Question about switching to Insurance for TRT

[tmaxey1]

Ok guys I've been on TRT for a few years now with Defy.
When I had my first labs my T was 168. I still have the old lab report. Of course every lab report since is normal or high. I am wondering if I went to a regular doctor and wanted to switch over to insurance instead of all out of pocket could the doctor use my labs from before I ever received testosterone treatment to submit to my insurance to get them to cover it?

I've read some insurance companies require 200 or below. I was there. But no way I can show those levels now since I am on TRT.

Thanks for any insight.

 

[Systemlord]

Those labs you have that show a Total T at 168 ng/dL, never happened! Labs testing is only good for 90 days, beyond that no doctor will consider your labs relevant. Too many unknowns, should your provider should you get approved for TRT, perhaps put on you on a protocol from the Stone Age (every 2 weeks) and now you’re stuck with incompetent doctors.

The care you’re receiving right now is top notch!

 

[tmaxey1]

Those labs you have that show a Total T at 168 ng/dL, never happened! Labs testing is only good for 90 days, beyond that no doctor will consider your labs relevant. Too many unknowns, should your provider should you get approved for TRT, perhaps put on you on a protocol from the Stone Age (every 2 weeks) and now you’re stuck with incompetent doctors.

The care you’re receiving right now is top notch!

It is top notch but after this many years the entire trt treatment process feels like something one can do on their own. My labs every 6 month are not hard to read and determine. My protocol doesn't change. My follow up appts have become just a repeat of the same appt 6 month before. Now with pending changes to the law using telemedicine looks to be getting harder and more expensive. Am I going to pay all out of pocket and need to pay for a yearly trip to Florida... Just has me wondering if I found a local doc who reviewed my last few years of labs, my protocol, and was progressive enough to get it, if it would just be easier and much cheaper to go the local doc with health insurance route.

And now I am out of test and it looks like a bunch of patients are at the mercy of empower and they extremely long delays.

I'm not feeling like this is top notch.

 

[Systemlord]

Just has me wondering if I found a local doc who reviewed my last few years of labs

You’re not understanding what I said in my previous post, your labs are too old for your doctor to diagnose you with a testosterone deficiency. You would have to stop treatment, get two tests showing <300, in order for insurance to cover treatment.

. Am I going to pay all out of pocket and need to pay for a yearly trip to Florida...

A lot of people are getting this all wrong, it’s one trip to see a doctor in person, after that it’s business as usual, as no need to see the doctor in person.

I believe testosterone will get a waver and this law will apply to the other controlled substance (opioids).

 

[Systemlord]

And now I am out of test and it looks like a bunch of patients are at the mercy of empower and they extremely long delays.

You’re human, adapt. Reorder your medicine a month ahead.

 

[tmaxey1]

You’re not understanding what I said in my previous post, your labs are too old for your doctor to diagnose you with a testosterone deficiency. You would have to stop treatment, get two tests showing <300, in order for insurance to cover treatment.


A lot of people are getting this all wrong, it’s one trip to see a doctor in person, after that it’s business as usual, as no need to see the doctor in person.

I believe testosterone will get a waver and this law will apply to the other controlled substance (opioids).

I am not sure this is accurate. If you are coming to a new doc or a new insurance plan and a previous doctor diagnoses you with a condition why would you have to be diagnosed. My company just hired a guy who takes high blood pressure meds. His pressure is good now. So based on this he would need to let his blood pressure run up in order to have his new insurance plan cover his medication?

I am not getting this wrong. I am aware of the 1 trip to see your doctor. That doesn't change what I had said about needing to book a flight, rental car, hotel ect to florida to see the doctor once. I have also heard some interpretation that it could be once per year. Either way thats a real significant expense that may be avoidable.

 

[tmaxey1]

You’re human, adapt. Reorder your medicine a month ahead.

They don't allow a month ahead.
Even if they did when they never had a month delays and now they do it isnt unreasonable to expect a notification and exception of the new delays. If fact when someone is ordering if Defy knows they are having massive delays then they should let the patient know and give them an alternative to avoid this.

Any other smart ass comments to make yourself look like aa bigger ass?

 

[Systemlord]

I am not sure this is accurate.

You may not like the answer, but it’s 100% accurate. The difference is you’re the one paying for the treatment, you’re the customer, if you want your insurance company to cover the treatment, you got to play their game, a low-T result <300 on two separate occasions.

Insurance companies aren’t in the business of handing out money, they collect premiums and ration out coverage for sickcare to generate a profit. There are good reasons why people are willing to put up with Empower Pharmacies inconveniences.

 

[HarryCat2]

It really depends on your insurance company, some will require you to get off of testosterone and then get 2 morning readings 4 weeks apart below 200. You could try calling your insurance company and asking for their medical policy document on TRT or searching their website.

 

[tmaxey1]

You may not like the answer, but it’s 100% accurate. The difference is you’re the one paying for the treatment, you’re the customer, if you want your insurance company to cover the treatment, you got to play their game, a low-T result <300 on two separate occasions.

Insurance companies aren’t in the business of handing out money, they collect premiums and ration out coverage for sickcare to generate a profit. There are good reasons why people are willing to put up with Empower Pharmacies inconveniences.

Its not about liking the answer.

It's not only about them covering the cost of testosterone. Thats cheap. I've heard its only around $50 at the pharmaacy.

What about the blood work and follow up appts. What about the other meds Defy may have you on like Tadafil or T3. Can't your reg doc get you these under insurance without the need for the crap they put you through for the test?

 

[jayt]

Ok guys I've been on TRT for a few years now with Defy.
When I had my first labs my T was 168. I still have the old lab report. Of course every lab report since is normal or high. I am wondering if I went to a regular doctor and wanted to switch over to insurance instead of all out of pocket could the doctor use my labs from before I ever received testosterone treatment to submit to my insurance to get them to cover it?

I've read some insurance companies require 200 or below. I was there. But no way I can show those levels now since I am on TRT.

Thanks for any insight.

I would definately switch.... I go to a Urologist, covered by my isnurance, he does my blood work and prescribes T and trimix. The T is 100% covered by my insurance....no copay. the trimix is not covered buy I get at a recommended compounding pharmacy for $90 for 5 ml vials which lasts me about 3 months (using it 3 to 4 times a week and it is awesome). Call around and ask people there are Urlologists who will be more flexible than others.....

 

[VacationMan]

I would definately switch.... I go to a Urologist, covered by my isnurance, he does my blood work and prescribes T and trimix. The T is 100% covered by my insurance....no copay. the trimix is not covered buy I get at a recommended compounding pharmacy for $90 for 5 ml vials which lasts me about 3 months (using it 3 to 4 times a week and it is awesome). Call around and ask people there are Urlologists who will be more flexible than others.....

In my case, I switched from a urologist to Defy...mainly because the urologist was stubborn and wouldn't listen to his patient [me]. He wouldn't test E2, didn't look at SHBG...would only test for total T and total E. It was obvious [to me] that he simply didn't know how to effectively treat low T. I transitioned to Defy and life has been sooooo much better.

I now work with my primary care physician for ordering labs. I basically tell him what labs to order and he just does it for me. I visit a Labcorp site and they do the draw. My insurance covers the labs at 100% with no copay. Then I use those lab for my 6-month follow-ups with Defy as well as my 6-month follow-ups with my PCP.

Before transitioning to Defy, I had grief getting more than 4 to 5 1 ml vials per refill of Test C when insurance was paying for it (with a high copay, might I add). Now through Defy/Empower, I get a proper amount of Test C each and every time I refill. The trick is staying on top of your "inventory" of medications and ordering ahead of time.

 

[jayt]

awesome man , whatever works for you.

 

[Todahoopyall1]

Ok guys I've been on TRT for a few years now with Defy.
When I had my first labs my T was 168. I still have the old lab report. Of course every lab report since is normal or high. I am wondering if I went to a regular doctor and wanted to switch over to insurance instead of all out of pocket could the doctor use my labs from before I ever received testosterone treatment to submit to my insurance to get them to cover it?

I've read some insurance companies require 200 or below. I was there. But no way I can show those levels now since I am on TRT.

Thanks for any insight.

 

[Todahoopyall1]

I just take my prescription and ask the pharmacy to use a “Good RX“ coupon… extremely cheap! Get the “Good RX” app and check prices. It is very easy to navigate and almost every pharmacy excepts their coupons… Much cheaper than my insurance company!

 

[t_spacemonkey]

you can save money by getting everything but T from defy.
cialis/t3 etc - any regular doc won't make a fuss about this
HCG - reliableRX/india
even a lot of RX stuff is cheap at reliablerx (they dont have T)

 

[Swilsondc]

I have been on TRT for 14 years and have always used my insurance. Have switched different doctors 3 or 4 times. My total initially was 123. I can’t remember but I think that some doctors I had to retest and some I didn’t. Like someone said probably best to check with your insurance. I have had a couple different ones over the years. But yes all of my insurance have paid for the visits & labs & test(of course it varies how much with each plan or company) based on a diagnoses of hypogonadism. My experience with the doctors has been good & not so good. Some have their set TRT protocol for everybody and some actually know what is current in the TRT world. Besides my doctor now all the others were urologist. The doctor I have now is an endocrinologist and is by far the best I’ve had. He seems pretty up to date on TRT. And he is open to my feedback & things I want to try within reason. I do test cyp 2x/wk subcu and his fine with that. I learned about HCG on here a couple years ago and he writes me a script. At first I had to go ever 3 or 4 months but now it is 6 months. I got lucky a friend of mine sees this doctor & told me about him. I say all that to say this it might be worth looking for an endo vs a urologist.