If you’re considering testosterone replacement therapy (TRT), you may be wondering if your insurance will cover the costs. Here’s what you need to know.
First, it’s important to understand that TRT is considered an elective or cosmetic treatment by most insurance companies. That means there is a chance that your insurance will cover the costs. The next thing to understand is how insurance companies work. Many insurance companies will want to see a medical need for testosterone before paying for it.
In fact, many health insurance carriers demand that you fulfill several criteria in order to receive coverage and many people are aware of this.
Does Insurance Cover Testosterone Therapy?
You’ve weighed out your options, discussed with your doctor the pros and cons, and decided that testosterone replacement therapy is right for you. Congratulations! You’re on your way to feeling better, having more energy, increased libido, and improved mental clarity. The trouble now is, you’re probably wondering whether it is covered by insurance and how to get insurance coverage if it is not.
In short, the answer is not always.
Unfortunately, most insurance carriers do not cover because they consider TRT as an elective or a form of cosmetic treatment. So, there is a chance that your insurance will not cover the costs.
One important thing to understand is how insurance companies work. Many insurance companies will want to see a medical need for testosterone treatment before paying for it. Which means, it needs you will need to be thoroughly examined by a hormone specialist doctor.
How To Get Insurance to Cover TRT
If you’re like most people, you’re also on a budget and the last thing you want to do is pay for something that your insurance should cover. To this day, testosterone replacement therapy is still one of the most effective ways to restore testosterone levels as well as keep you feeling young and vital.
The good news is that there are ways to get your insurance to cover the cost of testosterone therapy. You will just need to work with a doctor who can help you navigate the process and get the coverage you need.
Here are some tips on how to get your insurance company to cover testosterone therapy:
1. Know Your Insurance Coverage
Testosterone replacement therapy is more than just testosterone injections, which means it is important to understand what your health plan. This includes the office visits, the blood work, and the prescription costs.
Some policies have a very high deductible, which means you will be responsible for paying a large portion of the bill upfront. Others have a lower deductible but may not cover certain aspects of the therapy, such as the office visits.
Though it cannot be guaranteed your health insurance company will cover your testosterone replacement therapy, knowing your policy is the best place to start the process to help you get treatment coverage.
2. Work with a Hormone Specialist
One of the best ways to ensure you get the coverage you need is to work with a hormone specialist. Hormone specialists are doctors who are experts in hormone health and have extensive experience working with insurance companies to get coverage for their patients.
They will be able to help you understand your policy, work with the insurance, and get you the testosterone therapy coverage you need.
3. Get a Prescription
According to Mount Sinai Health, normal levels of testosterone in men is 300 to 1,000 nanograms per deciliter (ng/dL). When testosterone levels fall below the normal range, many insurance providers will be prepared to cover you.
When testosterone levels fall below the normal range for men, it can lead to serious health issues if it is not treated. As a result, many doctors are more than willing to justify that testosterone replacement therapy is medically necessary.
Here are a few common medical conditions that are covered by insurance:
- Pituitary tumors
- Klinefelter’s Syndrome
- Kallman’s Syndrome
- Removal of prostate
If testosterone therapy is required for issues with libido, balding, or mood, you will need to have some blood tests to ensure that you have low testosterone levels.
What If I Don’t Qualify?
If your insurance is not able to cover prescriptions or lab work, the best suggestion is to get in touch with a local testosterone replacement therapy clinic to see how they can work with you.
These clinics work with patients like you every day and are there to help you, so they may be able to offer you payment plans, discounts, or other financing options.
Many patients who are are undergoing testosterone replacement therapy and pay out of pocket find that the benefits they experience are well worth the cost. From improved energy levels and mood, to increased libido and better sleep, testosterone therapy can certainly improve your quality of life.
If you are struggling to afford treatment, be sure to talk to your doctor about how to get your insurance to cover testosterone replacement therapy. With a little bit of effort, you may be able to get the coverage and treatment you need.