My Testosterone is Low But Insurance Does not Want to Pay.

[Wingy]

I have a total score of 245. My insurance won't cover trt till I'm under 200. I'm 48 yo relatively healthy. I understand I should be in the 500-700 range for my age. Anybody else have insurance problems?

 

[Systemlord]

The problem with insurance isn't just about getting covered, it's about finding a doctor who knows what their doing. My co-pay is only $3 for 12 weeks worth of test cypionate and labs are covered, but doctors know next to zero about how to manage my hormones and refuse estrogen management which is essential for some on TRT. Let's say by some miracle your insurance pays for TRT, then you'll likely have to go through several doctors before you find one with half a brain that doesn't look at you like a deer in headlights who tried to understand but doesn't.

Then you'll come to the realisation that you must leave your health insurance and pay out of pocket for proper care. We pay through the teeth and get doctors who have no idea what their doing, so insurance is good for what? Common cold, broken bones, but not TRT. There are 90 year old men with higher levels than you, you don't want to wait this out until you hit 200 do you?

Why don't you skip plan A and move on to plan C and save yourself from wasting valuable time dealing with incompetent doctors only realizing 3 years from now you should have gone with plan C from the get-go and go self pay.

You have really sh*tty insurance! The endocrine society considers hypogonadism to be under 300, seems like insurance companies are deciding instead of doctors these days removing the doctors ability to do his/her job. It's no wonder doctors are leaving the sick care model, they must in order to provide proper care for their patients. This is why there are other options like Defy Medical, proper care is always better when we are paying for it.

My sh*tty insurance covered me at 225, but I was in very bad shape and had developed anemia, high blood pressure, elevated heart rate, muscle wasting in a short amount of time and insurance did what it had to do to mitigate future healthcare costs down the road that were a guarantee to cost them dearly if they did nothing.

 

[captain]

I been getting labs paid by insurance for years and my last labs bill came back not paid with not medically necessary on it. It don't state what part is not necessary but clearly says what I have to pay.

 

[Vince Carter]

The real only way to go about TRT is out-of-pocket and the prices can vary wildly amonst providers with Defy Medical having the very best cost structure. Fooling with insurance will get you nothing but headaches.

 

[Nelson Vergel]

Wingy

Your doctor can fax a prescription to www.EmpowerPharmacy.com or another compounding pharmacy for a testosterone cream or injection. You can also use www.GoodRx.com. Their price is low and you don't have to go through your insurance. Also, if insurance does not want to pay for your week 8, 16 and 24 blood test follow up, you can use www.DiscountedLabs.com and buy the tests yourself.

Testosterone creams run about $40-50 per month. Injections about $30 per month (dose dependent). HCG about $70 for 11 weeks. Blood test panels :

TRT Follow up (week 8 and possibly week 16 if you change doses, etc)

After everything is stable this panel is all you need every 3-6 months

 

[Saxon]

I have a total score of 245. My insurance won't cover trt till I'm under 200. I'm 48 yo relatively healthy. I understand I should be in the 500-700 range for my age. Anybody else have insurance problems?

If your Doc will write your prescription, just pay it out of pocket. Test Cyp is $40 per 10ml vial of 200mg/ml. Why would you even wait for the insurance to "cover" that? Adex: $5 for #12 1mg pills.

 

[Nelson Vergel]

Financial Assistance for Testosterone (injections,Androgel, Testim, Fortesta, Axiron)

 

[Wingy]

Thanks for all the great info. I will look into them.

 

[Nelson Vergel]

How much health insurers pay for almost everything is about to go public

New government rules are forcing insurers to post on websites what they pay for care or be fined, allowing consumers and employers to comparison shop for health services or negotiate better rates.

www.npr.org

 

[Drug350]

I have a total score of 245. My insurance won't cover trt till I'm under 200. I'm 48 yo relatively healthy. I understand I should be in the 500-700 range for my age. Anybody else have insurance problems?

I just went through a similar situation, but my numbers all came back below 200 NGDL so insurance is covering everything. My Urologist / endocrinologist told me there's only one high profile medical society that uses "200 NGDL", whereas every other nationally recognized medical society and US Govt use "300 NGDL" as the bottom, and even "350 NGDL". The insurance companies care about only one thing: maximizing profits. It sucks.

 

[jayt]

I have a total score of 245. My insurance won't cover trt till I'm under 200. I'm 48 yo relatively healthy. I understand I should be in the 500-700 range for my age. Anybody else have insurance problems?

fuck insurance.... use Good RX sing up for an account and use it for all your prescription drugs... CVS or Walgreens accepts it.

 

[Systemlord]

According to endocrine and AUA guidelines, @Wingy qualifies for TRT whether insurance covers it or not.

 

[Drug350]

The reason I chose to use use my insurance, rather than pay monthly, isn't because of the costs of the "testosterone cypionate". That's relatively inexpensive. But the doctors visits and blood work can really add up, especially initially while getting set up. Plus, if I decide I want to switch to say "pellets" or "patches" or if a brand new delivery system comes out, my insurance will cover it, which could be thousands of dollars each and every month. With paid Wellness Clinics, other testosterone options are pretty much off the table because of costs. If you can find a good doctor who knows what they're doing, why not go through insurance, if you have it, and if they'll pay for it ??? It's pretty much "lifetime", which for many could mean 20 - 40 year's on Testosterone. That could definitely add up in the end going through monthly Wellness Clinics paying out of pocket. I understand for many, maybe even most, insurance isn't an option because they don't want to cover unless you test ridiculously low, sub 200 NGDL, but for those of us who live near large cities, with lots of doctor choices, and get insurance to cover everything, it's pretty easy decision.