I agree, but I have no doctor here that knows trt. They will not pay for another dr. Plus, the good plan, is just the more I budget on it is out of my reach. We are talking after child support barely affording rent and utilities soon for me. Single, making 45 k a year paying 1000 in support and no deductions really gets you reamed in the USA.
Testosterone Health Insurance Advice ?
- Thread starter Markee
- Start date
Nelson Vergel
Founder, ExcelMale.com
tmckenzie
You can get your blood work paid for and try to access a cash based men's health clinic for HCG. If you blood work shows total testosterone under 350 ng/ml, all insurance companies will reimburse TRT (assuming you meet your out of pocket medication deductible).
HCG is usually not covered for non fertility uses (sex drive and testicular atrophy reversal) so most men buy it from compounding pharmacies if they convince the doctor that they need TRT+HCG. A good way to so is to print this study (attached to first post) and give them a copy: https://www.excelmale.com/forum/thr...se-Testicular-Shrinkage-and-Improve-Sex-Drive
You can get your blood work paid for and try to access a cash based men's health clinic for HCG. If you blood work shows total testosterone under 350 ng/ml, all insurance companies will reimburse TRT (assuming you meet your out of pocket medication deductible).
HCG is usually not covered for non fertility uses (sex drive and testicular atrophy reversal) so most men buy it from compounding pharmacies if they convince the doctor that they need TRT+HCG. A good way to so is to print this study (attached to first post) and give them a copy: https://www.excelmale.com/forum/thr...se-Testicular-Shrinkage-and-Improve-Sex-Drive
Nelson Vergel
Founder, ExcelMale.com
One more thing: you should always look at the insurance policy's formulary before getting one. On healthcare.gov they provide that information right when they list all your insurance options at the end of the process.
A prescription for testosterone via insurance can be obtained in several ways:
1. They will cover the testosterone, however only in 30 day supplies in 1 ml vials of 200 mg/ml (usually 2-4 vials per month).
2. They will cover the testosterone, however only with pre-authorization from your doctor.
This of course is a bit of a pain, but is more of an annoyance than anything else. Simply have your doctor fill out a form and then either fax it to the insurance company or mail it in. They will probably require your total T to be under 350 ng/ml unless you are transferring from another clinic that already had you on TRT.
3. They will cover the testosterone, usually one 10ml bottle and not require pre-authorization. Obviously this is the best situation. Most clinics will keep an eye on your refill frequency to ensure that you are not using a higher dose than prescribed. That bottle can last 9-20 weeks depending on dose.
4- Insurance will not pay due to your testosterone being over 350 ng/ml. Your doctor prescribes it due to your low T symptoms and you fill the prescription at a compounding pharmacy at about $75 to $110 per month for 10 mls. These doctors usually do not prescribe unless you have testosterone under 600 ng/ml or
I hope this helps!
A prescription for testosterone via insurance can be obtained in several ways:
1. They will cover the testosterone, however only in 30 day supplies in 1 ml vials of 200 mg/ml (usually 2-4 vials per month).
2. They will cover the testosterone, however only with pre-authorization from your doctor.
This of course is a bit of a pain, but is more of an annoyance than anything else. Simply have your doctor fill out a form and then either fax it to the insurance company or mail it in. They will probably require your total T to be under 350 ng/ml unless you are transferring from another clinic that already had you on TRT.
3. They will cover the testosterone, usually one 10ml bottle and not require pre-authorization. Obviously this is the best situation. Most clinics will keep an eye on your refill frequency to ensure that you are not using a higher dose than prescribed. That bottle can last 9-20 weeks depending on dose.
4- Insurance will not pay due to your testosterone being over 350 ng/ml. Your doctor prescribes it due to your low T symptoms and you fill the prescription at a compounding pharmacy at about $75 to $110 per month for 10 mls. These doctors usually do not prescribe unless you have testosterone under 600 ng/ml or
I hope this helps!
I see what you are saying Nelson, and I appreciate the input. But the companies I have to deal with are flatly telling me that regardless of levels when I started trt, below 300 if I remember right, trt is not covered. They really could to answer the bloodwork question. The lowest priced plan is like 400 bucks. Off the top of my head like a 7 k deductible. I will not meet that per year. And regardless, in a few months I might could to even afford that. The only thing the girl told me with fidelis I think it was yesterday was, she thought maybe that they would cover my t shots if I visited my dr for them every time. My primary will not treat me because she messd me up to start with. My trt dr is in Florida. The next closest one might be in NYC. I am on two shots a week, that makes no sense at all.
GettingAnswers
Member
Tm, it seems like you are dealing with separate issues or at least maybe you should look at it that way. One is health insurance for just about everything and the next is for TRT. If TRT is not covered by a plan then you really aren't out that much. Most of the labs should be covered by insurance. The testosterone is really not expensive. As I and others have said go to Goodrx and it is as cheap as $40 for a vial that will last you months. If you want HCG then no insurance plan will cover it and you will have to come up with it. Aromatase inhibitor are cheap if your doc will write a script.
I guess what I am saying is that even without coverage for TRT you can still get the test for like $15 a month.
Sorry if I am misinterpreting any issues you are having and good luck.
I guess what I am saying is that even without coverage for TRT you can still get the test for like $15 a month.
Sorry if I am misinterpreting any issues you are having and good luck.
If I had a local dr, it might work. But even if i did, they are telling me nothing connected with trt will be covered. Can't make this stuff up. As I said, I have seen a leukemia patient denied meds. Maybe it is just NY. But I still cannot afford to she'll out that much money for health insurance that is useless. It cover nothing but a catastrophe.
Nelson Vergel
Founder, ExcelMale.com
tmckenzie
Check out www.lowtestosterone.com and also email the folks at DefyMedical (Jbruce@defymedical.com) to compare cost of their programs.
I am assuming you tried this site and asked about formulary: https://nystateofhealth.ny.gov/individual
Check out www.lowtestosterone.com and also email the folks at DefyMedical (Jbruce@defymedical.com) to compare cost of their programs.
I am assuming you tried this site and asked about formulary: https://nystateofhealth.ny.gov/individual
Nelson, using defy already. Yes, talked to the state people. Then went on to find out what is really being covered when I talked to the two insurance companies aavailable to us in this county. I may be mistaken, but I thought the act was going to open the market up so that you had more choices. We have fewer choices now.
Markee
Member
My health coverage started on the first of March with Coventry Florida. Very cool I haven't had coverage for most of my adult life maybe 30yrs 
Anyways Labs are covered 100% through Labcorp Test Cyp is on there covered meds list with a $15 copay to me both covered as long as they runs through my listed primary doctor which is not a problem.
The problem is HCG its not on the covered med list. My doctor has no problem prescribing it and I've been using it as part of my HRT for maybe 10yrs already. I hear its possible to request and get your the insurance company to cover none listed meds and they will if you can show them good medical reasoning for prescribing it. For instance most insurance companies won't cover ED meds for ED issues but they will if prescribed for prostate treatment.
So my question is what would be some good solid medical reasoning that can could work to get my insurance to cover HCG ???????????
Anyways Labs are covered 100% through Labcorp Test Cyp is on there covered meds list with a $15 copay to me both covered as long as they runs through my listed primary doctor which is not a problem.
The problem is HCG its not on the covered med list. My doctor has no problem prescribing it and I've been using it as part of my HRT for maybe 10yrs already. I hear its possible to request and get your the insurance company to cover none listed meds and they will if you can show them good medical reasoning for prescribing it. For instance most insurance companies won't cover ED meds for ED issues but they will if prescribed for prostate treatment.
So my question is what would be some good solid medical reasoning that can could work to get my insurance to cover HCG ???????????
I am not sure about the hcg, but I am curious about how the healthcare act in Florida. Not being nosey, but how many providers did you have to pick from? Are you happy with what you get for the price pu are paying? I gave up trying to get insurance, it is just not affordable here in NY. I have began to have migraine headaches. Me and my dr was talking as she wants an MRI performed. She said she had hoped more people would get help. Instead she is seeing more middle class patients come in and have no insurance, where they used to have it. Amazing. I wish I could afford the MRI, but I will just have to go without.
Markee
Member
Want to bump this up hoping someone can give me some advice here anyone ???????
My health coverage started on the first of March with Coventry Florida. Very cool I haven't had coverage for most of my adult life maybe 30yrs
Anyways Labs are covered 100% through Labcorp Test Cyp is on there covered meds list with a $15 copay to me both covered as long as they runs through my listed primary doctor which is not a problem.
The problem is HCG its not on the covered med list. My doctor has no problem prescribing it and I've been using it as part of my HRT for maybe 10yrs already. I hear its possible to request and get your the insurance company to cover none listed meds and they will if you can show them good medical reasoning for prescribing it. For instance most insurance companies won't cover ED meds for ED issues but they will if prescribed for prostate treatment.
So my question is what would be some good solid medical reasoning that can could work to get my insurance to cover HCG ???????????
Nelson Vergel
Founder, ExcelMale.com
I doubt that any insurance company will cover HCG unless you can have a medical necessity letter that says you are using to enhance fertility. But even that will not guarantee coverage.
Here are the indications for HCG: http://allthingsmale.com/pdfs/hcg.pdf
To be honest, I would not waste my time fighting insurance companies (well, not your time but your doctor's) and instead I would buy it for $75 for 11 week supply from any compounding pharmacy like aps.meds or empowerrxpharmacy.com
Here are the indications for HCG: http://allthingsmale.com/pdfs/hcg.pdf
To be honest, I would not waste my time fighting insurance companies (well, not your time but your doctor's) and instead I would buy it for $75 for 11 week supply from any compounding pharmacy like aps.meds or empowerrxpharmacy.com
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