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Thread: anyone having trouble with bcbs?

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    dep30's Avatar
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    anyone having trouble with bcbs?

    I have been on hrt for over two years and for some reason effective January blue cross blue shield says they won't cover my script for test anymore because of one of the compounds in it.. this is strange because a friend and co-worker who goes to the same Dr. And pharmacy and has the exact same insurance as me has had no problems this year getting his script covered... Anyone else have this problem?

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    j2048b is offline Associate Member
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    What is the compound in it they wont cover??

    I got bcbs and all they did was make sure i only get the amount i need per month as opposed to a full 10ml vial per month wich blows as i got to pay the same amount for 4 ml as 10 ml....

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    dep30's Avatar
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    Quote Originally Posted by j2048b View Post
    What is the compound in it they wont cover??

    I got bcbs and all they did was make sure i only get the amount i need per month as opposed to a full 10ml vial per month wich blows as i got to pay the same amount for 4 ml as 10 ml....
    It's just test cyp. And they do mine the same I have to get pre loaded syringes... Another friend of mine that has bcbs and goes to a diffrent Dr gets 10 ml bottles perscribed.. I think it depends on what they will actually prescribe for u. My pharmacist friend says they will cover up to 10 ml. A month if it's prescribed.

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    Quote Originally Posted by dep30 View Post
    I have been on hrt for over two years and for some reason effective January blue cross blue shield says they won't cover my script for test anymore because of one of the compounds in it.. this is strange because a friend and co-worker who goes to the same Dr. And pharmacy and has the exact same insurance as me has had no problems this year getting his script covered... Anyone else have this problem?
    I got a letter from BCBS of Illinois saying they wouldn't be covering my shots due to a lack of medical necessity. I pointed out that they have been covering them for over a year. Then they said they hadn't received the lab values they requested from my Dr. Checked with the Dr.'s office and they had the fax confirmation showing they had submitted the values.
    Called BCBS, got an Addy and mailed them copies of my labs. Sent it w/ a signature required. Called them back again and they said "Oh, it's ok, you are good to go"

    I asked them if there was any plans to not pay their part for my shots in the future and they said no, it is medically necessary.
    We'll see.
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    j2048b is offline Associate Member
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    Quote Originally Posted by dep30 View Post
    It's just test cyp. And they do mine the same I have to get pre loaded syringes... Another friend of mine that has bcbs and goes to a diffrent Dr gets 10 ml bottles perscribed.. I think it depends on what they will actually prescribe for u. My pharmacist friend says they will cover up to 10 ml. A month if it's prescribed.
    yes they will, but i use to just get a 10 ml vial and now they will onl give me what im prescribed per month from that 10 ml total, unless the pharmacist told me, if i want to pay out of pocket etc....

    is there any way u can switch docs? or is it strictly based on the insurance? it sounds odd they would quit allowing it, i know i have to get a pre authorization this year

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    dep30's Avatar
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    In my case I would rather not switch docs just for the fact that the Dr. I'm with now specializes in hrt. I also get anastrozol perscribred monthly and letro if I ever need it. I just spoke with the office manager at my Dr. And she says the reason bcbs isn't wanting to cover is because my Dr has a in-house pharmacy where They manufacture the test from powder... She says that's why their not covering it. Over per say Watson or some other branded testosterone ... I would rather stay with my doc because I hear it's hard to get ancillarys from the other docs. But I guess I'll have to find out.. I'll let y'all know what I find out. The office manager sent a pre authorization so let's see what happens

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    In my case, bcbsnc stated they wouldn't fill my prescription without prior auth - never done that in the past. I told this to my doctor's office and they said bcbs had to send it to them - they would no longer request the documents for prior auth (thanks to ob-care). Regardless, I had to wait a three and a half weeks to get this taken care of. I am now told I have to do this every time I get a new script from the doc. They also require blood work every 6 mths.

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    j2048b is offline Associate Member
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    ^^^^ this is new this year! And ur doc sends a pre auth to the insurance not the other way around..... And if u only use say 4 ml like i do, thats all u get each month and ur pre auth is for the full year

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    Quote Originally Posted by j2048b View Post
    And ur doc sends a pre auth to the insurance not the other way around.....
    Well, supposed too. My doctor's office has stopped initiating pre-auths. I have heard of other offices starting this practice too. I have to contact the insurance company and tell them to send the pre-auth form to the office, with my name/etc, and then my doc will fill it out. Took several days just to get the prescription authorized because of the finger pointing. I'm thinking of going with the med savings account route and just getting it from Empower.
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    Low Testosterone is offline ~ HRT Specialist ~
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    You will find that doctors are doing less and less when it comes to insurance - meaning either they won't take what you have or they won't do anything extra to help you with it, meaning you're going to have to do more of the foot work. Why? Because the reimbursement from insurance is growing smaller and smaller, less and less. A colleague I know in Sacramento (not part of the LowT program), has completely stopped accepting insurance for any form of HRT in all cases as it doesn't cover his cost.

    The good news for many of you is that most doctors have little to no business sense, and it will take some time before they notice the hole they're digging themselves into.

    A bit of a personal note - I find health insurance to be one of the biggest jokes in history. It's a perceived safety net that's generally no net at all. Sure, when it comes to catastrophe plans it's needed and a good thing to have, but beyond that it's generally a giant waste of money, in my opinion. Yes, there are exceptions.

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    Quote Originally Posted by Low Testosterone View Post
    You will find that doctors are doing less and less when it comes to insurance - meaning either they won't take what you have or they won't do anything extra to help you with it, meaning you're going to have to do more of the foot work. Why? Because the reimbursement from insurance is growing smaller and smaller, less and less. A colleague I know in Sacramento (not part of the LowT program), has completely stopped accepting insurance for any form of HRT in all cases as it doesn't cover his cost.

    The good news for many of you is that most doctors have little to no business sense, and it will take some time before they notice the hole they're digging themselves into.

    A bit of a personal note - I find health insurance to be one of the biggest jokes in history. It's a perceived safety net that's generally no net at all. Sure, when it comes to catastrophe plans it's needed and a good thing to have, but beyond that it's generally a giant waste of money, in my opinion. Yes, there are exceptions.
    agree 100% on all of this!!

    health insurance is a huge joke, thats why the 1%'s have always just used the er as their health insurance.... no need to spend 300+ per month on insurance that is basically hardly used... what a waiste of money, but hey got to keep tons of people employed or where would mericka be?

    just got my paper copy of my pre auth.... good until script runs out etc....

    and another reason why i got rid of md's all together and would rather go to a D.O. instead.... musch more willing to listen and easier to talk to and they dont seem to have some secret agenda like kickback for statins etc....

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    j2048b is offline Associate Member
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    Quote Originally Posted by roxer View Post
    Well, supposed too. My doctor's office has stopped initiating pre-auths. I have heard of other offices starting this practice too. I have to contact the insurance company and tell them to send the pre-auth form to the office, with my name/etc, and then my doc will fill it out. Took several days just to get the prescription authorized because of the finger pointing. I'm thinking of going with the med savings account route and just getting it from Empower.
    i may ask for straight scripts as well next time and go thru empower, their prices are affordable and better for my pocketbook....

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    As I keep saying, welcome to Obamacare.
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    Quote Originally Posted by lovbyts View Post
    As I keep saying, welcome to Obamacare.
    Why do you say that? Don't you know Obamacare is the salvation of mankind?
    It's funny though isn't it? Most hate it but most people voted for it even though it really wasn't a secret as to what this monster of an entitlement would be. If it was a secret to someone, well that someone was an idiot. But what's really funny (not haha funny) despite this massive failure and numerous others, if he could run for a 3rd term I bet he'd win again.

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    Quote Originally Posted by Metalject View Post
    Why do you say that? Don't you know Obamacare is the salvation of mankind?
    It's funny though isn't it? Most hate it but most people voted for it even though it really wasn't a secret as to what this monster of an entitlement would be. If it was a secret to someone, well that someone was an idiot. But what's really funny (not haha funny) despite this massive failure and numerous others, if he could run for a 3rd term I bet he'd win again.
    And that's the whole problem, entitlement. To many people see healthcare as an entitlement and it should be the same for everyone among many other privileges in life. There are to many with this mentality and dependent on government assistance instead of being willing to work hard to succeed so they vote for what is easy but ultimately will keep them locked in a depressed and stagnant way of life. They are not willing to give up the freebies (it's never free) to gain more eventually.

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    Quote Originally Posted by lovbyts View Post
    And that's the whole problem, entitlement. To many people see healthcare as an entitlement and it should be the same for everyone among many other privileges in life. There are to many with this mentality and dependent on government assistance instead of being willing to work hard to succeed so they vote for what is easy but ultimately will keep them locked in a depressed and stagnant way of life. They are not willing to give up the freebies (it's never free) to gain more eventually.
    Yep, 100% agree. The entitlement mentality is horrific. The only thing anyone should be entitled to is the right to liberty, that's it. Successes and failure are all on you. And some will have to work harder than others, and some will be better looking than others, some will be smarter than others....on and on, but that doesn't matter and shouldn't matter. I've said it before, as much as everyone hates what Jonathan Gruber said, he wasn't entirely wrong. But what's even worse than the ignorance of the American voter is the one who isn't ignorant, speaks out against the entitlement society, yet takes part in it. I've heard this many times, such and such entitlement is a terrible thing, but you might as well take it if they're going to give it to you.
    lovbyts and RaginCajun like this.

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    Ok got some feedback the pre auth. Was denied due to the fact that my Dr has an in house pharmacy and brews their own test and bcbs won't cover because of one of the compounds used. Looks like I'm gonna have to find a new Dr that will write scripts to normal pharmacys like cvs... Apparently brands like Watson are still covered...

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    Quote Originally Posted by dep30 View Post
    Ok got some feedback the pre auth. Was denied due to the fact that my Dr has an in house pharmacy and brews their own test and bcbs won't cover because of one of the compounds used. Looks like I'm gonna have to find a new Dr that will write scripts to normal pharmacys like cvs... Apparently brands like Watson are still covered...
    If you are in the South, I have found Watson Test E hard to come by unless you can hopefully snag some 5ml vials. No 10ml to be found - at least in NC. I decided to stick with 10ml test C since it is more widely available. Also make sure the doctor specifies the one you want - either 10ml test C or E. When BCBS does the pre-auth, you will not be able to switch unless you get another script and get that authorized too.

    I used to be able to just snag a new script and that was it. No more.

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