HRT or TRT with Blue Cross Blue Shield

[tarponowski]

Good morning all, new to the board.

I have looked through the forums and have found very little info about insurance covering HRT. I know most HRT clinics do not accept insurance. I am in Texas and was wondering if anyone with Blue Cross could point me point me in the right direction? A Texas doctor is not a must. I pay a small fortune for insurance and would like to let them cover my TRT. Insurance covered all my initial blood work but I would like for them to pick up the rest of my therapy as well.

On a side note, I have been talking to a compounding Pharmacy and if I go that route I would have to cover the meds up front and then file my own insurance reimbursement. Has anyone had any luck collecting in this manner.

Thanks in Advance.

 

[Zyglamail]

Just look through your blue cross website for the dispensory and see if there is test in it, if there is they likely will cover it but it will have to be through a general doc or endo.

Sourcing legit test through a pharm isnt the hard part you will still need a script if you go through a compounding pharm. Most regular docs start you on horribly low doses and long intervals which generally makes you fee worse. They also usually want to inject you themselves requiring expensive office visits for nothing.

 

[tarponowski]

Thanks for the information. I guess I will just keep trying different doctors in the Houston area until I find one that will work with me. Would I have better luck with an Endo than a GP? Anyone on the board have a good GP or Endo they use in the Houston area?

Thanks in Advance.

 

[Stillgoing]

Alot of compounding pharmacies will not directly bill insurance companies. You have to buy it first and submit it to them. If it is covered, you will get reimbursed. The best way to handle it is call the insurance company and ask them if they cover compounded medication. You can also check the medication exemption list they you should have received with your annual enrollment process. If they don't cover it, get a pre-authorization form, which your doctor will fill out and send to your insurance company.

The HRT clinics in Houston are a scam. Call the compounding pharmacy you are working with and they will give you a list of doctors that they work with that take BCBS. Go with a doctor or a clinic that works on hormone replacement but not one of those boutique HRT only clinics. They were also started by one doctor and spread throughout Houston and they gouge you.

Also, worst case, if its not covered you can submit to your HSA or FSA medical reimbursement plans.

Finally, PM on the way of a compounding pharmacy in Houston area that we like.

 

[gman773]

It took me a few docs to find one that would give me a script and let me pin myself. Just started actually (only been a week). I am having a hell of a time with insurance - they will cover it but only in one month supply so a 10ml vial is not allowed. I have to get two 1ml vials every month... thinking of supplementing with some test though other avenues. They are actually not charging me anything for the 2 1ml vials (so far) - I'll see what happens next month but it's harvard pilgrim not BCBS. Keep searching for a regular doc or see if there are any sexual function urology specialists in your area.

 

[theemperor]

Everyone of you has said many true things here. Its very difficult to have coverage on BCBS for HRT, and I was told by last Doc that alot of the times it depends on how the Doctor's office gives the "procedure code" meaning it has to be a code that BCBS accepts in order for us to be qualified for coverage. So, its a circus and can be frustrating. Too much to talk on this subject, political, competition in the area, scammers, liars, and gougers!!!

 

[sunnycali]

I have BCBS and get regular scripts every month (one 10ml vial per month test cyp 200mg.ml). I don't go to an HRT clinic, just regular doc. He writes my script and it is filled usually with Watson 10ml bottle. I pay 10 bucks a month. He has no problems with my own pinning.

I have a great insurance plan though... Pharmacy is also great and always keep bottles in stock. I am on 200mg every week. For 10 bucks a bottle, can't complain. Of course check your insurace coverage.

Also, I have a friend who gets a script for androgel and hates it! For me pinning is the only way to go, and compounding is hard to get any insurance to pay for.

Best of Luck!

 

[theemperor]

That is a true blessing ^^^^

 

[bluecross-blue-shield]

You may try bluecross blue shield
for gather knowledage about insurance
bluecross-blue-shield.org

 

[ChemWiz]

Good luck! They would not pay for mine.