Coverage really boils down to how your MD codes the procedures and how they fall out in your insurance company's fee schedule. Most companies have at least 2 fee schedules - one is an elective schedule and anything that is coded on that schedule will always be denied. If you want your Ins to cover the HRT, it needs to be code so that it is not on the elective schedule.
I have BC/BS and it is pretty easy with them. I started with an initial diagnosis of hypogonadism/hypothyroid. For my blood work, because I get it done so frequently, my MD codes it as necessary because of "at risk medication."
For my scripts, it has never been an issue with BC/BS because of the initial coding of condition. My Test and Aromatase inhibitor (AI) were both generic at Walgreens and was covered and the copay was $10 each per month. HCG was on a separate schedule and was $100.
Nolva and Clomid were generic and $10 per refill.
Again, it depends how your MD codes the work. I've not had any issue out of BC/BS.
I think others have had some problems with other insurance carriers.
The big thing to remember is make sure your MD codes it with a specific condition diagnosis code. Most carriers have hypogonadism or some form of that like hypothyroid ect.
At the end of the day, I do know that Chip's price structure with Maxius is very very affordable and they can work with you for several months at a time whereas I had to run to Walgreens every month b/c BC/BS would only do a 30 day order.
Just as an aside, when you are on a first name basis with the lady at the Walgreen's drive through and you look like I do pick up a script for Testosterone, you get a lot of nasty stares.
