Since testosterone replacement therapy is considered a “new” therapy, many patients ask us, “Does health insurance cover testosterone therapy for me?”
Most health insurance companies will cover the bulk of the costs of treatment for testosterone loss in males if you have a valid reason for needing it.
Naturally, the sum your insurance policy covers differ between providers as well as according to your particular health insurance plan and other aspects such as your deductible.
While we cannot ensure whether your insurer will pay for the expense of the testosterone replacement therapy, we can help you begin by providing no cost consultation or by making a phone contact to your insurance company.
Your health insurance company might have approved your testosterone replacement therapy if you suffer from certain medical issues or a diagnosis from a doctor. According to what insurance you choose, those conditions could include:
A pituitary tumor
Klinefelter’s Syndrome
Kallman’s Syndrome
Other medical conditions, like undergoing a prostatectomy, could also prevent the need to test to confirm the presence of testosterone.
For Men–How Does Health Insurance Cover Testosterone Therapy?
We’ll examine the benefits of your health insurance provider to determine if they will pay for the therapy you require.
Unfortunately, during your complimentary consult, we can’t assure you that the insurance plan will pay for the expense and that coverage will vary between insurance companies and from one insurance policy to the next.
The purpose of the appointment is to determine if you have low testosterone levels and answer your questions.
The majority of insurance companies require you to show that you require therapy. Indeed the majority of medical insurance providers require that you satisfy several requirements before making a payment for therapy.
Most health insurance providers will require two blood tests indicating low total OR testosterone levels. The blood tests are done on two separate days before 10:00 am. What is considered low testosterone could differ between insurance companies.
The most common service we offer is testing for testosterone. We assist in establishing your health insurance policy’s requirements by conducting a series of simple blood tests; the most basic cost is only $150.
We will send the information to the insurer when we receive the test results.
There are also low testosterone diagnoses from your primary doctor or specialist. We can help you with that, too; however, we ensure that we conduct our blood tests and verify the results of other tests.
Does Health Insurance Cover Testosterone Therapy for Women?
Also, it depends on the health insurance provider you choose. However, insurance typically only covers testosterone in women with certain medical conditions.
Why do health insurance companies sometimes offer coverage for testosterone therapy for men but not women?
The answer lies in the FDA.
Unfortunately, the FDA is not yet able to think that low testosterone is an identifiable condition for women buying it.
However, health insurance usually covers treatment with testosterone if you’ve had certain breast or mammary cancer. There could be other situations where your insurance policy will cover the cost.
So, will the health insurance plan provide coverage for testosterone therapy for females? Most of the time, it is contingent upon the plan you have.
We will ask your health insurance company to determine what’s covered and not included.
Does Health Insurance Cover Testosterone Therapy?
Generally, Yes. But What If it Doesn’t?
Most often, your health insurance will cover testosterone therapy when your physician has a reason to believe you require it.
But only some have health insurance.
Sometimes, even if you are insured for health, you could be with a bill you have to pay due to one or the other. For instance, your hormone levels might not be sufficiently low to warrant a claim to the health insurance company you have; however, you could be suffering from symptoms.
Luckily, the price of treatment with testosterone is affordable, even if you pay out of pocket.
