Does Florida Blue Cover Hormone Replacement Therapy - (2023)

Side Effects Of Bioidentical Hormone Replacement Therapy

Hormone Replacement Therapy & Breast Cancer

As with most medications, bioidentical hormones can cause side effects. Some examples of side effects you may experience with estrogen and progesterone replacement include:

Call 911 or get immediate medical attention if you develop symptoms like chest pain that doesnt go away, shortness of breath, or slurred speech. And make sure that youre performing regular self-exams to check for lumps in your breasts.

If you still have a uterus, using estrogen by itself can raise the risk of uterine cancer. Taking progesterone with it may help lower this risk. But if youve had a hysterectomy , using estrogen by itself is typically OK.

What Kinds Of Therapy Does Blue Cross Blue Shield Not Cover

Like most insurances, it is not typical for Blue Cross Blue Shield to cover services unrelated to a diagnosable mental health condition, such as:

  • Couples counseling Couples counseling is typically not covered by insurance, because relationship issues, while a significant source of stress, are not considered a diagnosable mental health condition.
  • Life coaching Life coaching is not covered by insurance because it focuses on achieving personal goals, rather than treating a diagnosable mental health condition.
  • Career coaching Career coaching is not covered by insurance because it focuses on achieving professional goals, rather than treating a diagnosable mental health condition.

Blue Cross Blue Shield is also unlikely to cover therapy sessions occurring outside the therapy office, because of the greater potential for risk involved. While clients may sometimes benefit from services rendered outside of the therapy office, such as a client with an eating disorder needing support in the grocery store, or a client with a phobia of driving needing support in the car, these services are not likely to be covered by insurance and must be paid for out-of-pocket.

Does Medicare Cover Hormone Replacement Therapy

Many Medicare Advantage plans may cover prescription drugs, which maycover hormone replacement therapydrugs.

The drugs that are covered by a Medicare Advantage plan or a Medicare Part D prescription drug plan may vary. To find out what drugs are covered by your plan, you should refer to your plan formulary, or list of drugs that are covered by the plan.

A licensed insurance agent can help you compare Medicare Advantage plans that are available in your area and help you find a plan that may cover your hormone replacement therapy drugs.

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Telemedicine Takes Transgender Care Beyond The City

Shortages in rural health care workforces, low rates of insurance coverage, and long distances from health care facilities have made it challenging for many Americans outside urban areas to find high-quality, affordable health care. Transgender people in rural areas often face particularly acute challenges when it comes to finding competent providers and obtaining health insurance.

Douglas Knutson, a psychologist who studies health and resiliency among LGBTQ populations at Southern Illinois University, said rural trans populations often have high rates of anxiety, depression and suicidality.

That doesnt mean theyre all eager to flee. Connections to home, land, language and heritage are powerful, said Knutson: People have specific reasons for living in rural areas.

Lange certainly does. Although she would love to be in a more welcoming environment, she remains in Houston County because of her son. Im a good parent, she said. I love him too much and Im not going anywhere.

She also has no intention of leaving law enforcement. If she did, shed be leaving behind a retirement plan. Plus, she was recently promoted to sergeant in criminal investigations, and she finds it deeply satisfying to help people and solve crimes.

Lange enjoys her job working in criminal investigations and was recently promoted to sergeant.

Lange hangs out at home with friends Balducci and Buchanon-Romano, who came over for a cookout.

Increasingly, she said, I think theyd be surprised.

Communication Is Key For Smooth Transition

Does Florida Blue Cover Hormone Replacement Therapy - (1)

If you are considering using these new health insurance benefits to transition, contact your health plan first and see exactly how they are going to handle the benefits. We know that you will need a diagnosis of gender identity disorder or gender dysphoria. Some plans may want to approve a treatment plan in advance. The communication you and your doctor can have with the insurance company, the fewer hassles you will encounter.

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Is Bioidentical Hormone Therapy Covered By Insurance

Are you looking into bioidentical hormone replacement therapy ? If you are, you want to know how much it will cost. A myriad of factors determines the cost.

If your healthcare provider prescribes BHRT, your insurance will likely cover the costs. Did you select an alternative specialist outside of your insurance network?

If so, much of the cost will be out-of-pocket. A looming question is this, Is bioidentical hormone therapy covered by insurance? The short answer is, yes, sometimes. Read on to find out more.

Bioidentical Hormone Therapy Changes Lives For The Better

For women who are starting menopause or are in menopause, its common to suffer from the following symptoms:

  • reduced libido or pain during sex
  • vaginal dryness
  • loss of energy and fatigue
  • night sweats and problems sleeping
  • weight gain and foggy thinking

Bioidentical hormone therapy effectively eliminates those menopausal symptoms, resulting in a happier, healthier you.

Even men are helped when they use bioidentical hormone pellets. Men go through andropause as they age, just like women go through menopause when they age. Men also suffer from:

  • loss of energy and fatigue
  • problems sleeping

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Does Health Insurance Cover Testosterone Therapy Generally Yes But What If It Doesnt

Usually, your health insurance does cover testosterone therapy if your medical care provider can show a need.

However, not everyone has health insurance.

And sometimes, even when you have health insurance, you may be stuck paying out of pocket for one reason or another. For instance, your hormone levels may not be technically low enough to demonstrate a need to your health insurance company, but you may still be experiencing symptoms.

Fortunately, the cost of testosterone replacement therapy is very reasonable, even when paying out of pocket.

Generally, $299 a month is enough to cover the cost of weekly testosterone injections, injections that you can get quickly and easily, without a long wait. We also offer flexible hours and multiple locations, giving you the ability to get therapy when and where it best suits you.

Most of our patients who pay out of pocket find that the benefits of feeling happy, healthy, and like themselves again far outweigh the coststhey see the value in therapy.

Medication Guides For Medicare Eligibles

How Quickly Does Bio-Identical HRT Help Reverse Weight Gain?

The Medication Guides are updated monthly. Links are included below to the Medicare approved Formularies and the most recent updates to the printed version of the Medication Guide for Medicare Eligibles.

  • BlueMedicare Plan Information

Please have your patient refer to the pharmacy endorsement or rider issued with his or her contract, Evidence of Coverage, member handbook or certificate of coverage to determine whether a particular medication listed is covered. If your patient is unsure about particular coverage/benefits or has questions about the Medication Guide, please have the member call the Customer Service number on his or her ID card. The fact that a particular drug is listed in the guide does not necessarily mean that it is covered under each member’s contract, Evidence of Coverage or certificate of coverage.

1If you are not sure if your group is a small-group or large-group, please ask your HR administrator.

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What Are Bioidentical Hormones Used For

As you get older, your hormone levels decline. These changes are usually most significant during menopause, especially with estrogen and progesterone. Lower levels of these hormones can result in symptoms like hot flashes, sleeping problems, and vaginal dryness.

Hormones including bioidentical hormones are used to replace these hormones in your body to help provide relief. This is referred to as hormone replacement therapy . Sometimes the term BHRT is used when specifically talking about bioidentical hormones.

Bioidentical hormones are used to treat a number of menopause symptoms, including:

  • Pain during sex

  • Bladder problems

Some hormone products are also used to help prevent certain medical conditions that are influenced by hormone levels, like osteoporosis.

Depending on your specific symptoms, your healthcare provider will recommend the best option for you. For example, vaginal estradiol may work best if youre experiencing vaginal symptoms. And some healthcare providers may treat other symptoms, like low libido, with testosterone. But this is considered an off-label use for FDA-approved testosterone products.

Bioidentical hormones arent just for women. Theyre used in men, too. Thats because age and other factors can cause testosterone levels in men to decline. Low testosterone can cause symptoms like hair loss, erectile dysfunction, and mood changes. Read more about testosterone replacement options here.

What Is The Purpose Of Hormone Replacement Therapy

Lifestyle changes are the first-line treatment option for symptoms related to hormone fluctuations that The Womens Group team recommends. In most cases these provide relief. However, in cases where they dont, and symptoms are severe, hormone replacement therapy may be prescribed, and is almost always effective. Hormone replacement therapy is a replenishment of the decreased hormones in the body. They must be carefully measured to be returned to each womans healthy, pre-symptomatic levels.

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Plans With Transgender Exclusions

An easy-to-read summary that lets you make apples-to-apples comparisons of costs and coverage between health plans. You can compare options based on price, benefits, and other features that may be important to you. You’ll get the “Summary of Benefits and Coverage” when you shop for coverage on your own or through your job, renew or change coverage, or request an SBC from the health insurance company.

Read Also: How Do Doctors Check Hormone Levels

Covered Equivalents For Drugs Not On Our Formulary

Our three plan options have certain drugs that are not covered on their formularies. Each non-covered drug has safe and effective, alternative covered drug options. You can see the list of whats not covered and available alternative options for Standard Option and Basic Option. FEP Blue Focus members can apply for coverage of a drug not covered on their formulary with the Non-Formulary Exception Process form.

How Much Does Bioidentical Hormone Replacement Therapy Cost

How much bioidentical hormones cost depends on your insurance coverage. If your insurance covers the prescriptions, youll pay the set copay. Likewise, if your practitioner is a preferred provider, youll pay your regular copay.

If your insurance doesnt cover your prescriptions, you will pay out-of-pocket for them. If your healthcare provider is not in your insurance network, then you will pay per the plan rules.

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Tips For Lower Hrt Costs

As a patient dealing with the symptoms of hormonal imbalance, it can already be stressful enough — even before you even think about payments and insurance coverage. Here are a few tips to help you lower your hormone replacement therapy costs:

  • If you choose a private clinic for treatment, you will pay out-of-pocket for their services. However, you may be able to file a claim for the tests ordered by the HRT clinic, or you can go to a provider site to get the tests done for a covered cost.
  • Ask your HRT provider if they offer payment plans, interest-free financing, or discounts on large-quantity orders, like a six-month supply of estrogen.
  • Do your research and find the best treatment option for you. Beyond the costs of the treatment itself, its hard to identify other hidden factors or prices. Call your insurance provider, talk to your physician, and find what works for you to get the most value with what youre paying.

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

Custom hormone replacement therapy helping many stay active

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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How To Know If My Health Insurance Covers Hrt

Hormone replacement therapy HRT has a variety of uses for patients with different health concerns and needs. Examples of HRT include progesterone therapy, estrogen therapy, testosterone therapy, and human growth hormone therapy. Due to the usefulness of HRT in improving the physical conditions of patients who undergo such therapy, it can even be considered as a medical necessity. However, there is a catch the HRT cost is typically prohibitive, and you will most likely need health or medical insurance to help cover the cost.

Not all health insurance policies include HRT in their coverage, which is why you must know if your health insurance covers HRT.

Know the Significance of Coverage

Look into Your Summary of Benefits and Coverage

Most insurance plans have a Summary of Benefits and Coverage part in a printed insurance plan policy. The SBC can also be accessed online if you have an online account with your insurance company. This is an important source of information that lists the services covered by the health insurance plan and how much of the costs are covered.

Look for the List of Covered Drugs

Check the Plans Accredited Doctors

Is Hormone Replacement Therapy Monitored

Yes. Because a womans hormones and symptoms can change over time, anyone undergoing hormone replacement therapy will have her hormone levels evaluated via a blood on a regular basis.

Please call the office if you have questions regarding your health insurance. Effective July 1, 2018, we have added the Blue Select and My Blue plans to our list of accepted insurances. We do not currently participate in Humana Medicaid.

  • BCBS of FL Network Blue
  • BCBS of FL PPC, PPO, PPS Advantage 65 Select, Blue Choice Federal, Employee
  • BCBS of Florida Blue Select
  • BCBS-FL: State Employee Preferred Patient Care
  • Blue Cross Blue Shield
  • Blue Cross Blue Shield – BlueOptions
  • Blue Cross Blue Shield – PPO Only
  • Blue Cross Blue Shield Federal Employee Program
  • Blue Cross Blue Shield of Alabama
  • Blue Cross Blue Shield of Florida
  • Blue Cross Blue Shield PPO
  • CareFirst Blue Cross Blue Shield
  • Cigna – NALC Health Benefit Plan
  • Cigna-HealthSpring
  • Coventry Healthcare of FL – Carelink Silver
  • Coventry Healthcare of FL – Open Access
  • Florida Medicaid
  • Highmark Blue Cross Blue Shield
  • Pan American Life Insurance – PCHS
  • Pan American Life Insurance Company – First Health
  • VA Health Administration – Champva
  • Wellcare Medicare HMO GPG

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Does Health Insurance Cover Testosterone Therapy

  • Testosterone Replacement Therapy 101

Because testosterone replacement therapy is sometimes considered a new therapy, many patients ask us this question, Does health insurance cover testosterone therapy for me?

Most health insurance providers will cover the majority of the cost of testosterone replacement therapy for men, as long as you can demonstrate a need.

Of course, the amount that your insurance covers varies from provider to provider, and it also varies based on your specific health plan and other variables, like your deductible.

Though 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 with a simple call to your insurance carrier.

Your health insurance company may have already approved you for testosterone replacement therapy if you have certain medical conditions or diagnoses from a physician. Depending on the insurance company, these conditions can include the following:

  • A pituitary tumor
  • Klinefelters Syndrome
  • Kallmans Syndrome

Other conditions, like having had a prostatectomy, may also preclude you from needing tests to prove low testosterone.

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Are Bioidentical Hormones Safe

The WHI findings highlighted some of the serious risks associated with HRT. Since then, researchers have learned more about its potential benefits and risks.

Today, experts agree that most healthy women who are within 10 years of menopause can benefit from FDA-approved HRT to provide symptom relief. And there are ways to navigate some of these risks, like using the lowest dose for the shortest amount of time, and opting for local vaginal estradiol instead.

Your healthcare provider will weigh the benefits and risks of your specific situation to decide if hormone therapy is right for you.

As mentioned earlier, experts dont recommend compounded hormones. Thats because they havent been evaluated by the FDA. And because theyre made just for you, quality can vary by pharmacy. In fact, the FDA has tested compounded hormones from multiple pharmacies. The results showed hormone strengths ranging from less than 70% to almost 270% of what they should be.

This variability may cause the product to not work as well or cause more side effects. Yet, your healthcare provider may determine that a compounded hormone is right for you. If thats the case, its important to fill your prescription at an accredited compounding pharmacy they trust.

Also Check: How Can I Get My Estrogen Level Up


Does my Florida Blue cover therapy? ›

Does insurance cover therapy in Florida? Yes, most Florida health insurance carriers provide mental health benefits that cover therapy.

Does Florida Blue cover weight loss injections? ›

Note: Drugs FDA approved for weight loss, cosmetic use or lifestyle modification are not included in this list. They are not covered on your policy unless specifically purchased separately.

Is Florida Blue the same as Blue Cross Blue Shield of Florida? ›

Florida Blue, Florida's Blue Cross and Blue Shield company, is a leader in Florida's health care industry. Driven by its mission to help people and communities achieve better health, Florida Blue has more than 4 million health care members across the state.

Does Blue Cross Blue Shield of Florida cover fertility treatments? ›

Yes, Blue Cross Blue Shield offers extensive insurance coverage for infertility diagnosis and treatments.

Is Florida health care same as Blue Cross Blue Shield? ›

Ancillary Benefits

FCL is affiliated with Blue Cross and Blue Shield of Florida and independently licensed by Blue Cross and Blue Shield Association. FCL's array of products includes vision, dental, life insurance, AD&D, and disability.

What is the out of pocket maximum for Florida Blue? ›

Important Questions Answers Why This Matters: What is the overall deductible? In-Network: $250 Per Person/ $500 Family. Out-of-Network: $750 Per Person/$1,500 Family.

How much does mounjaro weight loss cost? ›

How much does Mounjaro cost? The average retail price of Mounjaro, without insurance or any discounts, is $1,539.54 for a monthly supply of four pen-injectors, each containing 2.5 mg/0.5 mL. (The medication is injected once weekly.)

Does Florida Blue pay for gastric sleeve? ›

Florida Blue covers several bariatric procedures, including the gastric sleeve or sleeve gastrectomy and the gastric bypass. These are the two most popular weight loss surgeries and are proven effective procedures.

Does Florida Blue have gym memberships? ›

Blue365 Deals is a national discount program that offers special deals and discounts on fitness equipment, gym memberships, nutritious food and many other products that promote healthy living. There are also many travel deals for when you need some well-deserved rest and relaxation.

What is the most popular Medicare Advantage plan in Florida? ›

Humana is the most popular Medicare Advantage provider in Florida. About 19% of enrollees have the Humana Gold Plus HMO plan. Another 9% of enrollees have HMO plans from the Humana subsidiary, CarePlus CareOne.

Is Florida Blue a good health insurance? ›

Florida Blue earned an A+ rating from the Better Business Bureau and 4.5 of 5 stars for overall customer experience from the National Committee for Quality Assurance (NCQA).

How much does a round of IVF cost in Florida? ›

In Vitro Fertilization Cost
Standard IVF Cycle Retrieval & Embryo Transfer$13,500 (One year of storage included)
Semen Analysis$185
Intrauterine Insemination (IUI)$400 (Does not include monitoring) Ultrasound monitoring fee $250
Anesthesia Fees$650 – 3rd party
Additional long term storage fees apply$500
3 more rows
Jan 6, 2023

Does Florida insurance cover IVF? ›

Florida isn't among the 15 states that require insurance to cover in vitro fertilization.

Does Florida Blue cover massage? ›

Services not covered by Medicare: If services are covered by the PPO Plan, the PPO Plan will pay as your primary coverage; some examples of services not covered by Medicare but covered by the PPO Plan are massage therapy, home health care, and acupuncture.

Is mental health covered by insurance in Florida? ›

Since 2014, most individual and small health insurance plans are required to cover mental health services

Does Florida blue cover Botox? ›

CVS Specialty® pharmacy (Caremark) notified Florida Blue that effective Jan. 1, 2022, they will no longer stock or dispense Botox. Providers wishing to administer Botox will no longer be able to access it through “Drug Replacement” from CVS Specialty.

What can I use my Florida Blue Rewards for? ›

Based on your plan and how many rewards points you earn, you'll be able to use them toward qualifying premium or health care costs. You'll need to visit the Rewards Center from your online Florida Blue member account and click Redeem Rewards. You'll need at least a $5 balance to start redeeming.

Do you need a referral to see a specialist with Florida Blue? ›

A referral from your primary care physician (PCP) is required to see a specialist.

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