT something that is recognized as a condition that is normally paid for by insurance or is it seen as a sort of elective treatment?

For those of you who pay for the tests yourself how much are you spending to get them done and where is the best deal?

Swale what are the minimum tests you will order if someone has to foot the bill themselves for the tests?

Any info on how insurance works regarding HRT will be appreciated. Thanks, stern

 

[gymrat1977]

The tests were well over 2k if I had to pay for them. My costs after insurance was only $181. I got a good discount on meds as well. There was a post not to long ago about labs. I'll look for it, but run a search and it should come up.

 

[stat1951]

I have had no problem with either Lab work or with Rxes.

I have an HMO (yet) and it charges nothing for Lab work (i.e., no co-pay) and my co-pay for the prescription depends on the brand name, etc. Like AG (monthly at local Pham) is $20 co-pay while Testim is $10.

Can also get long-term prescriptions - for 90-day supplies at one time - written and processed through MedCo (they are on contract with my HMO). Going that route, a year's supply of Testim is $80.00 a year co-pay ($20 four times a year)...

Larry

 

[cjsabbath]

My insurance covered all of the lab work. My out of pocket cost for Androgel is $9 a month.

I am extremely fortunate...

 

[earthdog]

Has anyone had a problem getting insurance to pay for HRT tests, rx's etc?
Is HRT something that is recognized as a condition that is normally paid for by insurance or is it seen as a sort of elective treatment?

For those of you who pay for the tests yourself how much are you spending to get them done and where is the best deal?

Swale what are the minimum tests you will order if someone has to foot the bill themselves for the tests?

Any info on how insurance works regarding HRT will be appreciated. Thanks, stern

My insurance pays for the lab work. They cost a small fortune if you have to pay yourself. If your insurance won't pay, try the LEF at www.lef.org. They have a men's health lab package deal for something like $300 or $400. Go to the Products area of their web page for exact info.

My insurance pays for the medication only if your total T is 270ng/dl or less. Rather than go through that hassle, Swale sends my scripts over to DeWitt Pharmacy, and I pay the retail price. 4-5 months of T cyp costs $110 and 2 months of hCG costs $46. I'm willing to pay that to avoid having my insurance (and my employer) messing around with that stuff.

I almost hate to say it, but the biggest costs in my TRT program are the OTC supplements "prescribed" to me by Swale, DIM and TMG. I say "prescribed" because they are OTC, LOL. They are somewhere in the neighborhood of $60 per month, if I remember correctly.

The Armour thyroid I'm on is dirt cheap. $25 for 100 tabs at DeWitt. There's no point in my going through insurance for that.

So the bottom line for you is, go to your insurance company's web site if they have one, or give them a call and find out for sure.

 

[stat1951]

I just did a quick math on mine, and I am paying $6.67 a month - averaged out - for 10 grams of Testim per month, as long as I get it from my long-term provider (and, like you said, zero for Lab work)...

Like you said, very fortunate... and no real paperwork.

My insurance covered all of the lab work. My out of pocket cost for Androgel is $9 a month.

I am extremely fortunate...

 

[BigPooka]

I have Blue Cross hmo. I have a $150 deductible a yr and then co-pay.
After I get my ded paid. the lab work costs me about $23. and the script is $10 for 90 days worth. The lab work is a bitch if u dont have insurance, the total was like $1500. good luck

Pooka

 

[mranak]

Is HRT something that is recognized as a condition that is normally paid for by insurance or is it seen as a sort of elective treatment?

HRT isn't the condition, it is the treatment. The condition is hypogonadism. It is a totally legitimate and recognized condition.

I'm currently fighting my insurance company to pay for the hCG on the basis that it is for hypogonadism rather than fertility treatment which is only covered at 50%. Yeah, hCG isn't that expensive, but no matter: I'm fighting for my contractual rights. I haven't had problems with coverage for anything else, except for some unrelated complications (my insurance only pays for labs if they are performed and billed by the physicians office).

 

[stern]

Do labs like Quest and lab corp take insurance? Thanks to all those who replyed so far.

 

[BigPooka]

Quest does in fact take insurance. That is who I have had my labs done by.

Pooka

 

[mranak]

Certainly, the labs accept insurance. I would imagine that most of their income comes from the insurance companies. But you need to check you own insurance policy to determine coverage. For example, my insurance only covers labs at 100% if the labs are performed and billed through the physician, which is nothing more than a tactic to avoid paying for labs.

 

[stern]

thanks to all those who replied. stern