No More Insurance for TRT

[Low Testosterone]

Humana announces today they will no longer cover TRT, this includes doctors visits, labs, medications, etc. Blue Cross Blue Shield soon to follow. It's only a matter of time before all follow suit. TRT is not considered a medical necessity, it is elective. While only elective for those that qualify, it's still considered elective.

[2Sox]

Sucks, big time. Hope there is a TRT lobby.

[Charlie6]

What if you're on trt because you have secondary hypogonadism? That's a medical necessity, not elective, isn't it? So they wouldn't cover any endo appointments?

[kelkel]

LT what exceptions are there?

[Beethoven]

As it is now, my Dr which is also my primary Dr and BW is the only thing covered. ( oh I forgot my Anastrozole ) but my test and HCG has never been covered.

[ngtmarpete]

You can thank our wonderful elected officials in Washington for all of this! I didn't even bother with my Ins when I started TRT. I knew this was coming so I just went to lowtestosterone.com.

[Rrexy]

I expected this from the beginning. That's why I too went to LowTestosterone.com first.

How about the Health Care Spending Plans - Can they still be used to pay for treatments?
I don't mean will they be accepted as a payment by LowTestosterone.com - I mean will this still be an expense that is approved by the Feds.?

[lovbyts]

Humana announces today they will no longer cover TRT, this includes doctors visits, labs, medications, etc. Blue Cross Blue Shield soon to follow. It's only a matter of time before all follow suit. TRT is not considered a medical necessity, it is elective. While only elective for those that qualify, it's still considered elective.

Thank you ObamaCare.... I'm sure Pain meds are still covered and soon to come end of life (suicide) pills. As Obama said, sometimes it's better to take the pill than it is to treat the problem. Yeah he really said that.

I sort of saw this comming and have been being a pack rat for the last few years just in case.... I suggest everyone do the same and try to stretch things out if possible. It's always nice to have a LITTLE extra in case the well runs dry for a while.

[2Sox]

LT what exceptions are there?

I'd like to know the answer to this question too. It would be indeed ironic if Medicare and Medicaid were the only two that would cover.

And I'd like to know the whole story on this.

I'd speculate that Big Insurance won't stop here. What's next? No coverage for illnesses connected to obesity - like diabetes, stroke, heart disease, high blood pressure, high cholesterol? "We're not covering you because you eat too much."

I'll bet the next news we'll be hearing about this are big time court challenges.

[lovbyts]

I'd like to know the answer to this question too. It would be indeed ironic if Medicare and Medicaid were the only two that would cover.

And I'd like to know the whole story on this.

I'd speculate that Big Insurance won't stop here. What's next? No coverage for illnesses connected to obesity - like diabetes, stroke, heart disease, high blood pressure, high cholesterol? "We're not covering you because you eat too much."

I'll bet the next news we'll be hearing about this are big time court challenges.

No no, see there is BIG money to be made due to Obesity, diabetes, blood pressure and especially cholesterol.

With HRT it many times lowers blood pressure, causes weight/fat loss lower cholesterol etc. They dont want to back anything that works as a cure. They want to treat the symptoms. There is more money to be made that way.

[2Sox]

No no, see there is BIG money to be made due to Obesity, diabetes, blood pressure and especially cholesterol.

With HRT it many times lowers blood pressure, causes weight/fat loss lower cholesterol etc. They dont want to back anything that works as a cure. They want to treat the symptoms. There is more money to be made that way.

That clears everything up. ;-)

[BMW550i]

My wife works for an insurance company and this doesn't suprise me. I haven't started yet but I have the prescription and she's totally against it. I tried comparing it to high blood pressure and diabetes and she said there's no comparison. There are deaths from high blood pressure, cholesterol and diabetes. There are no deaths from low T. She was telling me that, based on the news, treating low T can cause deaths. She's going by the recent news about heart attacks at the VA.

I told her about the symptoms and how it's connected to diabetes, altzheimer's (sp?), metabolic symdrome, artlesclerosis (sp?), high cholesterol, depression, and her response that they are connected but it's not proven. Her mindset is that anyone who has low T can change their diet, start exercising, lose some weight, stop smoking and drinking and be cured. I've noticed that alot of my friends believe that and even a few doctors. That's why I don't talk about testosterone outside of this message board. There's alot of misinformation about it and it looks like the misinformation is winning. I'm 6 feet, 195 lbs. I don't smoke, I don't drink, I exercise regularily and my diet is great but I still have low T. Her mindset, as well as my old docs, was that I was fine since my symptoms were mental (low libido, low energy, low drive, sleeping in the afternoon even though I slept 8-9 hours a night, lack of morning erections, etc.) My bloodwork was great (low cholesterol, good thyroid, good glucose, etc.), I just had low T.

It took me a while to find my TRT doctor because many of the docs I ran into thought the same way she did.

[lovbyts]

My wife works for an insurance company and this doesn't suprise me. I haven't started yet but I have the prescription and she's totally against it. I tried comparing it to high blood pressure and diabetes and she said there's no comparison. There are deaths from high blood pressure, cholesterol and diabetes. There are no deaths from low T. She was telling me that, based on the news, treating low T can cause deaths. She's going by the recent news about heart attacks at the VA.

I told her about the symptoms and how it's connected to diabetes, altzheimer's (sp?), metabolic symdrome, artlesclerosis (sp?), high cholesterol, depression, and her response that they are connected but it's not proven. Her mindset is that anyone who has low T can change their diet, start exercising, lose some weight, stop smoking and drinking and be cured. I've noticed that alot of my friends believe that and even a few doctors. That's why I don't talk about testosterone outside of this message board. There's alot of misinformation about it and it looks like the misinformation is winning. I'm 6 feet, 195 lbs. I don't smoke, I don't drink, I exercise regularily and my diet is great but I still have low T. Her mindset, as well as my old docs, was that I was fine since my symptoms were mental (low libido, low energy, low drive, sleeping in the afternoon even though I slept 8-9 hours a night, lack of morning erections, etc.) My bloodwork was great (low cholesterol, good thyroid, good glucose, etc.), I just had low T.

It took me a while to find my TRT doctor because many of the docs I ran into thought the same way she did.

Very simply, besides every thing you mentioned above being true; low T causes low Libido and for a man that's a death sentence alone. Yeah women may not get it but ask her how she would like to have her Tits cut off? How womanly would she feel then. That's a fair comparison. If she could prevent it wouldn't she?

[BMW550i]

Very simply, besides every thing you mentioned above being true; low T causes low Libido and for a man that's a death sentence alone. Yeah women may not get it but ask her how she would like to have her Tits cut off? How womanly would she feel then. That's a fair comparison. If she could prevent it wouldn't she?

It's not worth trying to convince her. I didn't even waste time trying to convince my old doctor. She even argued with Dr. Barry Gordon when I went to see him. Dr. Gordon wrote a book called the Testosterone Syndrome. She has the mindset of a lot of my old docs. They feels that it's either a normal part of aging or just bad lifestyle.

[kelkel]

I'd like to know the answer to this question too. It would be indeed ironic if Medicare and Medicaid were the only two that would cover.

And I'd like to know the whole story on this.

I'd speculate that Big Insurance won't stop here. What's next? No coverage for illnesses connected to obesity - like diabetes, stroke, heart disease, high blood pressure, high cholesterol? "We're not covering you because you eat too much."

I'll bet the next news we'll be hearing about this are big time court challenges.

You can bet that the congressional health plan covers it for all the dinosaurs there...

My wife works for an insurance company and this doesn't suprise me. I haven't started yet but I have the prescription and she's totally against it. I tried comparing it to high blood pressure and diabetes and she said there's no comparison. There are deaths from high blood pressure, cholesterol and diabetes. There are no deaths from low T. She was telling me that, based on the news, treating low T can cause deaths. She's going by the recent news about heart attacks at the VA.

I told her about the symptoms and how it's connected to diabetes, altzheimer's (sp?), metabolic symdrome, artlesclerosis (sp?), high cholesterol, depression, and her response that they are connected but it's not proven. Her mindset is that anyone who has low T can change their diet, start exercising, lose some weight, stop smoking and drinking and be cured. I've noticed that alot of my friends believe that and even a few doctors. That's why I don't talk about testosterone outside of this message board. There's alot of misinformation about it and it looks like the misinformation is winning. I'm 6 feet, 195 lbs. I don't smoke, I don't drink, I exercise regularily and my diet is great but I still have low T. Her mindset, as well as my old docs, was that I was fine since my symptoms were mental (low libido, low energy, low drive, sleeping in the afternoon even though I slept 8-9 hours a night, lack of morning erections, etc.) My bloodwork was great (low cholesterol, good thyroid, good glucose, etc.), I just had low T.

It took me a while to find my TRT doctor because many of the docs I ran into thought the same way she did.

Wow is she full of misinformation. Sorry you have to deal with that. It'll come full circle and haunt her when she actually needs added testosterone....

[lovbyts]

Wow is she full of misinformation. Sorry you have to deal with that. It'll come full circle and haunt her when she actually needs added testosterone....

Good point. Ask her to explain to you what Menopause is and what can be done about it. Not tell her will it's just a natural part of aging and she should just deal with it.....

[BMW550i]

I did give her 4 books to check out (Gordon's book, Morgenthauler's book, Shippen's book and Nelson's Vergen's book). She is looking at them but she still has the same mindset is that it's elective and not life threatening. I think that has to be the turning point. As long as people think it's 'elective', then it'll be something that people won't take seriously like heart disease, high cholesterol or diabetes.

I think Gordon's book will help. He has some examples of people that he's treated (people with muscle wasting, etc) that he gave testosterone to and they regained their health. There was one guy who was bed-ridden and after months of treatment, he started walking with a cane.

[frawnz]

Good counterpoint with menopause. I'm pretty sure that no women have died from menopause, although I'm also pretty sure that a good number of men have (died due to a woman's menopause).

[jasondd1]

Ive always used my HSA plan to pay for my meds, blood work(even online places), and doctor visits. Look into Health savings plans. Its a high deductible health insurance plan with no copays and then an individual can max out $3300 a year tax free into a health savings checking account and pay out of pocket. If your deductible is say $2500 your always rolling over at least $800 to the next year and after.

[lovbyts]

Good counterpoint with menopause. I'm pretty sure that no women have died from menopause, although I'm also pretty sure that a good number of men have (died due to a woman's menopause).

No one has ever died from HIV Aids either. Ask her of that shoukd not be treated. Her arguments are childish and selfish.

[Beethoven]

It's the insurance companies via the new healthcare law. It's not about healthcare it's about control. Abortions and birth control are being mandated. Trt is not a political issue at least on our side. It is because the only pub testosterone and any steroid gets is when these sports stars are being caught using them. Many people don't think there are legit medical conditions being treated by these except they are there only to enhance physical performance.
Yet, marihuana is trying to be legalized in many other states and is now the new wonder drug.

[BMW550i]

She's not the only one making the arguments. I've had many a doctor turn me and my low t numbers away. I got rid of my doc of 10 years because he just outright refused to treat me. He said I would get prostate cancer, a heart attack and fly into roid rage. I've also read that many people on several messages boards, and this one too, having a hard time getting TRT and dealing with the same mindset that she had. I used her as an example but she's not the only one.

Testosterone is demonized in the media. When you see a positive commerical for low T, all they show is some guy fishing or talking about getting the old him back. Those are the big pharma commercials. People won't take that commerical seriously. Now, the other commericals are lawsuits and news reports about athletes and steriod abuse and people having heart attacks. People will take those commericals seriously. It's an uphill battle. That's why I'm not suprised this is happening. What really sucks is that I have Blue Cross so I guess I'll just wait for the hammer to drop.

Please understand that I'm not arguing against TRT. I'm just passing along what I've heard and also disappointed since Blue Cross is going to follow suit and they are my insurance provider.

[Beethoven]

BMW you are right. Low t is not completely understood, even within the Medical community. How many times on this forum there is a new member either being denied or being given a protocol that is severely outdated. We don't have a powerful enough lobby representing us, that's why as the ACA takes effect, we will find ourselves more and more on the outside.

[Low Testosterone]

LT what exceptions are there?

As of now (this could change in the next few days/weeks) AndroGel is covered at tier 3, but that's it. Nothing else can carry any coverage, blood work, doctors visits, other meds, nothing.

[Low Testosterone]

What if you're on trt because you have secondary hypogonadism? That's a medical necessity, not elective, isn't it? So they wouldn't cover any endo appointments?

Hypogonadism is not considered a serious problem by most in government, insurance or the medical community. Further, the definition of hypogonadism is argued and disagreed upon by most. For example, Your total testosterone levels are 400 ng/dl, most physicians and "experts" would say you do NOT have low testosterone. You can then find physicians who say you do have low testosterone if Free levels are below 15 pg/ml but those physicians rarely make the rules.

[diesel101]

Thank god for blue cross blue shield insurance no questions asked everything is covered (So Far anyways)

[Low Testosterone]

Thank god for blue cross blue shield insurance no questions asked everything is covered (So Far anyways)

As mentioned above, Blue Cross Blue Shield will be following suit next. A lot of changes coming over the next 12+ months.

[kelkel]

As of now (this could change in the next few days/weeks) AndroGel is covered at tier 3, but that's it. Nothing else can carry any coverage, blood work, doctors visits, other meds, nothing.

What about pathology related? Tumors, etc...

[BMW550i]

What about pathology related? Tumors, etc...

Great question. What If I had a testicle removed or damaged? Or HIV? Or a pituitary tumor?

Or, are the insurance companies basically saying, "You can live....it'll be a miserable existance, but you can live."

Also, what is Tier 3? Does that mena Androgel will still be covered but not injections? Why is that? The gels are more money.

[Low Testosterone]

What about pathology related? Tumors, etc...

At this time I'm not sure. But if I were to guess I would say as this progresses the only way any type of TRT will be covered by insurance will be in cases of HIV or wasting.

[Low Testosterone]

Great question. What If I had a testicle removed or damaged? Or HIV? Or a pituitary tumor?

Or, are the insurance companies basically saying, "You can live....it'll be a miserable existance, but you can live."

Also, what is Tier 3? Does that mena Androgel will still be covered but not injections? Why is that? The gels are more money.

Tier 3 means higher copays, name brand only and medications that are not first line of defense. In short, if a medication is tier 3, such as Androgel, you'll be paying a lot for it.

[Low Testosterone]

Great question. What If I had a testicle removed or damaged? Or HIV? Or a pituitary tumor?

Or, are the insurance companies basically saying, "You can live....it'll be a miserable existance, but you can live."

Also, what is Tier 3? Does that mena Androgel will still be covered but not injections? Why is that? The gels are more money.

Tier 3 means higher copays, name brand only and medications that are not first line of defense. In short, if a medication is tier 3, such as Androgel, you'll be paying a lot for it.

[BMW550i]

Tier 3 means higher copays, name brand only and medications that are not first line of defense. In short, if a medication is tier 3, such as Androgel, you'll be paying a lot for it.

Wow, I just called Blue Cross. they said that it's on Tier 2 right now with a $45 copay. The full price from Blue Cross is $354.93 and if it was on Tier 3, I'd have to pay half of that.

Man, that is horrible....I can't imagine pay over $175 and that's for the minimum monthly dosage.

[Ryanmcd]

My doc told me this was coming a few years ago as he deals with a lot of high end cash only patients, the nice thing is he has free samples for just about everything


Also what's next is if you have insurance and say you have high BP or are over weight they make you go to a weight loss doc, if you don't go you become non-compliant and your rates go up 2-300%.

Also you have to do a yearly physical and the doc faxes over the results weight / BP / HDL / LDL to get the insurance discount rate of say 20%. I guess it's good and bad, good because we have a lot of fat people, bad to have someone paying 3-500$ a month for insurance.

[bullshark99]

BMW,

Feel your pain and agree with your position on how TRT is viewed by many. Its difficult because its your spouse, not worth getting a divorce over ( I dont think???) but for a woman to tell a man that TRT or Low T is not real, just deal with it is like a man telling a woman that giving child birth is a breeze, just suck it up and shut up!
When your on TRT and horny as hell, banging the next store neighbor maybe then she will realize that its serious business and not just in your head..

[2Sox]

Humana announces today they will no longer cover TRT, this includes doctors visits, labs, medications, etc. Blue Cross Blue Shield soon to follow. It's only a matter of time before all follow suit. TRT is not considered a medical necessity, it is elective. While only elective for those that qualify, it's still considered elective.

Can you give a link to the press release that informed you of this?

[kelkel]

BMW,

Feel your pain and agree with your position on how TRT is viewed by many. Its difficult because its your spouse, not worth getting a divorce over ( I dont think???) but for a woman to tell a man that TRT or Low T is not real, just deal with it is like a man telling a woman that giving child birth is a breeze, just suck it up and shut up!
When your on TRT and horny as hell, banging the next store neighbor maybe then she will realize that its serious business and not just in your head..

Epic post Bull!

[kelkel]

At this time I'm not sure. But if I were to guess I would say as this progresses the only way any type of TRT will be covered by insurance will be in cases of HIV or wasting.

Amazing. All they will do by doing this is to increase the profits of clinics, especially the unscrupulous ones. It will also create an even bigger black market for everything.

[BMW550i]

BMW,

Feel your pain and agree with your position on how TRT is viewed by many. Its difficult because its your spouse, not worth getting a divorce over ( I dont think???) but for a woman to tell a man that TRT or Low T is not real, just deal with it is like a man telling a woman that giving child birth is a breeze, just suck it up and shut up!
When your on TRT and horny as hell, banging the next store neighbor maybe then she will realize that its serious business and not just in your head..

Thanks but there's no pain. it's her opinion and she's entitled to it. I don't expect her to understand this. I'm more worried about the general public, insurance companies, healthcare providers etc. and their opinion. Those are the ones that matter. No matter how much she objects, it's not going to stop me, now if my insurance company decides not to cover it, that can put a serious dent in TRT for me.

[Ryanmcd]

TRT costs are not that high even w/o insurance ONCE you get it dialed in. 4 10ML a year @ 50$ each, HCG 30-40$ a month that's full price @ 5k unit, should last about 2 months for most, AI if needed and bloodwork, also insurance will still adjust the blood work cost just will not cover it, so you E2 test may list @ 120$ but after it's adjusted it's about 12$.

Also is this just on code 257.2? I am sure you can run blood work under other codes and get it covered.