Insurance help, code info?

**VTX1800** · 03-25-2013, 06:17 AM

Hey guys, can anyone possibly help me out here. I have anthem blue cross in GA, My meds were filled at a compounding pharm in Florida ACS. The pharmacist sent a claim form he signed for each script so I turned it in to insurance and they sent me a check for $28, lol total was $238 for. 2 month supply and that included overnight Saturday shipping.

Basically Im wondering what I need to have my doctor do about getting my meds covered. I was diagnosed under Secondary hypogonadism, and I think my insurance company doesn't know this. That's why they didnt cover more of the meds. Should I have my dr. Call them or write a letter that includes my diagnosis and BW?
I have good insurance and I pay ALOT for it so Id prefer to try and use it since Im on this for life. Any tips or suggestions are as always...Greatly appreciated.

**Moparman** · 03-25-2013, 06:21 AM

First thing to do is call your insurance co and ask what's up. Many times they won't cover testosterone so maybe they are paying for other things like the needles or anastazole.

Sometimes they only pay a portion of a claim. U need tO call and ask

**lovbyts** · 03-25-2013, 06:52 AM

I bet the over night shipping was a big part of that and no it wont be covered.

**VTX1800** · 03-25-2013, 07:07 AM

Originally Posted by lovbyts

I bet the over night shipping was a big part of that and no it wont be covered.

I didn't turn in shipping cost to insurance. They received a claim form for Each prescription that was signed by the pharmacist and showed the cost and info regarding the med. shipping has absolutely nothing to do with the insurance company.

**VTX1800** · 03-25-2013, 07:10 AM

Originally Posted by Moparman

First thing to do is call your insurance co and ask what's up. Many times they won't cover testosterone so maybe they are paying for other things like the needles or anastazole.

Sometimes they only pay a portion of a claim. U need tO call and ask

Thanks for the reply Mopar, That is on my to do list for when I punch out on the time clock. Def. need to speak directly to them for more information. Reason I ask, I read that it's on how the doctor writes up the diagnosis and what codes are used that insurance goes by. Thought someone may have encountered this same situation with ABCBS. Thanks man.

**VTX1800** · 03-25-2013, 02:54 PM

Just ended 53 minute phone call with Anthem, what a muther fu&$@ing joke!!! They won't cover the anastrozole because it was a 60 day supply, yet they cover the cyp and it was 10ml vial prescribed for 2 month supply?? As for my hcg and clomid I have resubmit because a NDC was not found. So now I have to contact the pharmacist and have him resubmit a claim form with NDC codes the. I have to mail both receipts plus more claim forms to insurance.

My entire shipment of meds was a 2 month supply. It makes no sense, maybe I should go and talk to the pharmacist at my local Wal mart. Take a list of my meds an see what he can get there. ??? Can't afford these prices with no insurance help for the rest of my life. I fear my government!!!!

**HRTstudent** · 03-25-2013, 03:47 PM

check Costco prices...

I hear good things about their cash prices consistently. Insurance is a BITCH!!! but do realize that it is a game, and their goal is to get you to bug off. Be persistent and do not give up if you believe you are right.

**lovbyts** · 03-26-2013, 12:12 AM

I checked Costco recently for HCG prices since I had a prescription. OMG.... it's still $$$ I just got my package from overseas and got 6mo+ for the same price as 1mo at Costco.

**VTX1800** · 03-26-2013, 05:45 AM

Originally Posted by HRTstudent

check Costco prices...

I hear good things about their cash prices consistently. Insurance is a BITCH!!! but do realize that it is a game, and their goal is to get you to bug off. Be persistent and do not give up if you believe you are right.

You make a valid point, don't give up!! I will continue to be persistent and next week is my 6 wk BW with the doc an hopefully he can send in a written diagnosis and insurance will be more likely to cover some of the cost every 2 months.

In the mid 2000's I always ordered my hcg , clen , nolvadex , and t3 from over seas and never had any issues. But that was also back when anyone with a valid ID could order hundreds of hydrocodone from Florida. Things are tighter now and customs are more aware of the growing use of anabolics.
Thanks HRT for our reply.