Hey guys quick question…
I have been with defy for almost a year now and love them to death. Only issue is that it’s not covered by insurance and it’s costing my on average about 100/month. Not bad at all. That said, my wife is going to be taking a year off to stay with our new born child next year and want to see if my pcp would be willing to prescribe my test and get it covered through insurance. I could still use deft for hcg if my pcp won’t prescribe it. I love my pcp and trust him. He’s about my age and I have been going to him for 10 years. I don’t think it will be a problem, but I am still a bit hesitant to bring it up to him as I haven’t told him about my trt protocol from defy. What are your thoughts on this? Should I just pinch pennies and stick with deft? See if my pcp would prescrive me the test or perhaps go to a urologist to get it?
The input I have gotten from you guys has been invaluable over the past few months. Thanks in advance for your replies.
Roc
Try pcp. Urologist. Endo. No reason to pay $$$
Get something in writing from defy signed by a MD with protocol and dx. Give to the Dr that you are trying to get to continue this.
You will be forced off TRT with the intent to prove whether or not you need it, this is the game you must play if you want insurance to pay for TRT. Your PCP while is probably a great guy, he must follow procedure.
If your TT was 300>, you will be denied TRT.
What were your pre-TRT labs?
I was afraid of that. I was about 430 with really low free t and that was about a year ago. I mean I guess I could just get off for two weeks and order a blood test from him?
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Then you are wasting your time, doctors and insurance companies don’t care about in range numbers, even if they are low. Your doctor knows insurance will deny TRT with in range numbers and he will turn around and tell you levels are normal.
FT would have to be below range on two separate tests to be reconsidered for TRT. I’ve seen men denied TRT when scoring 250 and 310, because he is +10 ng/dL, said guy was denied TRT.
That isn’t 100% true in 100% of cases. Is it likely? Probably. But the insistence that every doctor and insurance situation is out to get someone is getting old. They CAN prescribe based on symptoms. Will they? Who knows. It’s worth a shot if you think you have a chance.
The worst he’ll say is not happening or you have to come off first, etc.
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A lot of insurance companies don’t cover TRT unless <300, some insurance companies cut off for TRT is <200. The endocrine society and the AUA recommended TRT <300 on two separate tests.
This is not always true. I went from a clinic to my regular dr without any issue. My initial levels were 305ng before starting and my insurance didn’t require any other baseline testing before approving me. Maybe SOME ppl will run into issues with this but to say to this guy it’s hopeless is a bit far
I’ve literally never seen someone get denied by insurance with those levels assuming the doc says it’s medically necessary. I’ve seen people say it over and over and over on the internet though.
The trouble is that docs are typically following guidelines that you have to be that low to be symptomatic so they won’t prescribe it if you’re over that. But they can and some do based on symptoms.
Well wait.
If he stops TRT now cold turkey wouldnt he be much lower than his pre TRT values?
His natural T will not be restored quckly. If he can just test in that time frame he may succeed. Test cyp especially takes a lot of time to be cleared out of the system
You could show him that and go from there. He may be willing to prescribe it and try to get insurance to cover based on symptoms and history. It does happen. He may have you go off new labs and try to go through insurance if numbers warrant it. I do know some guys who were able to get their PCP to prescribe it for them after they started underground or with a TRT clinic. Even if insurance will not approve, he may be willing to write the script for you to take to a pharmacy to get filled. That will be pretty cheap too.
Just to add my datapoint…
Got my approval letter from insurance last week. Total was way low (< 230 when ref range started at 280), but free and bio were in the normal range. Low, but in range. Did 2 labs about 3 weeks apart, virtually no difference.
Let you T drop. Get bloods.
And keep your mouth shut. Don’t tell him you were taking anything!
However, my outof pocket is the same my bro pays with insurance.
PBS in aus doesn’t cover unless below 174ng
Problem is if secondary LH/FSH will be almost undetectably low… that’s a dead giveaway