Are Hormone Pellets Covered By Insurance - (2023)

Does Insurance Cover Compounded Hormone Therapy

Bioidentical Hormone Replacement Therapy (BHRT) utilizing pellets – Age Management Medicine

If youre thinking about using bioidentical hormones, here are 10 facts you need to know: Many health insurance companies dont cover compounded hormone therapy, or reimburse you if you pay out of pocket. Most users of compounded hormone therapy are not aware that these medications are not FDA-approved.

Does Insurance Pay For Bioidentical Hormone Replacement For Men

As men age, they have a gradual loss of hormones, especially testosterone. While not as well-known as female menopause, there is such a thing as andropause for men. Andropause interferes with a mans health and lifestyle.

Symptoms in men include weight gain, muscle loss, and fatigue. Other troubling symptoms include hair loss, urinary problems, and erectile dysfunction. Bioidentical hormone replacement therapy can help restore balance.

Here again, check with your insurance provider to see if it covers HRT. If you are looking for bioidentical hormone treatment, in particular, verify which hormones your policy covers.

Likewise, check to see what types of practitioners the plan includes and excludes.

Does Blue Cross Blue Shield Cover Bioidentical Hormone Therapy Does Insurance Cover Bioidentical Hormones

Blue Cross Blue Shield does not cover bioidentical hormone therapy or bioidentical hormone pellets, and its far from being the only health insurer that wont cover bioidentical hormone therapy. In fact, no insurance covers bioidentical hormones, bioidentical hormone pellets, but will cover the lab work necessary to calculate the optimum dose of the bioidentical hormones.

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Serving Women In A Variety Of Ways

At SOMA, were proud to educate and introduce new ways for Women at all stages of life to take care of themselves and live happy and healthy. In addition to our other services like CoolSculpting, BOTOX, Cosmetic Surgery, Face & Beauty, Sciton Lasers and more were excited to offer yet another service specific to Women SottoPelle Hormone Replacement Therapy.

What Should Be Included In The Cost Of Your Testosterone Therapy

Are Hormone Pellets Covered By Insurance - (1)

Another import consideration when evaluating the costs of your low testosterone treatment, is that you must take into account exactly what is included in a price that you may have been quoted for testosterone replacement.

Does the price for testosterone treatment include other aspects of your testosterone therapy beyond just the cost of your testosterone prescription, such as blood tests, follow-up doctors visits, and perhaps some additional nutritional supplements? Make sure when you get a quote for the monthly fee for low testosterone treatments, you know what else is included, and exactly what you are getting.

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What Are The Effects Of Pellet Therapy

The most common response from our patients about pellet therapy is that it has restored their quality of life. With Bioidentical Hormone Replacement Therapy, both men and women may experience the following benefits:

  • Greater Focus and Mental Clarity
  • Relief from Hot Flashes, Night Sweats, and Insomnia

References Related To Testosterone Estrogen And Pellet Implant Therapy

  • Turner R, Kerber IJ. A theory of eu-estrogenemia: a unifying concept. Menopause, Vol. 24, No. 9, pp. 1086-1097. Estrogen action through Estrogen Receptors is critical for homeostasis in women and men. Considering there are more than 3,600 ubiquitously distributed Estrogen Receptors and signaling pathways, it is biologically naive to conclude that estrogen, with its complex genomic and nongenomic actions, should be deficient from a menopausal womans body.
  • Bianchi VE. The Anti-Inflammatory Effects of Testosterone.The Journal of the Endocrine Society, 2018 Oct 22 3:91-107. Low Testosterone level has implications for metabolic health in both males and females and should be considered a risk factor because of its correlation with metabolic syndrome and all-cause mortality.
  • Samantha Worboys, et al. Evidence That Parenteral Testosterone Therapy May Improve Vasodilation in Postmenopausal Women Already Receiving Estrogen, The Journal of Clinical Endocrinology & Metabolism, Volume 86, Issue 1, Jan 2001, 158161. This study provides evidence that testosterone implant therapy may improve arterial vasodilation in postmenopausal women already using HRT. This supports the concept that androgens have important physiological actions in women as well as in men, and provides additional safety data pertaining to postmenopausal testosterone use.
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    New Patient Process What Are The Cost And What Is Included With Those Fees

    • We have a one-time new patient fee of $350 dollars after that there are no contracts or annual renewal fees it includes:
    • Your fist visit includes and a review of your medical history, medications, and a light patient exam.
    • The provider will then spend most of the visit learning about you and your symptoms attempting to understand their severity and impact on your life.
    • If it is determined that youre a candidate for treatment we will draw your blood here in our office. We will test for the hormones above but will also perform a full thyroid panel. If an issue is discovered with your thyroid we are specialists in optimizing its function as well.
    • We will then perform an extensive body composition test detailing the breakdown of muscle mass, body fat, and water in your body. That will end visit one.
    • During your second visit the provider will review your lab work in detail and provide you an individualized treatment plan to fit your specific conditions.
    Note: Both visits, lab work, body comp, and treatment plan are part of the $350 new patient fee.
    Note: After the initial new patient fee we do not require any contracts or annual renewal fees. You are considered a "Patient for Life" at all of our centers.

    How Are Hormones Measured Before And During Therapy

    Troubleshooting Testosterone Pellets for Women

    Before hormone pellets are administered, well draw your blood and send it to the lab for analysis. This will allow us to establish baseline hormone levels in your system. We can then determine the optimal hormone dose on an individual basis.

    For women, we will measure testosterone, free testosterone, estradiol, and follicle-stimulating hormone. Levels of thyroid hormone may also be checked.

    For men, testosterone, prostate specific antigen, estradiol, blood count, and liver profile levels will all be checked.

    Recommended Reading: Does Insurance Cover Testosterone Injections

    Why Are Pellets The Best Choice For Hormone Therapy

    Unlike creams, pills, and patches, pellets deliver more consistent and healthy levels of hormones into the body. Pellets are absorbed over the course of 3-5 months for women, and over the course of 4-6 months for men. Pellets are ideal because they avoid the delivery fluctuations experienced with other hormone delivery systems.

    Additionally, these natural hormones dont increase the risk of blood clots in the same way as synthetic hormones. Pellet therapy maintains an extremely high success rate, even for patients who have tried other systems of hormone therapy with little or no results.

    Testopel Is Covered By A Majority Of Commercial Insurance Plans*

    The majority of commercial insurance plans cover TESTOPEL®. A doctor’s office experienced with prescribing TESTOPEL® can work with you to explore your benefit coverage.

    *Insurance coverage and reimbursement for TESTOPEL® are not guaranteed. Coverage and reimbursement depends on an individual patient’s insurance plan. We recommend that you contact the insurance provider to verify TESTOPEL® coverage and reimbursement.

    Data on file. TESTOPEL® TRP Transactions Report. May 2018 . Endo Pharmaceuticals Inc.

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    How Is Hormone Pellet Therapy Different From Other Hormone Therapy

    Hormones can be administered using pills, patches, injections, and creams. The goal of all hormone therapy is to maintain a constant physiologic level. Changes in the level, whether too high or too low, cause undesirable side effects such as nausea, breast tenderness, low libido, acne, trouble sleeping, tiredness, and weight gain. A constant hormone level from hormone pellets allows patients to avoid many of these side effects.

    Hormone pellet therapy also addresses the issue of low testosterone in women. Prior testosterone treatments for women have been less than satisfactory due to the multiple side effects, including acne, hair loss, deepening of the voice, hair growth, and loss of breast tissue. These side effects are uncommon with the use of pellets.

    Why Are Pellets The Best Choice For Testosterone Replacement Therapy

    Are Hormone Pellets Covered By Insurance - (2)

    Unlike creams, pills, and patches, pellets deliver more consistent and healthy levels of hormones into the body. Pellets are absorbed over the course of 5-6 months for men. Pellets are ideal because they avoid the delivery fluctuations experienced with other testosterone replacement methods.

    Additionally, these natural hormones dont increase the risk of blood clots in the same way as synthetic hormones. Pellet therapy maintains an extremely high success rate, even for patients who have tried other systems of hormone therapy with little or no results.

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    Is Estrogen Still Important Even After Menopause

    Dr. Bloy believes that women should continue pellet therapy as long as they would like. Benefits experienced from pellet therapy will continue as long as the treatment does. Additionally, estrogen is vital to protecting against osteoporosis and premature loss of teeth. Estrogen could possibly reduce the risk of heart disease and Alzheimers.

    What If You Don’t Take Ht

    Menopause symptoms can be upsetting and uncomfortable. But you don’t have to suffer through them. There are other things besides taking HT that you can do to help.

    The first step is to have a healthy lifestyle. This can reduce your symptoms and also lower your risk of heart disease and other long-term problems linked to aging. Eat a heart-healthy diet, get regular exercise, don’t smoke, and limit caffeine, alcohol, and stress.

    If you still need help dealing with symptoms, you might try:

    • Breathing exercises to help with hot flashes and emotional symptoms.
    • Black cohosh and dietary soy, which may reduce hot flashes.
    • Vaginal lubricants and moisturizers to help with vaginal dryness, and vaginal estrogen to relieve soreness.
    • Antidepressant medicines, a blood pressure medicine called clonidine, or gabapentin. These may lower the number of hot flashes you have. And they can make hot flashes less severe when you do have them.

    To manage symptoms before you start menopause, you might think about taking low-dose birth control pills.

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    Being Your Own Advocate

    Downplaying the seriousness of hormone changes or imbalance as a normal effect of aging does a disservice to people experiencing what are often challenging, or even devastating, symptoms. Only you know your limits, including what you can live with and what you can live without. And yet, sometimes patients accept inferior or suboptimal care dictated by the limitations imposed by insurance companies.

    Each of us must advocate for ourselves and decide on the quality of life we desire and demand. Your insurance company may recognize one standard treatment path that does not align with what your provider deems best for you. Sometimes wanting more and desiring a greater standard of care means paying additional out-of-pocket fees. With proper treatment, you can anticipate symptomatic relief and an enhanced sense of well-being. And when that treatment is customized for your unique body and its systemic needs, you can optimize your chances of success.

    If you are considering bioidentical hormone replacement therapy, BodyLogicMD can help. The BodyLogicMD network is comprised of expert practitioners who will work with you to create a customized plan based on your current hormone levels and your future goals. Contact a local practitioner to schedule your first appointment, or take the BodyLogicMD Hormone Balance Quiz to gain more insight into the impact of hormones on your everyday life.

    Bioidentical Hormone Pellets Are Safer And More Effective

    Hormone pellet therapy: Worth the risk?

    Compared to other hormone therapy treatment options, bioidentical hormone pellets are more effective. Because they are implanted beneath the skin, the hormones are absorbed into the bloodstream in a direct fashion. Oral synthetic hormone replacement therapy medications are partially broken down in the stomach acid and the liver before it gets in the bloodstream. This means only a small amount actually is available to do its work inside your body.

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    Are Bioidentical Hormones Covered By Medicare

    Original Medicare has limited prescription drug coverage. It doesnt cover hormone therapy medications at all, even those for menopause.

    If you need coverage for HRT, youll need a Medicare Part D Prescription Drug Plan. You can opt for a private insurance company. Or, you can add a stand-alone Part D Prescription Drug Plan to your original Medicare.

    Another avenue is a Medicare Advantage Prescription Drug. This plan covers prescription drugs, including those for hormone therapy.

    For a list of covered medications, see the plans formulary. A formulary is a list of covered medications. If your doctor prescribes a drug thats not on the formulary, you can request a substitute.

    What Have We Learned

    When compared to the cost of drugs to treat the individual symptoms of hormone decline or to other forms of BHRT, testosterone pellets are very cost effective. In addition, theyre easy to use, require minimal doctors visits, and keep your hormone levels on an even keel.

    If youre ready to feel younger, get healthy, and get your mojo back, we can help. Well dig deep to find the root cause of your health concerns and create a customized wellness plan to help you regain your health, vibrancy, and vigor.

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    Is Hormone Pellet Therapy Expensive

    Office visits and testing are usually covered by insurance. We are in network with most insurance companies. The cost of the pellets and the insertion is not a covered benefit. The price of insertion, including the testosterone pellets is $300.00. If an estrogen pellet is also needed, there is an additional $50.00 charge. For some patients, hormone pellet therapy can cost less than traditional hormones due to the ever increasing cost of medications and co-pays.

    Testosterone Replacement Therapy With Injections

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    Injecting an oil of Testosterone Cypionate, Testosterone Enanthate, or Testosterone Propionate is a common form of Testosterone Replacement Therapy . These oil solutions are fairly inexpensive and quite cost-effective. Testosterone injections work quite well and provide good levels of serum testosterone when dosed appropriately.

    If hypogonadism is documented as discussed previously then insurance may cover testosterone replacement with testosterone injections. The price for testosterone injections covered by insurance depends on your specific insurance plan and coverage.

    Ive seen patients pay as low as $10 per month for their testosterone prescription. However, they have to get their syringes and needles separately. Many times they end up pay $10-20 per month for their needles and syringes as well making their total about $20-30 per month.

    If you elect to pay cash for your testosterone cypionate the price varies based on pharmacy. Some of the larger chains tend to be more expensive in our experience. It is common to find it for around $130 for a 10mL vial. You can certainly find it less expensive at some of the other pharmacies. For example, we charge $75 for a 10mL vial. That is the same price charged by NextGenRx. Needles and syringes are included in this price. Depending on dose, your monthly cost ends up being $15-30 month without having to deal with the headaches of insurance.

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    How Is My Hormone Pellet Therapy Treatment Determined

    Hormone pellet therapy treatment is based upon your symptoms and your hormone levels. Baseline hormone levels are required by blood or saliva to determine your starting dose. Dosage may be increased or decreased based upon your symptoms and your bodys response to the hormones. Once the proper dosage has been determined, additional testing may not be necessary.

    What Are The Costs Of Hormone Replacement Therapy

    The cost of hormone replacement therapy out of your pocket with the help of a health insurance plan will be around $5 to $30 per month as a form of copay. Those who lack health insurance coverage will be spending anywhere from $10 to $85 per month.

    Generic estrogen-only or progesterone-only medicine are some of the more affordable drugs in this area while brand name estrogen-plus-progesterone drugs or patches such as the Prempro the CombiPatch are some of the more expensive types of hormone replacement medications.

    Most health insurance plans do cover hormone replacement therapy for women who are undergoing menopause. However, some health plans like Kaiser do not cover this type of treatment. Typically, women are given the hormones estrogen and progestin or a combination of the two to treat the symptoms of menopause. These drugs come in many forms such as a patch, a pill, a cream, or a gel.

    Some additional costs of this treatment includes a $75 to $200 physician visit for those who lack health insurance. In addition, with insurance, a blood test ordered by the doctor can cost as much as $1,000. Furthermore, it is beneficial for a patient to speak with their doctor about the various risks of hormone replacement therapy. According to a study conducted in 2002, this type of treatment for menopause can increase the risk of blood clots, heart disease, strokes, and breast cancer.

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    Testosterone Propionate Implant Pellets

    The suggested dosage for androgens varies depending on the age, and diagnosis of the individual. Dosage is adjusted according to the person’s response and the appearance of adverse reactions. The dosage guideline for the testosterone pellets for replacement therapy in androgen-deficient males is 150 mg to 450 mg subcutaneously every 3 to 6 months. Various dosage regimens have been used to induce pubertal changes in hypogonadal males some experts have advocated lower doses initially, gradually increasing the dose as puberty progresses, with or without a decrease in maintenance levels. Other experts emphasize that higher dosages are needed to induce pubertal changes and lower dosages can be used for maintenance after puberty. The chronological and skeletal ages must be taken into consideration, both in determining the initial dose and in adjusting the dose.

    Dosages in delayed puberty generally are in the lower range of that listed above and, for a limited duration, for example 4 to 6 months.

    What Is Bioidentical Hormone Replacement Therapy

    Testosterone Pellet Results – 2 Month Update

    A hormone is a medication prescribed by a doctor. You can take hormone medications as a pill, injection, or applied to the skin using a patch or gel.

    Doctors prescribe Hormone Replacement Therapy to treat hormone imbalances, such as menopause and thyroid. Men also can also receive hormone therapy for andropause .

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