Will My Insurance Cover Testosterone Therapy?

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The endocrine profile depends on the presence and quantity of human hormones. If an individual is healthy, all the common characteristics are in normal condition. Some people feel fatigued, depressed, and suffer from other symptoms caused by the low level of testosterone. If the Low-T condition is proven, the treatment course is prescribed. Many patients are interested in the question if there is a possibility to get testosterone injections covered by insurance.

Some clinics prove the fact that some expenses for their insured clients are available for free. But there is no exact insurance for testosterone therapy. Anyway, there is a range of medical services and medications that are not covered by even the most comprehensive plans. It is necessary to focus on this aspect and understand which costs can become charge-free with the patient’s insurance.

Is Testosterone Replacement Covered by Insurance

Insurance for Testosterone Replacement Treatment

If the individual does not have medical evidence for the Low-T course, the insurance carrier will not pay for the treatment therapy a penny. It means that the patient should prove the fact of his low level of testosterone with the help of the laboratory tests. It is worth noting that most plans allow Americans to save money on blood testing and visits of the endocrinologist’s cabinet thanks to their insurance plans.

Any doctor’s examination and lab works are covered by the insurer. This privilege reduces the final price for testosterone treatment. Nevertheless, it is difficult to get injections covered by insurance in full. The most popular coverage plan provider is a Blue Cross, Blue Shield. This insurer offers the best conditions for patients who require testosterone replacement therapy.

What Insurances Cover Testosterone

Blue Cross, Blue Shield Insurance Guidelines

A special license provided by the association of the BlueCross and BlueShield companies became available first about five years ago. In 2015, these two organizations united to assure patients with the medical service provision on the grounds of insurance for testosterone therapy. At the same time, BlueCross & BlueShield guidelines inform willing individuals about must-have criteria to get the full coverage of the medication, lab works, and other costs related to the Low-T course.

Does Blue Cross Blue Shield Cover Testosterone Therapy

One of the obligatory requirements is documentation on the low level of the sexual hormone in the patient’s organism. These tests should take place in the morning because this is the best time to see accurate blood levels. The patient should pass hematologic examination twice to prove the fact of the Low-T condition. All the laboratory copies with results should be provided to the insurer. Besides these procedures and the medical specialist’s opinion, there are other criteria to take into consideration:

  • Additional clinical tests are done before the request of insurance for testosterone therapy (liver function tests, hematocrit examination, prostate-specific antigen (PSA) test, etc.).
  • There are no contradictions. The hypersensitivity to the medication is excluded.

It is worth noting that new criteria can be added into the guideline when its new version comes in force. The insurance company informs clients about changes and adds new points to the circumstance list timely. If one of the above-mentioned criteria is not met, the patient can get a refusal for his insurance request. If all the conditions are observed, the insurance plan would be approved. The BlueCross & BlueShield provider offers a 1-year compensation for testosterone replacement treatment if the answer is positive.

Testosterone Therapy Covered by Insurance

As can be seen, the main requirement for Low-T patients is the availability of blood value results. According to the Blue Cross & Blue Shield guidelines, these showings should be lower than the normal average results. The insurance provider agrees to cover the testosterone replacement therapy if the individual provides lab copies with results that are below 300 ng/dl.

It means that a blood sample should show <300 ng/dl. If values are higher at least in one lab test, the insurer can withdraw from medical service coverage. This criterion takes into account other insuring providers that cover the testosterone treatment expenses partially.

Read about: How Much Does the Testosterone Replacement Therapy Cost?

Other Insurers to Take into Account

Some insurance companies take into consideration only blood levels of testosterone and the endocrinologist’s opinion. At the same time, their plans allow patients to reduce final treatment costs incompletely. For example, Cigna and Regence insurers offer the coverage of lab works and clinic-based medical services but do not compensate expenses on injections and other oral prescriptions.

Testosterone Replacement Therapy Cost No Insurance

Nevertheless, many patients would like to save at least some money during their Low-T courses. That is why people agree to receive partial compensation from their insurers. Most American pharmacy establishments and private clinics with the endocrinologist’s cabinet bill the insurance of the following organizations:

  • Health Net;
  • ODS;
  • UnitedHealthcare, etc.

At the same time, it is possible to start therapy without insurance at affordable prices. US-based clinics provide consumers with profitable discounts. Some price books include special offers for regular procedures that are not covered by the insurance. For example, each second visit to the doctor will cost twice as little as the first appointment. Or the option of injection administration will be compensated in the second course of treatment.

It is necessary to keep track of the pricing plan of the hospital you would like to place confidence to. Each medical service provider differs like insurers as well. The more patients ask questions about the ongoing therapy, its costs, and the rules of the healthcare establishment, the more budget-friendly treatment they get.

Contact our physician here to get a free consultation about Insurance for Testosterone Replacement Treatment