Insurance and HRT?

[modernist (imported)]

Does anyone know how insurance treats HRT for eunuchs? Context: I corresponded with Dr. Arnkoff's office by email and they sound fairly receptive to my reasons for surgery. I've been on blockers before and liked what I felt, and plan to do another trial in the fairly near future to double check (Cyproterone is expensive!). However, if I am castrated, I will still want to be able to control the T in my body - to keep up my energy and bone density. Anyone have experience with getting insurance to cover HRT after voluntary castration?

[raymar2020 (imported)]

Why would you volunteer that you were castrated by choice? If you are not local to Dr. Arnoff, then there is no reason that you need to reveal that you chose to be castrated. To get T , you need only to see your regular doctor, although an endocrinologist is a good idea.

Say to the doctor what you choose, I had an accident , and they removed them, I had a serious cancer risk , and removal was advised, they were a congenital issue.

Injectable testosterone is actually pretty cheap. Under 50.00 a month without insurance. Its the gel products that are crazy expensive. Insurance does NOT like to provide self injected products to patients, but with a letter from a doctor they will. I found it really funny that when Androgel stopped being as effective for me, and I asked to go back to shots, that insurance preferred to pay the higher price for Androgel.

Raymar

[modernist (imported)]

Thanks, practical advice! Just looking to the future. Good point, they really have no reason to know it was voluntary. Heh.

[Uncle Flo (imported)]

I don't know about Ohio but, some states do not allow insurers and providers to treat self imposed conditions any differently than they treat naturally occurring conditions. You might want to check out how your state deals with this. --FLO--

[Riverwind (imported)]

With the VA its a NO. final answer.

River

[Eddie (imported)]

With the VA its a NO. final answer.

I'm with the VA and get my Androgel thru them for 10 years now monthly for a $8 copay.

[scarnick (imported)]

I was on HRT prior to castration, due to low T levels. My insurance did agree to cover it and has continued the coverage for almost 6 years, now. They did require the doctor to complete forms certifying the need, however that was all in place prior to my castration.

[daifu-orchid (imported)]

Yes, my HRT is covered by BCBS and seems to be no problem. My PCP checks the T-levels from time to time and it all seems no problem. The expense is relatively small as it comes to just 2 small injections a month from a vial that lasts 5 months. Full price for the vial would be about $100, and I pay just $20 with the insurance.

Maybe if i wanted to slather myself daily with the expensive t-goop, they might want papers, and forms, and goodness knows what else besides!

[kristoff]

Yes, my HRT is covered by BCBS and seems to be no problem. My PCP checks the T-levels from time to time and it all seems no problem. The expense is relatively small as it comes to just 2 small injections a month from a vial that lasts 5 months. Full price for the vial would be about $100, and I pay just $20 with the insurance.

Maybe if i wanted to slather myself daily with the expensive t-goop, they might want papers, and forms, and goodness knows what else besides!

Full price of a vial that size should rarely ever exceed $60.00, and $5 for a 10 pack of syringes.

[cheetaking243 (imported)]

Hormones are a touch-and-go matter. Some cover them fully, some won't cover them at all. Getting testosterone HRT covered really shouldn't be that hard, though, because it is deemed much more of a medical necessity than, say, transgender hormones. When I visited my doctor in Columbus, what he said to me would seem to indicate to that getting gender-appropriate hormones is indeed usually covered by insurance. Because when he gave me my prescription for estradiol, he said "this might not be covered by your insurance since you're still listed as male legally." This would seem to indicate to me that hormones which do match the sex on your records are indeed usually covered.

[daifu-orchid (imported)]

Hmm. I just checked with Walgreens and RiteAid and neither will break the $100 barrier for 10ml 200mg/ml t-cypionate, at least not for me. Myabe they know I usually get it on the BCBS insurance, but it's good to know that a better deal can be had. Probably most, including Kristoff are better hagglers than me.

[mrt (imported)]

Check out the copay cards that most drug companies have. Its possible to end up paying much less on the copay when you have one and tell the pharmacist. And I just wanted to add a comment about "voluntary castration." If it was not voluntary (in some fashion) it could only be involuntary castration which I think would be a really bizzare requirement for Insurance coverage.

I think I had a valid reason for asking for an orchiectomy (I still say castration is for critters not people) If you believe your reason for asking for one is invalid? Maybe its worth more time to think about having it done? Dealing with hormones all the time and seeing an endo on a regular basis is kind of a pain. I'm ok with it because it solves seeing a different kind of doctor on a regular basis (Pain and Urology) But if your "ok" now? Again - I would really ponder the reality of what you get if you do this.

[mrt (imported)]

Why would you volunteer that you were castrated by choice? If you are not local to Dr. Arnoff, then there is no reason that you need to reveal that you chose to be castrated. To get T , you need only to see your regular doctor, although an endocrinologist is a good idea.

Say to the doctor what you choose, I had an accident , and they removed them, I had a serious cancer risk , and removal was advised, they were a congenital issue.

Injectable testosterone is actually pretty cheap. Under 50.00 a month without insurance. Its the gel products that are crazy expensive. Insurance does NOT like to provide self injected products to patients, but with a letter from a doctor they will. I found it really funny that when Androgel stopped being as effective for me, and I asked to go back to shots, that insurance preferred to pay the higher price for Androgel.

Raymar

I was feeling a bit tenderized by the weekly injections so I asked to go on one of the gels and I had the same problem. They just don't work anymore. When I went back on one I felt terrible. I don't know if I've suddenly become unable to absorb the stuff or the dose is goofed up (Really bad) It took me a while to figure out that was why I was acting more insane then usual and went back to injections. I agree that some clinics don't like patients doing self injections but its an awful chore going in all the time to have a nurse do it. Ask to be "trained" by one of the nurses. Its not that big a deal to do an injection into the thigh muscles.