Short story: how would an insurance company know if a prescription is for on/off-label use?
I have a silly question in regards to trt and insurance that I’m hoping someone who’s been through this could assist with. Forgive the stupid question as I have NEVER had any private health insurance coverage before. How does insurance know if a prescription is for off label use?
I have just started looking into my work drug plan coverage and test cyp is covered without prior authorization requirements. HCG is covered as well if used for fertility purposes Again without prior authorization required. My doctor is prescribing me test because I fall on the low end of the spectrum for my age and have numerous symptoms but by most standards considered normal (350 total test, 300-1000 scale). My fsh was also on the low end naturally (2 fsh,1-16 scale) so the doctor recommended hcg or clomid if cost is a concern. This means that the prescriptions are technically off-label use and optimization rather than therapy(based on numbers and not my symptoms). How would the insurance companies ever know if it’s off label if there is no prior authorization though? I would just like to cover my bases before I start HCG because I can’t afford the full cost of it without insurance. If I can’t get them to cover it I am going to say no to the clomid and just take the test. I just got insurance for the first time and am a little unsure of how this works and obviously can’t talk about cheating their system with them. I’m in Canada as well of that makes any difference.