Will your insurance cover testosterone injections? Learn now!
In today’s post, we’re going to talk about insurance for testosterone therapy and explain when it covers the price for the treatment prescribed to maintain proper testosterone levels and recover from disorders brought by hormone hunger.
Testosterone is important both for men and women to regulate bone density, maintain physical strength and muscle mass, control fat distribution, be responsible for red blood cell production, and regulate sperm quality in men.
When testosterone replacement therapy (TRT) is prescribed and is it possible to save money with the help of insurance? Let’s see!
Can I use TRT just to improve my health?
If a middle-aged man has low testosterone levels, it certainly brings unpleasant symptoms and threats to his physical and mental health in the closest future. T-hormone replacement therapy is prescribed to enhance physical endurance, increase the sex drive of men suffering from its decrease, and improve the overall quality of life.
The therapy helps to reduce body fat and increase muscle strength, get rid of mood swings and depression as well as eliminate a number of disorders caused by hormonal imbalance. So, what are the symptoms of low testosterone? They are pretty harsh:
- memory and concentration issues;
- low stamina;
- erectile dysfunction;
- hair loss;
- fitful sleep;
- mood swings;
- inability to lose weight despite the strict diet;
- muscle and bone weakness.
If you experience some of the mentioned symptoms, it’s time to consider starting testosterone replacement therapy. But is it a costly task? Let’s review it in detail.
Testosterone Replacement Therapy Cost: No Insurance
The good news is that therapy is not always expensive. Most insurance companies cover the cost of testosterone replacement and this can become affordable for people with average financial capacities.
If the TRT cost is covered by insurance, a patient will pay just a part of the price for the treatment.
The cost for a TRT covered by insurance ranges from $30 to $100 per month but it depends on the clinic, its protocol, and the regulations included in insurance for the testosterone therapy plan.
If you’ve got no insurance or your insurance doesn’t cover the cost of TRT, then you can choose the T-hormone injections as the cheapest (and the most effective) type of testosterone replacement therapy.
Other types of TRT treatment are a bit more expensive and their cost is as follows:
- testosterone granules for intradermic use – about $500 per month (or higher based on the dosage);
- testosterone creams, gels, and patches – approximately $200-500 per month.
Still, whichever testosterone replacement treatment you choose, its cost may vary from month to month as the doctor customizes your treatment plan on an individual basis.
Does insurance cover testosterone replacement therapy?
The majority of insurance companies provide coverage for testosterone replacement therapy for men, but this requires medical evidence confirming that this therapy is required.
Of course, each insurance company provides its own percentage of coverage for T-hormone replacement therapy, and the only way to discover the exact amount of cost to be compensated is to consult your insurance agent and ask if you are able to get testosterone injections covered by insurance.
Sometimes hormone therapy is required for treating chronic disease, inborn syndromes, and severe illnesses like Pituitary tumors, Klinefelter’s syndrome, or Kallmann syndrome. In that case, insurance is provided to a patient by default.
Some specific conditions identified by the insurance plans help to save costs on lab work, for instance, they cover the blood tests confirming low T, prostatectomy procedure, etc.
How does health insurance cover testosterone therapy for men?
To get your testosterone therapy cost covered with insurance, you should first officially confirm that the therapy is indicated to you based on your diagnosis.
Some insurance companies sometimes require a client to meet certain demands to receive treatment coverage. First, you should undergo 2 blood tests to indicate if the low T really exists. The tests should be made in the morning for a few days, and anyway, each insurance company has its own criteria for estimating the test results to be enough or not for providing insurance coverage to clients.
However, some insurance companies just require official feedback from a thyroid specialist that confirms the lowered testosterone diagnosis.
Does health insurance cover testosterone therapy for women?
Health insurance only covers testosterone replacement therapy for women if they have other medical indications for receiving it except for low testosterone shown by the blood tests. For instance, women should prove that low testosterone has resulted in significant disorders or illnesses that should be also officially diagnosed.
The FDA does not consider low testosterone levels in women to be evidence for hormone replacement therapy. The exception is TRT coverage for women who have recently recovered from breast cancer or women who can prove the necessity of getting the therapy based on some other medical evidence individually discussed with a doctor and insurance agent.
Does Blue Cross Blue Shield cover testosterone therapy?
Blue cross, blue shield organizations can provide insurance coverage for lab work and further hormonal treatment. Some other companies also offer medication coverage but it differs based on the type of insurance plan. The conditions for obtaining insurance for your treatment are as follows:
A T-hormone test and further testosterone replacement therapy are indicated for men with strict symptoms of androgen deficiency.
Insurance for women is provided if they have an overbalance of androgens (e.g., polycystic ovary syndrome and functional hypothalamic amenorrhea).
The coverage is provided if a patient purportedly has a disorder resulting in elevated or decreased SHBG (Sex Hormone Binding Globulin) levels.
- It is possible that a patient needs to pay for regular lab tests required during TRT.
- It is given if a man is taking enzyme inhibitors for prostate cancer treatment.
When lab work is not covered by insurance:
- If there is no medical evidence confirmed (nonspecific or absent symptoms).
- If a doctor has determined that it’s not required for a female patient to undergo additional lab evaluation to confirm her deficiency symptoms.
- If testosterone levels testing is made just for diagnostic purposes.
Testosterone Therapy Covered by Insurance
Most often, health insurance will cover testosterone replacement therapy if your healthcare provider officially confirms your diagnosis. However, not all clients have health insurance for hormone therapies.
Their insurance plans may be created in such a way that they suppose the coverage neither for the hormonal treatment itself nor include certain conditions describing when the hormone levels are considered to be low enough to allow a client to claim for the treatment coverage.
If your testosterone levels are low but the test results are not enough to get insurance, you will have to pay the full price. In this case, you should spend about $300 per month to cover both testosterone injections and possible additional costs.
To save money it should be better to address several different clinics and ask for their prices and available discounts. Just don’t refuse the treatment once you’ve learned that your insurance doesn’t cover it. The hormones affect all body systems and their lack or overbalance can significantly harm your health. The treatment is worth the money you invest in it and your health is worth your expenses.
Be healthy and live a long and active life without any discomfort or pain. For more concerns contact our experts.