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  1. #1
    tarponowski's Avatar
    tarponowski is offline New Member
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    HRT or TRT with Blue Cross Blue Shield

    Good morning all, new to the board.

    I have looked through the forums and have found very little info about insurance covering HRT. I know most HRT clinics do not accept insurance. I am in Texas and was wondering if anyone with Blue Cross could point me point me in the right direction? A Texas doctor is not a must. I pay a small fortune for insurance and would like to let them cover my TRT. Insurance covered all my initial blood work but I would like for them to pick up the rest of my therapy as well.

    On a side note, I have been talking to a compounding Pharmacy and if I go that route I would have to cover the meds up front and then file my own insurance reimbursement. Has anyone had any luck collecting in this manner.

    Thanks in Advance.

  2. #2
    vvnapoli is offline New Member
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    I'm in Michigan, but have blue cross blue shield, and they've covered everything! From bloodwork to shots, I haven't paid a dime.

  3. #3
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    38jumper38 is offline Senior Member
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    I'm on Florida, all cover here.

  4. #4
    tarponowski's Avatar
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    Was that through a general practitioner or a HRT clinic? I have been in contact with a compounding pharmacy in Florida but they do not accept insurance and will have to file my own claims. I would much rather have insurance cover and just cover my co-pay. Maybe I just need to find the right doctor here in Houston.

  5. #5
    TGraham is offline Junior Member
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    I had BC BS last year. My GP ordered the TRT medication and they paid for everything, no hassle at all. They just want to see low baseline scores for the initial blood work.

  6. #6
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    tarp - I just moved from Houston and was on BCBS and had TRT coverage for about 14 months during that time - I had partial coverage - let me explain.

    Had problems finding an on-network Dr. to prescribe TRT after going to my GP, then to an endo and had multiple and $$$ bloodwork performed. Endo finally agreed to prescribe gel and didn't want to even test for E2. I realized she didn't know squat about what I needed or TRT in general, so I found a local Dr., however he wasn't on-network. Had to pay out of pocket for his visits (once every 3 months) as well as bloodwork, but he had a good discount on quest labs and I think it was cheaper to pay out of pocket for labwork than my portion through BCBS. Now, I know BCBS does cover out-of-network Dr. visits, but you had to meet the deductible which I didn't.

    But, and the good thing, is that since he wasn't just an AA clinic, he prescribed Test and adex which I could pick up at a local pharmacy, and it WAS covered by BCBS insurance.

    So the bottom line was that Dr. visits were more $$ than if you saw someone on-network, but the meds were much cheaper than if you go through a clinic and a compounding pharmacy that's not covered by BCBS.

    So I guess what I meant to say is that YES you can get everything covered IF you find the right Dr., but that's a big IF.

  7. #7
    tarponowski's Avatar
    tarponowski is offline New Member
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    So I guess I am back in the same boat. I have already been to 2 different GPs in Houston. I guess I can try a few more and see if I can find one that has a little more experience with HRT. It has been pretty frustrating not to mention expensive. Anyone in the Houston area that can refer me to an experienced doctor or Endo?

    Thanks in advance.
    Last edited by tarponowski; 03-06-2011 at 08:30 AM.

  8. #8
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  9. #9
    tarponowski's Avatar
    tarponowski is offline New Member
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    Maybe I should have been more specific. Anyone working with an experienced HRT doctor or Endo. Houston is a pretty big city and there are tons of doctors. I was hoping someone could point me in the right direction - maybe someone they are using or have used in the past. Not interested in the creams or patches.

    Thanks in advance.

  10. #10
    subnet's Avatar
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    sent you some info earlier this morning tarp...

  11. #11
    lovbyts's Avatar
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    Quote Originally Posted by tarponowski View Post
    Maybe I should have been more specific. Anyone working with an experienced HRT doctor or Endo. Houston is a pretty big city and there are tons of doctors. I was hoping someone could point me in the right direction - maybe someone they are using or have used in the past. Not interested in the creams or patches.

    Thanks in advance.
    Gotcha, yeah I guess it's hard to know who is good and not without experience and who wants to wade through a bunch of quacks.

  12. #12
    tarponowski's Avatar
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    I have my waders on! Been through 3 so far - just hoping to narrow the search a little.

  13. #13
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    Not many clinics are accepting insurance claims due to not getting paid until 4 months later if that.

  14. #14
    SlimmerMe's Avatar
    SlimmerMe is offline ~Knowledgeable Female Extraordinaire~
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    from my experience, BCross did not cover the anti-aging doc, BW nor compounded pharma scripts ..CASH ONLY
    .... but maybe your policy is different from mine....

    Maybe an endo is the route to go for this to make sure.

  15. #15
    tarponowski's Avatar
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    Quote Originally Posted by SlimmerMe View Post
    from my experience, BCross did not cover the anti-aging doc, BW nor compounded pharma scripts ..CASH ONLY
    .... but maybe your policy is different from mine....

    Maybe an endo is the route to go for this to make sure.
    I was not expecting them to cover the doctor - his visit is cheap. I was wondering if anyone had any luck getting BCBS to reimburse the out of pocket expenses for the compounding pharmacy. At the end of the day I will just pay out of pocket to get myself right again. I was hoping someone may have had some experience with it.

  16. #16
    SlimmerMe's Avatar
    SlimmerMe is offline ~Knowledgeable Female Extraordinaire~
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    Like I said above, BCBS did not cover compounded pharmacy scripts for my HRT. So if you are looking for "luck only post," sorry and good luck.
    Most anti-aging docs either get a lot of their cash in 2 ways: for the doc visit or a less cost for the doc visit and then a kickback from the compounded pharmacist. They meet each other at conferences and throw each other the deal. Why do you think lots of scripts come across the country mailed in when there is a compounded pharmacist down the street?

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