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Blue cross drops HRT?

nikehotel

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Got a denial letter from blue cross blue shield, they are no longer going to reimburse labs or testosterone therapy. They also sent me my last lab results as proof I no longer have medical need to get test...as I was @ 600 after my last shot. Awesome huh? Good thing I have another insurance. They also made my doc out of network. Makes me wanna go the sponsor route.
 

j4ever

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Got a denial letter from blue cross blue shield, they are no longer going to reimburse labs or testosterone therapy. They also sent me my last lab results as proof I no longer have medical need to get test...as I was @ 600 after my last shot. Awesome huh? Good thing I have another insurance. They also made my doc out of network. Makes me wanna go the sponsor route.
so they sent you a denial letter based on increased test levels that resulted from your trt injects?
 

nikehotel

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Yep. Wonder of they are going to drop my wife's insulin, now that her blood glucose is under 200...
 

hemipower

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Got a denial letter from blue cross blue shield, they are no longer going to reimburse labs or testosterone therapy. They also sent me my last lab results as proof I no longer have medical need to get test...as I was @ 600 after my last shot. Awesome huh? Good thing I have another insurance. They also made my doc out of network. Makes me wanna go the sponsor route.
That is seriously messed up! Your labs show trt is working...so we will no longer pay for it. WTF? I love how insurance co and big pharma are now teaming up to be more crooked AND create more of a black market...
 

jamescb77

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this is the problem with the uneducated idiots that are running these companies. the look at it as oh your fixed now there is no more need. They don't realize that after 2-3 week syou would be back in the toilet. bunch of idiots is what they are.
 

BOOMSHAKER

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Got a denial letter from blue cross blue shield, they are no longer going to reimburse labs or testosterone therapy. They also sent me my last lab results as proof I no longer have medical need to get test...as I was @ 600 after my last shot. Awesome huh? Good thing I have another insurance. They also made my doc out of network. Makes me wanna go the sponsor route.


Ask your doctor to write a letter to BC/BS and send it to their appeals dept. Your doctor can formulate your needs better then you can if you wanted to do it yourself. You doctor can explain why it would be necessary to keep you on it, rather then dropping you off all together.
 

nikehotel

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Yeah I'm going to fight it, but I think they are dropping TRT from supported treatments. Dunno. I have Cigna too, so if they pay I can keep seeing my current doc, but I have another TRT doc in my area, maybe they will bill differently.
 

buck

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perhaps this is all related to them dropping your Dr. if he isn't in the network perhaps his testing etc. is not being allowed?
 

NOSUPERMODEL

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Holy crap!!! I have BC/BS

I will have to do some checking on it.
 

SAGE74

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I have Fallon health and they don't pay for anything. They said TRT is for vanity! I had a 69 test level!
 

discohornet

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This is the games insurance companies play. It's called "deny everything and only pay out on those who fight us on it". They simply deny anything they can and figure if you don't fight it then they saved money.

There are a lot of people out there who won't appeal these claim denials, so it benefits them to just do sweeping denials like this.

I know a lot of you aren't in favor of mandated health care in this country, and I don't blame you, but the fact of the matter is, no other industry can thrive in this world by adhering to such bullshit. The only reason they get away with it, is they're the only game in town. If they knew you had options they would work their ass off to take care of you.

Could you imagine walking into a Hotel and the front desk person's job boils down to figuring out why they don't have to honor your reservation? And yet this happens all the time in the health insurance industry. And we take it, because we like our freedom.
 

richiec

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Ask your doctor to write a letter to BC/BS and send it to their appeals dept. Your doctor can formulate your needs better then you can if you wanted to do it yourself. You doctor can explain why it would be necessary to keep you on it, rather then dropping you off all together.
I wish I could like this 1000 times!!! Get your doc to help you out here, that's what he's there for!
 

nikehotel

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So I did some more research into this with both my Doc & the BCBS...so Test via injection is indeed approved & on the formulary, but they kicked my Doc out of network & denied his lab results.....sounds like it is more of a issue for him and his lawyer. they are going to keep co-pays ect, treatments the same, but I have a feeling the days are numbered for his clinic. Got another appointment with a new Doc, but now I have to abstain from TRT for a week or so to drop my levels back into the shitter. I have been on for 4 years so I am shut down hard. my Nat level was in the 300's 4 years ago...best I could do on Clomid, HCG, Tribulus, AND a shot of tripolin was, was 500, when I was trying to get my sperm count up. But when I stopped all that...I fell to 200.....I am on TRT for life. This is the problem with TRT, it is either docs who give a RX for test once every month, or a life extension place you need to pay for....I need to find a smart doc to do things the correct way, and bill my lame insurance Co. Bummer. This bs makes me feel like a med seeker. :banghead: thanks or all the responses
 

BOOMSHAKER

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Sounds more like a Credentilaling issue. He didn't get his paper work in on time during the year to be re-enrolled in that perticular insurance. Happens all the time in hospitals. However, the insurance company should have paid at non-par rates rather then dropping him all together. And now consider him a out of network physician. That's bad insurance bussiness practice.
 

mcswag

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most ridiculous thing I have ever heard.. do these people understand the science behind TRT??
 

nikehotel

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No they do not. I was told on the phone by a chick @ blue cross that test is "investigational" for it's effectiveness. Luckily the place I go to will sell me preloaded syringes, so I might just buy a couple weeks, & find a endo that's not a retard. I have Cigna too so I should be able to figure this out. I'm just annoyed that I have to give up seeing my current guy, I really like him & it costs me nothing per visit. Now I'll either have to pay a copay or get a rx & pay for a vial of test. Other problem is that I'm up higher in dose, 300mgs a week puts me @ 600/ng dl
the following Monday, I know some docs will balk @ that. Anyone know the mail order pharm cost for test?
 

Marine0811

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Fuck I have BC/BS guess I should get ready to start my fight. Did they say anything about androgel? I could go back to that, but hate that shit.
 

nikehotel

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I dunno about gel never used it. U can look up on your states bcbs formulary to see if it's covered
 

buck

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i should have mentioned earlier that Blue Cross paid for my test 4 weeks ago and the month before that as well. they were out of the 200mg/ml so the pharmacy supplied me with the 100mg/ml.
 
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