Insurance denied coverage for my Test C prescription

[shizzy]

I am 39 and tested testosterone was 335.
Doc prescribed it but insurance won't pay for it.
Insurance said it was not low enough to qualify for testosterone replacement therapy (TRT). I have regence blue cross/blue shield in washington state.
1. Any experience appealing this decision? Am I stuck paying for it myself?

I have a legal prescription for 10ml test c.
2. If I order from overseas to save some money but get busted by customs does the prescription protect me from any prosecution?

 

[Thunderstruck]

Test C is pretty cheap. If you got a legit script why risk it.

 

[shizzy]

Here is the Answer to the second question. Sorry, i should have googled it myself.
justanswer.com/law/0sery-legal-buy-overseas-prescription.html

 

[zgx]

From what I have gathered so far there's more to it than just injecting testosterone. Talk to Todd @ IMT which is a sponsor of this forum to discuss your options.

 

[BigFella]

^^^
+1

I'm curious: How much does it cost without insurance?

 

[Misc]

did you tell the doctor? who the hell is the insurance to tell you what your diagnosis is. thats fucking bullshit. id be mad if i was the doctor cause there basically saying hes wrong.

 

[theguy9129]

How is insurance qualified to make that decision. But I guess at the same time I guess insurance is sick of being ripped off.

 

[mfpd]

I can't stand dealing with the insurance company I have. However, the insurance company is not stating that the diagnosis is incorrect, they are just stating it doesn't meet their guidelines to qualify for payment. Failure to pay does not mean incorrect diagnosis.

I hurt my back and saw a PT for about 24 treatments. My insurance policy only paid for 20 because that is all they cover. I was on the hook for full payment of the last 4.

I really hate health insurance policies!!!

 

[theguy9129]

yeah it sucks. maybe see if you can switch, Or find out how much out of pocket the meds cost. Also some pharmacys will help you out on payments. Also look into a pharmacy card, they cover just perscriptions they usually dont pay for it all but offer some sort of discount.

 

[wvdave]

my partner is prescribed 100mg/wk through his PCP and a 10ml vial is somewhere around 70-80$ at Sams Club pharmacy without insurance.

call the pharmacies in your area for a price.

 

[shizzy]

Doc is going to test me again. The low threshold is 332 so i was 3 points to high.

I called around for out if pocket prices. Target was $100, Wally world was $110, little mom and pop place was $70

 

[BZOERB]

Go to a compounding Pharmacy they can do for like $50 better not to even worry about the ins company screw them.

 

[cmc83]

my ins done me the same way

 

[Misc]

Doc is going to test me again. The low threshold is 332 so i was 3 points to high.

I called around for out if pocket prices. Target was $100, Wally world was $110, little mom and pop place was $70

well you could get some test. run it and then drop it and get blood taken again when your T is at its lowest and then tell the insurance to suck it and pay for your meds... just sayin...

 

[shizzy]

well you could get some test. run it and then drop it and get blood taken again when your T is at its lowest and then tell the insurance to suck it and pay for your meds... just sayin...

interesting idea. I'm actually about to start a new thread on a similar question; how to appear like a compliant patient with my testosterone replacement therapy (TRT) but still show low on a blood test to get a higher dose script.

 

[bribridg]

I had a similar problem with my insurance. Just have your doctor word the perscription differently. Trust me he KNOWS how to do it.

 

[UJMRYDER]

I had a similiar issue. My total was barely in range but my free was below. They wanted total to be under (200) or free to be under and several symptoms. I appealed it. Basically told them that my free is under and I attributed my symptoms to other things so I did not mention them all to my doc.

Suprisingly the ins (Medco) got back to me within three days and approved my prescription. So.....file an appeal if you can. It worked for me.

 

[corvettels3]

I thought we could not post prices here. Legit or not.

 

[BigFella]

Ah! Good point. My bad.

 

[Misc]

I thought we could not post prices here. Legit or not.

why not if legit? i mean i could call target or walmart myself and get this info....