T Nation

Doc Said He'd Write But Insurance Won't Pay


#1

I'm a 34 year old with total test 352. My Doctor said "he" believed the lowest "any" person should ever have is 400. I'm thinking this is a done deal, then he says the problem is my insurance, blue cross blue shield, Dr. says since I'm not below their minimum, which is 240, they will not pay. Anyone else run into this or is it BS?


#2

Yes, I ran into it with authorization for Testopel. Because I've used Androgel for NINE years, we had no records showing I can get that form of treatment because of my normal values from using Androgel. The advantage I have is that if I don't use Androgel, my levels are VERY low. In order to get an authorization for Androgel, he had me stop using for a week, and my value showed 147. Then I got the authorization for Testopel.

He should write a letter to the insurance company - which is what my doc did - with a thorough explanation of why he wants you to be on T.

My mom once made as huge stink over coverage for removal of a pituitary tumor. It worked. So make a stink yourself as well.


#3

there should be an appeals process that the doctor can use to describe all of your symptoms and why the diagnosis of low T is accurate even though you don't meet the insurance lab range criteria. Worst case you have to pay for shots out of pocket which equals about $75 every three months for 50mg E3D T-Cyp shots.


#4

I have to pay about $70/month for 125mg every 5 days, but that is the dosage that works for me. So, it may cost a little more or little less than PureChance stated, but it won't break the bank.
Luckily my E2 levels are good enough (25-27 depending on the test) so I don't have to buy Arimidex. That is some expensive shit.


#5

I could live with $70 a month, he made it sound like it'd be $200 a month... He said if I could get me levels lower we wouldn't have a problem, is there a way to lower your level?


#6

My insurance company seems to require extra paperwork and an override form by the Doctor for anything Testosterone related so far (Kaiser of Colorado). I guess there must be a lot of abuse out there on this stuff, but it pisses me off that a doctor prescribes something, then you go to the pharmacy and get told you have to wait a week for the paperwork to go through to get it approved. What is this, freaking Canada!?


#7

Man, you guys are paying a lot for shots. I was paying a $2.80 co-pay when I was on shots recently. The insurance portion was like $8 bucks. So the whole thing out of pocket should have only cost $10 a shot, and that was for 200mg.

If you are on Adrogel -- I just found out they have a discount card you can sign up for on their website that will knock your co-pay way down!

Cheers,

  • Hakrjak

#8

I wouldn't do it, but people have:

http://www.T-Nation.com/free_online_article/sex_news_sports_funny_grok/your_doctor_your_dealer