TRT typical cost and insurance coverage?

**Cruzmeyers** · 01-04-2012, 08:28 AM

Hey I'm new here, I use to cycle deca and Sust. I would get my gear from mex since I lived on the border. I just moved to SLC and have no connections. I am considering TRT but it seems fishy to me. I find that all of the clinics I have researched do not accept insurance, some say you can send the bill to the insurance company. Is there something I should look for in a med ins policy that will cover this? If so what is needed as I am currently shopping around for policies. Also, what are typical prices for a initial exam, blood work, prescriptions, follow ups, etc...? I find they range from 500 to 1000 dollars for the initial exam and then run a few hundred dollars a month for prescriptions and follow ups. Does that seem right? Thanks

**Times Roman** · 01-04-2012, 08:32 AM

I have kaiser, and my copay covers my test. it is very nominal

**Cruzmeyers** · 01-04-2012, 09:06 AM

Awwe Kaiser, I use to be insured by them when I lived in Cali, unfortunately Utah is outside there coverage area. How hard was it for you to go through their process of being diagnosed with lowT? Was this treated by your personal Dr. or did you have to see a specialist? I only ask because it took me 3 months to see a nephrologist over some kidney issues.

**SEOINAGE** · 01-04-2012, 02:30 PM

Sounds typical of utah clinics to try and rip you off like that. there have been a few posts about price on this board that are fairly recent topics.

**yannick35** · 01-04-2012, 04:17 PM

Testosterone delatestryl is 33$ for 5ml without coverage, my insurance covers this so i pay 9$ for 5ml. I take 100mg per week so that last me 10 weeks, cheaper then creatine.

I live in Canada not sure what the US pricing is or coverage. Also deca will be prescribed but to people who have cancer and HIV it is not used for TRT right now.

**Bill_boy2005** · 01-04-2012, 05:39 PM

Originally Posted by Cruzmeyers

Awwe Kaiser, I use to be insured by them when I lived in Cali, unfortunately Utah is outside there coverage area. How hard was it for you to go through their process of being diagnosed with lowT? Was this treated by your personal Dr. or did you have to see a specialist? I only ask because it took me 3 months to see a nephrologist over some kidney issues.

I am from SLC as well. I ended up going to the U o fU hospital Urology department after getting a very low test result from my GP. After all the screening for bad possibilities, Dr. Lowe started me on TRT the day of my visit, and gave me a large bag of Cialis (seemed she focused on my wifes "pain" more than mine). I raised the question of hcg and an AI, but she will not budge and suggested that I go to the endo there at the U, Dr. Miekle. I have opted to skip the endo and am in Lansing for an appt with Crisler tomorrow.

As a note, I am on BC BS and they are paying for my current testosterone and have paid all tests and lab work so far. I am paying Crisler out of pocket, but will send the bill to the insurance company, hes not a preferred provider, but I may beable to get some of that back, and the meds and labs will be covered according to the insurance rep.

**kelkel** · 01-04-2012, 06:29 PM

Great BB! Post up as soon as you can please....

**zaggahamma** · 01-04-2012, 07:29 PM

rare for insurance to pay for hrt through a anti aging clinic...i heard of it but rare

**Bill_boy2005** · 01-04-2012, 07:36 PM

Originally Posted by jpkman

rare for insurance to pay for hrt through a anti aging clinic...i heard of it but rare

I'm hoping the rep was right. I'll know soon enough I guess.

**gmantheman** · 01-04-2012, 09:32 PM

I pay out of pocket. If I remember correctly, they charge $975 per. year for injections and that includes blood work.

**HRTstudent** · 01-05-2012, 01:45 AM

insurance will probably pay the vast majority for T injectable. it's been around forever. testim is pricier and I believe around $150 a month before insurance. androgel is cheaper I believe, but nowhere near as cheap as injectable.

not sure on the bloodwork and visits to the doc because I have insurance. but I do have $20 copay for each visit and bloodwork is no extra charge because it's necessary.

**zaggahamma** · 01-05-2012, 06:44 AM

Originally Posted by hrt

insurance will probably pay the vast majority for T injectable. it's been around forever. testim is pricier and I believe around $150 a month before insurance. androgel is cheaper I believe, but nowhere near as cheap as injectable.

not sure on the bloodwork and visits to the doc because I have insurance. but I do have $20 copay for each visit and bloodwork is no extra charge because it's necessary.

are you saying that even if he goes to an anti aging clinic?

**kelkel** · 01-05-2012, 07:45 AM

When I was on agel 1.62% x 6 pumps per day it cost my insurance over 1k per month. I used to look at the receipt every month where it said "your insurance saved you $1,028.00" and just say damn! For what I'm saving them using cyp they should be sending a hot nurse over twice a week to assist me! My .02!

**lvs** · 01-05-2012, 08:56 AM

recently switched myself and yes over $300 per bottle and 1 bottle is only good at 2-pumps per day for 1 month. really can't believe the cost of the gels. Funny thing is my insurance doesn't cover the t-cyp at all at $96 for 10-weeks. I am still waiting for the nurse assistance myself!

Originally Posted by kelkel

When I was on agel 1.62% x 6 pumps per day it cost my insurance over 1k per month. I used to look at the receipt every month where it said "your insurance saved you $1,028.00" and just say damn! For what I'm saving them using cyp they should be sending a hot nurse over twice a week to assist me! My .02!

**HRTstudent** · 01-05-2012, 12:03 PM

Originally Posted by jpkman

are you saying that even if he goes to an anti aging clinic?

I frankly have no idea. To the insurance company I would think this depends entirely on how the clinic codes/bills for the Rx. I say that because if it's medically necessary and approved usage then why oh why would an insurance company not pay? You might have to submit the paperwork yourself but that just means they will send you a check instead of to the doctor.

Also, going out of pocket with T injectable is probably the best bet if money is a major concern. Worst case scenario here and you will be out of pocket for about 100 dollars. That's not bad for 10 weeks of treatment.

At the end of the day, I don't think money can be a major concern if you're in a first world country and you legitimately suffer day to day from the symptoms of low T.

**sirupate** · 01-05-2012, 01:02 PM

My health insurance pays for most of my doctor (endo or urology) bills related to TRT. I just pay a fairly low co-pay for office visits and a bit more of a co-pay for bloodwork. Pharmacy insurance covers a good bit of my gel scrip....well, it is just a co-pay really. If TRT is shown as medically needed...I'll be covered.

Just FYI...I called a local Bodylogic "franchise" for information. They do the whole bioidentical hormone thing. They don't accept insurance, but will give you a superbill so you can try to recover from your insurer. They charge $625 for an initial (and fairly extensive) male panel. The first hour with the doctor is about $395. The send their scrips to a compounding pharmacy...don't know how much that would run. This is too expensive for me right now, so am looking at a local urology practice as a next choice.

**zaggahamma** · 01-05-2012, 04:31 PM

Originally Posted by sirupate

My health insurance pays for most of my doctor (endo or urology) bills related to TRT. I just pay a fairly low co-pay for office visits and a bit more of a co-pay for bloodwork. Pharmacy insurance covers a good bit of my gel scrip....well, it is just a co-pay really. If TRT is shown as medically needed...I'll be covered.

Just FYI...I called a local Bodylogic "franchise" for information. They do the whole bioidentical hormone thing. They don't accept insurance, but will give you a superbill so you can try to recover from your insurer. They charge $625 for an initial (and fairly extensive) male panel. The first hour with the doctor is about $395. The send their scrips to a compounding pharmacy...don't know how much that would run. This is too expensive for me right now, so am looking at a local urology practice as a next choice.

definitely a super bill
lol

**Bill_boy2005** · 01-06-2012, 07:33 PM

BCBC covered my HCG from Crisler. $10 copay on my plan. I do see that the FDA has it listed as a treatment for hypogonadism, so I am sure that helps not being off label. So test and hcg are covered for me, I will see what they pay of Crisler's bill and let you all know.

**injured1** · 04-07-2013, 11:23 PM

Originally Posted by Bill_boy2005

BCBC covered my HCG from Crisler. $10 copay on my plan. I do see that the FDA has it listed as a treatment for hypogonadism, so I am sure that helps not being off label. So test and hcg are covered for me, I will see what they pay of Crisler's bill and let you all know.

Any updates?

**VTX1800** · 04-08-2013, 10:25 AM

I go to an anti aging dr. That won't accept insurance. I have anthem and I send my bill with claim form to them, they cover the test cyp. But that's it. They gave me some 2 month supply bs about the hcg , clomid and anastrozole. I'm still waitin to see how much they will cover on the office visit. Cost me $175 for in house visit blood work is extra.
I'm going to Pcp who has me on androgel today and hopefully can convince him to switch me to injectables and Add hcg so that way everything is covered by insurance and I won't have to go back to the anti aging dr. In 6 months. I've printed off Crislers protocol and hcg write up, hopefully he will be willing to work with me. But he did tell me that testosterone will not lower my sperm count, lol he obviously isn't in the "know" regarding TRT.

**HRTstudent** · 04-08-2013, 02:01 PM

Originally Posted by Bill_boy2005

BCBC covered my HCG from Crisler. $10 copay on my plan. I do see that the FDA has it listed as a treatment for hypogonadism, so I am sure that helps not being off label. So test and hcg are covered for me, I will see what they pay of Crisler's bill and let you all know.

What version of BCBS do you have? Like BCBS of ____ .

**tm123** · 04-09-2013, 01:48 PM

I got lucky and found a doctor who is totally on board and in the know about TRT. He's not in my network, so I pay out of pocket for the visits, but prescriptions for test cyp are covered as is arimidex . test is $5.00 per 10 mL and Arimidex is like $9.00 for a 3 months supply or something silly like that. I do use a flexible spending account to pay for the doc visits, so at least they're tax free.

**riotz0r** · 04-09-2013, 02:56 PM

After more research and phone calls then I care to talk about I believe I have come up with an answer that helped me and could help others as well. TRT is covered under my HSA account and as long as I am billed under medical code 96372(injections) my insurance will cover it. I have spoke with lowt.com and they have assured me I could be billed under medical code 96372. So if anyone is wondering if TRT is covered under their insurance, find out if your insurance covers medical code 96372(if they want the CPT number its 257.2).

I posted that about a week ago in another forum, let me know if it helps.