TRT & Insurance Coverage: Sexual Dysfunction

[tempest2003]

Hey all, ive recently been written a test script for sexual dysfunction. i feel like my doc is not doing me any favors. My insurance wont cover it due to it being related to sexual dysfunction. Now my pharmacy and everyone who works there knows WHY im getting it because the pharmacist had to read it out loud to me as to why my insurance wouldnt cover it.... talk about embarrassing. Anyhow, i believe in the US you have the right to amend your health records, which i am considering trying to do so that i can get insurance to cover my script at least partially.... any advice or input would be appreciated.

currently paying around $110 for 200mg/ml 10ml vial. it adds up in a hurry

 

[Swopemaster]

Tell Dr. to write symptoms as "Hypogonadism".

 

[newtotheaasworld]

True you could rewrite it but he already made a diagnosis. Perhaps another doctor in your plan can give a "2nd opinion" of Hypogonadism.

BUT $110 would be a 10 week or 2 1/2 moth supply were talking $11 bucks a week. Just kill 2 visits to McDonalds and you have it covered

 

[Arabian]

Did you actually go to a HRT doctor for this script or your regular doctor. My insurance covers mine because I received a referral from my primary care physician and then was given a blood test from my HRT doctor showing my test levels were low. He then wrote a prescription for Cypionate in which my insurance covers. You have to have a deficiency before an HRT doctor will actually treat you however almost all HRT doctors treat male sexual dysfunction. Another thought , is you could call your insurance company and ask them directly what you need to do, or the diagnosis you need for them to reimburse for it. I would see if I could get a referral and go to a real HRT doctor. BTW: $110.00 is nothing for a script for something that can do so much for you. What dose are you on? 250 mgs per week? They also offer Androgel and Pellets that are implanted under the skin that is a slow release form of Test.

 

[glimmerman70]

LOL...I only laugh because the same thing happened to me...my doctor diagnosed me with Hypogonadism...my insurance didnt wanna pick up the bloodwork that had to be done bi-monthy...200 bucks a pop..doctor didnt know why because she diagnosed me with Hypogonadism...but insurance kicked the bill back to me and said they didnt cover sexual disfunction or sex changes...I had to call the lab and the insurance several times to explain that it wasnt the case...it all came down to how the blood work was submitted with the ICD-9 codes..they had it coded as 302.74 which is sexual disfunction...it needed to be coded as 302.74 with 257.2 with it...the 257.2 is a explaination of the original code..have been back and forth with the lab on the last bill for 3 months because they keep forgetting to add the last code..perhaps its the way they are coding it...The way it turned out for me was that my perscription would only cost me 10 bucks for the bottle 10cc of cyp..but doc didnt wanna let me do my own shots even though I used to be a state certified EMT...and insurance wouldnt cover the doctors visits for the injections or injection fees...so I had to take matters into my own hands..insurance sucks..

 

[Headholio]

It should be easy to resubmit with the right code and have it covered. I had a similar experience with a homocysteine lab test. Insurance (Aetna), didn't cover it. I asked why. They told me it wasn't covered when tested as a marker for cardiovascular risk, but is covered if you have some disease that causes high homocysteine. They told me if the charge was resubmitted with the right code, it would be paid. The people handling the billing don't give a crap what's going on with your health, they just follow the rules of their job. Give them the right code, they give you the cash.

Switch: I am a new member and found this thread because I am thinking about TRT and was wondering about insurance coverage. It sounds like there are a lot of potential costs. I would like to hear what other people's experiences have been with insurance coverage, specifically;
Coverage of Dr. visits, lab testing, follow up testing, how often can you get follow up tests etc.
Coverage for the drugs; test, AI, hcg, etc.

Thanks.

 

[stevesmi]

my best advice is don't go on TRT... your body produces test on its own for free. so why pay to replace it ?

what are your levels? what is your lifestyle? how old are you? do you do deadlifts/squats? that will release hormones in the body naturally.

maybe we can work on getting your natural levels up so you can delay going on till later. i know this isn't the advice you want to hear but i believe in fixing the root problem first ... i hate to see guys go on TRT then later on regret it and try to get back to natural T production.. .its very difficult to turn back once you open that can of worms

you want to avoid going on TRT as much as possible, I plan on not going on till atleast 55 or even 60.

also boosting your testosterone levels will not always cure your ED issues. a lot of times there are other factors besides low test that are contributing to the problem. stress, work, lifestyle choices, et.c