Author Topic: Insurance Trick for HRT (Testosterone)  (Read 6293 times)


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Insurance Trick for HRT (Testosterone)
« on: July 23, 2013, 06:40:04 pm »

I think all of these sites have a doctor on staff that the order is placed with.  In California it's the law that a doctor must order diagnostic tests so this is the way they get around it.  LEF.org is the same way.

In case this of use to anyone in terms of insurance/blood work, etc...

I have recently switched to Dr Shippen and need the flexibility to get bloodwork at my convenience to gradually titrate doses of HCG, etc. I live in one of those screwed up states where you have to get a dr's orders for bloodwork and then they won't give you the results directly. Here is what I've done. I'm using an HMO probably like most of you guys:

1) If you want to see an out of network doctor (which I assume applies to a lot of you, especially if you're going to a TRT clinic), if you push hard enough you can get an out of network referral with something called an IPA Reviewer Signature. I believe this stands for Independent Physician Association. If you make your case and get it approved, you then can get the claim reimbursed to some extent. (Still waiting to find out as I'm in the process of submitting mine.)

2) For bloodwork, I did end up joining lef.org and got their discounted rates. In fact, they were having a sale so I got a lot of tests done for a couple hundred bucks. This worked out well, since I needed a full adrenal panel. Now I am getting in the process of getting a back dated out of network lab authorization. You have to justify it, so you need to think of a good reason why you would have to use an out of network lab. I'm in the process of drafting a letter so that my PCP will submit an out of network lab referral to my HMO.

3) For medications, I assume compounded pharmaceuticals are probably not reimbursable but I'm going to find out. As it turns out, though, they are not so bad in terms of cost. For example, 0.1mg Arimidex sublingual "troches" are only $50 for 30. So at about 2/week, that's 15 weeks for $50. Not so bad, and they are flavored like cherry so it is like have a cherry candy a couple of times/week.

It seems like you need to understand the "nooks and crannies" in the system to milk it for all it's worth. And fight with insurance companies to the end...it's showing me that I still must have a lot of testosterone reserve left in my nuts, as I have been aggressively pursuing these reimbursements like a pit bull.... :o
Recovering from adrenal fatigue through Paleo diet+exercise+vitamins/supplements; formerly used HCG & Clomid at various dosages


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Re: Insurance Trick for HRT (Testosterone)
« Reply #1 on: July 23, 2013, 07:07:32 pm »
I split this out as it is interesting and excellent information.  Thx Davie...

And I actually posted it here for other men to read: http://www.peaktestosterone.com/Hormone_Replacement_Therapy_Doctors
« Last Edit: July 23, 2013, 07:56:50 pm by PeakT »
And check out my New Peak Testosterone Program: http://www.peaktestosterone.com/peak_testosterone_program
If you are on medications or have a medical condition, always check with your doctor first before making any lifestyle changes or taking new supplements.  And low testosterone is a medical condition.

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Re: Insurance Trick for HRT (Testosterone)
« Reply #1 on: July 23, 2013, 07:07:32 pm »