allready on testosterne therapy

[mranak]

Regarding insurance, I've always been a low normal level test range person, a recent blood work done revealed that my test level was 197ng/dl...I called my insurance company with the paperwork from the bloodtest to support my request to have the insurance company pay for my HRT/TRT...the insurance ask me if there was an underlying medical issue, I said the doctor said no. The insurance company said then it's not a medical necessity and would not cover it. I have a PPO insurance company, one of the biggest in the U.S. Mine is simply low due to me being a low test production kind of guy and even lower now since I am getting older.

Wrong answer. Medical insurance only covers medical issues... no surprise. The underlying medical issue is hypogonadism. The root cause of that hypogonadism is unknown.

When you asked your insurance company to pay for your TRT/HRT, what exactly were you trying to get them to cover? The visit to the doctor and the bloodtest that you already had at that point? Or just the prescription for the testosterone ? Is the physician in network?

PPO insurance is usually pretty good. Most guys don't have problems with a PPO plan for TRT. HMOs are a whole different story.

[Knight1811]

Wrong answer. Medical insurance only covers medical issues... no surprise. The underlying medical issue is hypogonadism. The root cause of that hypogonadism is unknown.

When you asked your insurance company to pay for your TRT/HRT, what exactly were you trying to get them to cover? The visit to the doctor and the bloodtest that you already had at that point? Or just the prescription for the testosterone ? Is the physician in network?

PPO insurance is usually pretty good. Most guys don't have problems with a PPO plan for TRT. HMOs are a whole different story.

Mranak,

The insurance company went on some BS explanation about "medical necessity." They claimed it is not a medical necessity so I'm screwed. Period. I raised he!! and to no avail. So, I skipped the treatment aspect of it. Rat bastards they are. I was under the misconception also that PPOs were good ....but the longer I am PPO, the more I wonder why I pay almost 5 times the amount my coworkers are paying for simple HMO.

On another topic, what experience do you have or knowledge in relations to HRT/TRT? I'm curious.

[JohnnyB]

Mranak,

The insurance company went on some BS explanation about "medical necessity." They claimed it is not a medical necessity so I'm screwed. Period. I raised he!! and to no avail. So, I skipped the treatment aspect of it. Rat bastards they are. I was under the misconception also that PPOs were good ....but the longer I am PPO, the more I wonder why I pay almost 5 times the amount my coworkers are paying for simple HMO.

On another topic, what experience do you have or knowledge in relations to HRT/TRT? I'm curious.

Your Dr needs to appeal it and send them medical reason you need it. I went through the samething and got it in 2 weeks, your Dr should know how to do it. If you test is below normal, it's a medical need, if it's not, it's not medically needed

JohnnyB

JohnnyB

[anabolicbruce]

Mranak,

The insurance company went on some BS explanation about "medical necessity." They claimed it is not a medical necessity so I'm screwed. Period. I raised he!! and to no avail. So, I skipped the treatment aspect of it. Rat bastards they are. I was under the misconception also that PPOs were good ....but the longer I am PPO, the more I wonder why I pay almost 5 times the amount my coworkers are paying for simple HMO.

On another topic, what experience do you have or knowledge in relations to HRT/TRT? I'm curious.

Mranak was one of the mods on Dr. Crisler's (SWALE) TRT forum. He is very knowlegable in regards to TRT in males. I back all of his statements, along with Jonny B's statements.

As the Senior patient consultant at an Anti-Aging clinic, I see much confusion when it comes to the difference between HRT and and cycling AAS. I have sat in front of, and consulted plenty of 20 yaer olds that want to "go on test" and/or various other compounds without even seeing their labwork. This grey line, and Dr.s like Oldman's doc is what will close down all these clinics, whose real purpose should be to treat disease (hypogonadism) and improve patient health.

[mranak]

As the Senior patient consultant at an Anti-Aging clinic, I see much confusion when it comes to the difference between HRT and and cycling AAS. I have sat in front of, and consulted plenty of 20 yaer olds that want to "go on test" and/or various other compounds without even seeing their labwork. This grey line, and Dr.s like Oldman's doc is what will close down all these clinics, whose real purpose should be to treat disease (hypogonadism) and improve patient health.

Yeah, appropriate HRT can really make a tremendous and healthy impact on the lives of those that need it, but abuse isn't helping the cause.

btw: Thanks for the kind words.

[mranak]

The insurance company went on some BS explanation about "medical necessity." They claimed it is not a medical necessity so I'm screwed. Period. I raised he!! and to no avail. So, I skipped the treatment aspect of it.

Is it just the prescriptions that thay won't cover? 10mL of testosterone cypionate will last many guys for 20 weeks. As far as prescriptions go, it is a pretty good value.

My insurance covered the testosterone no problem, but the hCG was only covered at 50% because fertility and ED meds are only covered at 1/2 on my policy, and hCG is commonly used for reasons of fertility. So I understood what happened and figured I could easily remedy the situation by providing the necessary information: that I was using hCG for hypogonadism and not fertility. I got back a letter than their head pharmasict said hCG wasn't indicated for hypogonadism. Seeing as hypogonadism is listed on the package insert for hCG, I sent them a letter that put that pharmacist to shame.

So then they said that I was using the hCG for the ED aspect of hypogonadism and therefore it was properly only covered at 50%, which is BS because hypogonadism by itself is a legitimate medical diagnosis in and of itself. So I got a note from my doctor that I am being treated for hypogonadism for depression (which is true. The TRT cured my depression). About to send that in. The entire process has taken over six months thus far, but they are in the wrong so I'm not giving up until my options have run out.

Anyway, yeah, the insurance companies asses are tightening up like never before. On the other hand, the cost of medical insurance continues to increase, which is blamed on rising medical costs. The truth of the situation is a mixed bag.

If you need TRT, then do whatever you need to do to get it. Living with low testosterone isn't right and it isn't healthy.