Defy Medical and Insurance

[drirun]

While this question is not directly about Testosterone, it is about paying for my testosterone. I use Defy for TRT. Just finished my first 3 months and awaiting the results of the bloodwork. I know you can order a claim form from Defy to submit to your insurance to see if they cover anything. My questions are: Has anyone done this? With success or failure? Was the claim for the "visits" or for the prescribed medication?

 

[HealthMan]

Every insurance is different. The only way to know is to submit the paperwork to the insurance company. I think most insurance companies will not cover for the consultations. But will cover labwork and a lot of times some medications. My insurance is Cigna. They dont cover the consultations. But cover all labwork and some of the medications (HCG and FSH is not covered. Testosterone is covered but I dont wanna handle the hassle of getting it approved etc so I buy out of pocket).

 

[drirun]

I have Horizon, so I'm unsure of what they would cover. I have pretty good insurance and have never had nothing denied, as far as I can remember. All my bloodwork has been covered without issue. Any way I could save some money would be nice, but as you said sometimes the hassle isn't worth a few dollars saved.

 

[HealthMan]

One problem for testosterone for example. My copay is USD 10. And if i use my insurance they will most likely fill my prescription with the 1ml bottles (because of the bs 30 days expiration date for injectables). So that means USD 100 for 10 bottles + the defy call in fee. Not worth it.

 

[cleverusername]

I have United Health Care, the plan I chose through my work has a low deductible and instant coverage on Dr visits at $25 a pop. The only downside is I am limited to a "Network" or Dr's and unfortunately Defy isn't one of them. They do however cover my labs at 100%. I asked if they will cover the meds and was told NO because the ordering Dr is out of network.

 

[Vince]

I tried a number of times over a two year period and gave up. I'm still a patient of Defy for over 3 years now.

 

[Vince Carter]

I used to file my own claims for reimbursement and while I did get some payments, it was a nightmare getting them to pay out and the aggravation and frustration were unbelievable. Medication claims were the worst, Dr Visits and labs were only marginally better. I gave up, wasn't worth the headaches, not at all worth it. This isn't the easy thing you think it's going to be. Worst part really was submitting a claim, seeing it process over about 4 weeks time, having it rejected, then having to resubmit everything all over again, wait another 4 weeks for processing, only to have it rejected, again.
Too, you have to know all their little codes and things, like diagnosis codes and CPT codes. If there was one little thing out of place: rejection. And they don't call you to fix it and help you in any way...

If you need to have insurance cover things for you Low T Center at least used to take insurance but Low T Center is a terrible place for treatment. (personal Exp)

 

[FeelingLost]

I tried to play the med ins game for about 6 months. Anthum Blue Cross wants two blood tests at least 30 days apart and TT must be below 250ng/dL.
As I understand it Defy will only give you paperwork you have to do all the leg work since as far as they are concerned they do not accept med insurance.

I don't blame them. my PCP has more office workers to deal with ins claims then he has nurses. It's a joke.

 

[Dr Justin Saya MD]

I don't blame them. my PCP has more office workers to deal with ins claims then he has nurses. It's a joke.

Very sad, yet also VERY true. A significantly flawed and extremely inefficient system that we (American citizens) currently pay a high price tag to sustain.

 

[drirun]

Seems like the general conscious is that it is not worth the time to deal with the insurance claim. If it was something simple to submit, it might be worth it. At this point, I'd rather not deal with the aggravation. Thank you guys for your input.