HCG Coverage : Insurance Appeal, please help!

Gokk

New Member
Dear All,
This year my insurance has denied coverage of HCG (while they covered it last year). They introduced new requirements, specifically they wanted to see the results of blood work prior to the start of TRT. In such blood work my total testosterone was 288ng/dL with a lab range of 270-1070. They say that because my result was within the lab range I cannot claim to suffer from low testosterone!
I am now preparing my appeal which is based on the following key points:

1) even though my result was indeed within the lab range (which is just a statistical figure and not the result of clinical assessment) such result was well below the 300ng/dL threshold which is generally considered the cut-off value for the diagnosis of Hypogonadism.

2) following the above test, I arranged on my own, through discounted labs, another test (which was not shown to my insurance) performed at a Labcorp lab, and this time my result was 292ng/dL, higher than in the previous case but well outside the lab's normal range: 348-1197.

While I do think that point 2) above should be sufficient to overturn the initial decision of my insurance, I am trying to compile a list of references to support point 1) above. I have already found quite relevant material (for instance the Endocrinology Guidelines for the diagnosis of Hypogonadism where they confirm 300ng/dL as the cut-off value).

I would therefore be very grateful if you could please point out any relevant study which I can cite in my appeal to support the thesis that 300ng/dL is indeed generally considered the cut-off value for the diagnosis of "Low Testosterone" (together with the assessment of symptoms of course).

Thank you very much for your help
 
What is your copay? You can bypass insurance and buy 11,000 IU for about $80-100 from compounding pharmacies.


With insurance you have to proof of one of these diagnoses:

1. Prepubertal cryptorchidism not due to anatomic obstruction. In general, HCG is
thought to induce testicular descent in situations when descent would have occurred at
puberty. HCG thus may help to predict whether or not orchiopexy will be needed in the
future. Although, in some cases, descent following HCG administration is permanent, in
most cases the response is temporary. Therapy is usually instituted between the ages of 4 and 9.

2. Selected cases of hypogonadotropic hypogonadism (hypogonadism secondary to a
pituitary deficiency) in males.

3. Induction of ovulation and pregnancy in the anovulatory, infertile woman in whom the
cause of anovulation is secondary and not due to primary ovarian failure, and who has
been appropriately pretreated with human menotropins.
 
Last edited:
reliablerx is the place to go.

Isnurance isn't worth fighting them over when you can get it plenty of other places like this or compounding pharms like Nelson stated. You can do an HCG support program thru Defy they're prices are $40/5000iu, or $70/10000iu
 
Agree with all above. Factoring in copays and the hassle of struggling with the insurance company (which may turn out to be an ANNUAL battle), there are much better options available.
 

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TRT Hormone Predictor

Predict estradiol, DHT, and free testosterone levels based on total testosterone

⚠️ Medical Disclaimer

This tool provides predictions based on statistical models and should NOT replace professional medical advice. Always consult with your healthcare provider before making any changes to your TRT protocol.

ℹ️ Input Parameters

Normal range: 300-1000 ng/dL

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Results will appear here after calculation

Understanding Your Hormones

Estradiol (E2)

A form of estrogen produced from testosterone. Important for bone health, mood, and libido. Too high can cause side effects; too low can affect well-being.

DHT

Dihydrotestosterone is a potent androgen derived from testosterone. Affects hair growth, prostate health, and masculinization effects.

Free Testosterone

The biologically active form of testosterone not bound to proteins. Directly available for cellular uptake and biological effects.

Scientific Reference

Lakshman KM, Kaplan B, Travison TG, Basaria S, Knapp PE, Singh AB, LaValley MP, Mazer NA, Bhasin S. The effects of injected testosterone dose and age on the conversion of testosterone to estradiol and dihydrotestosterone in young and older men. J Clin Endocrinol Metab. 2010 Aug;95(8):3955-64.

DOI: 10.1210/jc.2010-0102 | PMID: 20534765 | PMCID: PMC2913038

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