Is TRT covered by insurance? Will my insurance cover testosterone therapy? The short answer is NO. So why don’t insurance companies cover comprehensive testosterone replacement therapy, aka TRT?
Since testosterone replacement therapy is sometimes viewed as a “new” therapy, many patients ask us this question: “Will my health insurance company cover testosterone therapy for me?”
Most health insurance companies cover a large part of the cost of testosterone replacement therapy for men, provided you can prove the need.
Of course, the amount your insurance covers will vary from provider to provider, and will also vary based on your specific health plan and other variables, such as Your deductible.
While we cannot guarantee that your insurance will cover the cost of your testosterone replacement therapy, we can at least help you get the process started with a free consultation or a simple call to your insurance company.
Your healthcare provider may already have approved you for testosterone replacement therapy if you have certain medical conditions or medical diagnoses. Depending on the insurance company, these conditions may include:
- A pituitary tumor
- Klinefelter syndrome
- Kallman Syndrome
Other diseases such as a prostatectomy, can also prevent you from needing tests to indicate low testosterone levels.
For men: is TRT covered by insurance – How does health insurance cover testosterone therapy?
We check your insurance benefits with your health insurance company to see whether the health insurance company will cover the costs of your therapy.
Unfortunately, during your free consultation, we cannot guarantee that insurance will cover the cost and coverage may vary from provider to provider and from one insurance plan to another.
The main purpose of the consultation is to screen you for low testosterone levels and to answer all your questions.
Most health insurance companies require you to provide proof that you need therapy. Many health insurance companies require you to meet various standards before paying for therapy.
Typically, health insurers require that you take two blood samples before 10 a.m. on two different days, each of which indicates low OR-free total testosterone levels. What low testosterone is can vary by the insurance company?
One of the services we offer is testosterone testing. We’ll help you establish the criteria your health insurance requires through several simple blood tests, the first of which cost just $150.
Once we have the results of both blood tests, we can pass the information on to your insurance company.
You may also have a diagnosis of low testosterone from your GP or a specialist – we can work with that too but we always make sure we do our blood tests and corroborate the work of others.
Is TRT covered by insurance – How can I be sure?
The easiest way to find out if you have insurance is to contact your cell phone provider.
Some insurance companies may request additional information about your medical condition and treatment suggestions, such as Several blood tests to determine your testosterone levels.
If you’re still unsure, we recommend taking our free online testosterone self-test, followed by a free in-office exam by one of our hormonal doctors (usually $150). From there we can discuss all your insurance questions.
Is TRT covered by insurance – What if I don’t qualify?
If your insurance cannot cover prescriptions or laboratory work, please contact us. We believe everyone should be able to afford to improve their health, which is why we partner with local compounding pharmacies to bring you significant discounts.
Does health insurance cover testosterone therapy for women?
Again, it all depends on your healthcare provider, but insurance usually only covers testosterone for women with certain medical diagnoses.
Why does health insurance sometimes reimburse testosterone therapy for men and not for women?
The answer lies with the FDA.
Unfortunately, the FDA does not currently consider low testosterone to be a diagnosable condition for women per se.
However, health insurance will often cover the cost of testosterone replacement therapy for you if you have previously been treated for certain types of breast or breast cancer, and there may be other instances where your specific insurance will cover the cost.
So does health insurance cover testosterone therapy for women? Mostly it depends on your plan. What exactly is reimbursed and what is not, we will clarify with your health insurance company.
Does health insurance cover testosterone therapy? Generally yes. But what if that’s not the case?
Normally, your health insurance will cover testosterone therapy if your doctor can show you need it.
However, not everyone has health insurance.
And even if you have health insurance, sometimes you have to pay for one reason or another. For example, your hormone levels may not be low enough to show your doctor a need, but you may still have symptoms.
Luckily, the cost of testosterone replacement therapy is very affordable, even if you’re paying out of pocket.
In general, $299 per month is enough to cover the cost of weekly testosterone injections, injections that you can get quickly and easily without long waiting times. We also offer flexible hours and multiple locations so you have the opportunity to receive therapy when and where it is most convenient for you.
Most of our self-paying patients find that the benefits of feeling happy, healthy, and being themselves again far outweigh the costs – they recognize the value of therapy.