Re: battling the insurance company

[Guest guest]

My cardiologist says that there is NO scientifically adequate evidence that

would support testosterone replacement therapy. Says he wouldn't recommend it

for any of his relatives and wouldn't take it himself. And he is a noted

researcher with over 50 articles in the scientific literature.

An the other hand, my insurance does cover Androgel. As a matter of fact, of

the three ways they categorize drugs, relating to the amount of co-pay, they put

it in the middle category, i.e. I pay $40 for a 90-day supply.

Go figure.

battling the insurance company

Here's a question for everyone in a way. I have just

been denied a

second time and have to appeal for insurance coverage on my Androgel.

Talking with two different pharmacists I have heard this is a very

common problem, not just with my insurer, Anthem-BC-BS. Anyone else

had this problem? Sounds like a class action sexual discrimination

lawasuit waiting to happen. If I was a women prescribed estrogen there

would be no problem getting it filled and covered.

Thoughts? Success stories. Prepared to send the appeals department a

fed-ex package with a 5 inch stack of medical articles to go through

since there is no established " normative " statisical range to

reference. All the tests to date have been flowed, small sample size,

unhealthy men etc. A new study is underway but the results are at

least ten years away.

Alan

[Guest guest]

Insurance is a bitch today. Getting coverage for certain Rxs is less

about what's right or what's medically accepted and more about premiums

and " tiers. " Simply put, depending on what " level " or " tier " your

employer (or you with an individual policy) has signed up and pays in

premiums, determines which drugs and co-pays you have. Thus, if your

employer has a policy with high premiums and a lot of people paying in,

almost everything is covered. Conversely, if it's a small company with

small premiums, hardly anything is covered. Anthem for example, has

many different " tiers. " Two people can have the same RX and one

person's Rx is covered while the other is not, depending on the " tier "

and related premiums. It's all about making money, and lots of it. At

the end of the day, the more your company (and you) contribute, the

more they cover. They also do an " audit " every year, and depending on

how much the insurance co. made (or lost) determines the next years

premiums.

Life is a bitch, especially with insurance companies. They want you to

pay premiums, but not pay anything out.

Hope this helps.

Bill

On Sep 18, 2006, at 5:37 PM, doberman1066 wrote:

> Here's a question for everyone in a way. I have just been denied a

> second time and have to appeal for insurance coverage on my Androgel.

> Talking with two different pharmacists I have heard this is a very

> common problem, not just with my insurer, Anthem-BC-BS. Anyone else

> had this problem? Sounds like a class action sexual discrimination

> lawasuit waiting to happen. If I was a women prescribed estrogen there

> would be no problem getting it filled and covered.

>

> Thoughts? Success stories. Prepared to send the appeals department a

> fed-ex package with a 5 inch stack of medical articles to go through

> since there is no established " normative " statisical range to

> reference. All the tests to date have been flowed, small sample size,

> unhealthy men etc. A new study is underway but the results are at

> least ten years away.

>

> Alan

>

>

>

[Guest guest]

Alan,

If insurance won't cover it go the compounded route. It would

probably be more cost effective than Androgel and should do the same

job. The mix can be pretty much customized to suit your needs,

including being made more concentrated so you need less to get the

same dose. Compounds always work for me! Good Luck, Vickie

In , " doberman1066 " <doberman1066@...>

wrote:

>

> Here's a question for everyone in a way. I have just been denied a

> second time and have to appeal for insurance coverage on my

Androgel.

> Talking with two different pharmacists I have heard this is a very

> common problem, not just with my insurer, Anthem-BC-BS. Anyone

else

> had this problem? Sounds like a class action sexual discrimination

> lawasuit waiting to happen. If I was a women prescribed estrogen

there

> would be no problem getting it filled and covered.

>

> Thoughts? Success stories. Prepared to send the appeals department

a

> fed-ex package with a 5 inch stack of medical articles to go

through

> since there is no established " normative " statisical range to

> reference. All the tests to date have been flowed, small sample

size,

> unhealthy men etc. A new study is underway but the results are at

> least ten years away.

>

> Alan

>

[Guest guest]

Let the cardiologist " walk in our shoes " and see how he reacts to

HRT.

My $0.02

Jack P

>

> My cardiologist says that there is NO scientifically adequate

evidence that would support testosterone replacement therapy. Says

he wouldn't recommend it for any of his relatives and wouldn't take

it himself. And he is a noted researcher with over 50 articles in

the scientific literature.

>

> An the other hand, my insurance does cover Androgel. As a matter

of fact, of the three ways they categorize drugs, relating to the

amount of co-pay, they put it in the middle category, i.e. I pay $40

for a 90-day supply.

>

> Go figure.

>

> battling the insurance company

>

> Here's a question for everyone in a

way. I have just been denied a

> second time and have to appeal for insurance coverage on my

Androgel.

> Talking with two different pharmacists I have heard this is a

very

> common problem, not just with my insurer, Anthem-BC-BS. Anyone

else

> had this problem? Sounds like a class action sexual

discrimination

> lawasuit waiting to happen. If I was a women prescribed estrogen

there

> would be no problem getting it filled and covered.

>

> Thoughts? Success stories. Prepared to send the appeals

department a

> fed-ex package with a 5 inch stack of medical articles to go

through

> since there is no established " normative " statisical range to

> reference. All the tests to date have been flowed, small sample

size,

> unhealthy men etc. A new study is underway but the results are at

> least ten years away.

>

> Alan

>

>

>

>

>

>

>

>

>

[Guest guest]

On Tue, 19 Sep 2006 01:49:31 -0000, you wrote:

>Let the cardiologist " walk in our shoes " and see how he reacts to

>HRT.

>My $0.02

>Jack P

Yep. And do they even think about issues like bone density when

making such ignorant statements?

>

>>

>> My cardiologist says that there is NO scientifically adequate

>evidence that would support testosterone replacement therapy. Says

>he wouldn't recommend it for any of his relatives and wouldn't take

>it himself. And he is a noted researcher with over 50 articles in

>the scientific literature.

>>

>> An the other hand, my insurance does cover Androgel. As a matter

>of fact, of the three ways they categorize drugs, relating to the

>amount of co-pay, they put it in the middle category, i.e. I pay $40

>for a 90-day supply.

>>

>> Go figure.

>>

>> battling the insurance company

>>

>> Here's a question for everyone in a

>way. I have just been denied a

>> second time and have to appeal for insurance coverage on my

>Androgel.

>> Talking with two different pharmacists I have heard this is a

>very

>> common problem, not just with my insurer, Anthem-BC-BS. Anyone

>else

>> had this problem? Sounds like a class action sexual

>discrimination

>> lawasuit waiting to happen. If I was a women prescribed estrogen

>there

>> would be no problem getting it filled and covered.

>>

>> Thoughts? Success stories. Prepared to send the appeals

>department a

>> fed-ex package with a 5 inch stack of medical articles to go

>through

>> since there is no established " normative " statisical range to

>> reference. All the tests to date have been flowed, small sample

>size,

>> unhealthy men etc. A new study is underway but the results are at

>> least ten years away.

>>

>> Alan

>>

>>

>>

>>

>>

>>

>>

>>

>>

[Guest guest]

On Tue, 19 Sep 2006 01:47:40 -0000, you wrote:

>Alan,

>If insurance won't cover it go the compounded route. It would

>probably be more cost effective than Androgel and should do the same

>job. The mix can be pretty much customized to suit your needs,

>including being made more concentrated so you need less to get the

>same dose. Compounds always work for me! Good Luck, Vickie

They may be far happier to cover injections. Injections are about $10

a pop compared with about $450 a month for androgel.

>

>

> In , " doberman1066 " <doberman1066@...>

>wrote:

>>

>> Here's a question for everyone in a way. I have just been denied a

>> second time and have to appeal for insurance coverage on my

>Androgel.

>> Talking with two different pharmacists I have heard this is a very

>> common problem, not just with my insurer, Anthem-BC-BS. Anyone

>else

>> had this problem? Sounds like a class action sexual discrimination

>> lawasuit waiting to happen. If I was a women prescribed estrogen

>there

>> would be no problem getting it filled and covered.

>>

>> Thoughts? Success stories. Prepared to send the appeals department

>a

>> fed-ex package with a 5 inch stack of medical articles to go

>through

>> since there is no established " normative " statisical range to

>> reference. All the tests to date have been flowed, small sample

>size,

>> unhealthy men etc. A new study is underway but the results are at

>> least ten years away.

>>

>> Alan

>>

>

>

>

>

>

>

________________

I am human; nothing in humanity is alien to me.

Terence

[Guest guest]

Another thought on insurance coverage is to present them with the AACE

guidelines - if your total T levels are under 300 and show them that

the AACE says 300 is the treatment threshold. That's best practice. If

they're denying coverage for medically needed best practices threaten

to sue them and report them to your state insurance commissioner (if

you're in the US)..

On Tue, 19 Sep 2006 01:47:40 -0000, you wrote:

>Alan,

>If insurance won't cover it go the compounded route. It would

>probably be more cost effective than Androgel and should do the same

>job. The mix can be pretty much customized to suit your needs,

>including being made more concentrated so you need less to get the

>same dose. Compounds always work for me! Good Luck, Vickie

>

>

> In , " doberman1066 " <doberman1066@...>

>wrote:

>>

>> Here's a question for everyone in a way. I have just been denied a

>> second time and have to appeal for insurance coverage on my

>Androgel.

>> Talking with two different pharmacists I have heard this is a very

>> common problem, not just with my insurer, Anthem-BC-BS. Anyone

>else

>> had this problem? Sounds like a class action sexual discrimination

>> lawasuit waiting to happen. If I was a women prescribed estrogen

>there

>> would be no problem getting it filled and covered.

>>

>> Thoughts? Success stories. Prepared to send the appeals department

>a

>> fed-ex package with a 5 inch stack of medical articles to go

>through

>> since there is no established " normative " statisical range to

>> reference. All the tests to date have been flowed, small sample

>size,

>> unhealthy men etc. A new study is underway but the results are at

>> least ten years away.

>>

>> Alan

>>

>

>

>

>

>

>

________________

I am human; nothing in humanity is alien to me.

Terence

[Guest guest]

On Tue, 19 Sep 2006 01:47:40 -0000, you wrote:

>Alan,

>If insurance won't cover it go the compounded route. It would

>probably be more cost effective than Androgel and should do the same

>job. The mix can be pretty much customized to suit your needs,

>including being made more concentrated so you need less to get the

>same dose. Compounds always work for me! Good Luck, Vickie

Sorry for all the separate posts. One more thing about dealing with

insurance companies. DOn't do anything by phone. Do everything by

letter and insist on written responses. In addition I send all

correspondence to them certified mail with a return receipt. they have

to sign to get it and you get proof they received it. This receipt

when stapled to a copy of the letter you sent is acceptable evidence

in legal proceedings. It tells them you are preparing and documenting

all their representations. I find it gets their attention wonderfully.

But they will still often try to respond by phone. My letters insist

on a written response and if they call I tell them to put it in

writing and send it to me.

Document all their excuses and actions.

>

>

> In , " doberman1066 " <doberman1066@...>

>wrote:

>>

>> Here's a question for everyone in a way. I have just been denied a

>> second time and have to appeal for insurance coverage on my

>Androgel.

>> Talking with two different pharmacists I have heard this is a very

>> common problem, not just with my insurer, Anthem-BC-BS. Anyone

>else

>> had this problem? Sounds like a class action sexual discrimination

>> lawasuit waiting to happen. If I was a women prescribed estrogen

>there

>> would be no problem getting it filled and covered.

>>

>> Thoughts? Success stories. Prepared to send the appeals department

>a

>> fed-ex package with a 5 inch stack of medical articles to go

>through

>> since there is no established " normative " statisical range to

>> reference. All the tests to date have been flowed, small sample

>size,

>> unhealthy men etc. A new study is underway but the results are at

>> least ten years away.

>>

>> Alan

>>

>

>

>

>

>

>

________________

I am human; nothing in humanity is alien to me.

Terence

[Guest guest]

That doctor, who doesn't think TRT works, seems more

like a quack than healer. Folks are suffering, and all

he offers is no solutions but more partial research.

Perhaps, your insurance can give you other TRT's that

would be covered rather than Androgel.

I started out on the patch and then moved to the gel.

As the gel worked some what, made me eat more, it

wasn't increasing my T the way the injections are.

It was a point where I had to take 200 MG of gel,

which had to come in 2.5 packets; I had to take like 5

of them on each arm. That blowed!

I think, the injections are hit and miss. Maybe they

work on primary males more.

If your insurance company doesn't pay for Andogel,

which is a bit newer form of TRT, try a different

avenue.

I still dread a bit when I have to give myself a

needle; just the feeling of the needle as it goes thru

the muscle makes me blah, but that's it.

So, until you get this situation cleared up, I hope

you are taking some form of TRT. Don't discontinue

while being bitter toward your health company.

Patience and remaining balance is ideal in getting

healthy.

Combat for what you feel is just, but continue to get

healthy, because you can get there friend. Good luck

and a lot of us are with you in spirit.

--- Farrell <specialdoc2002@...> wrote:

> My cardiologist says that there is NO scientifically

> adequate evidence that would support testosterone

> replacement therapy. Says he wouldn't recommend it

> for any of his relatives and wouldn't take it

> himself. And he is a noted researcher with over 50

> articles in the scientific literature.

>

> An the other hand, my insurance does cover

> Androgel. As a matter of fact, of the three ways

> they categorize drugs, relating to the amount of

> co-pay, they put it in the middle category, i.e. I

> pay $40 for a 90-day supply.

>

> Go figure.

>

> battling the insurance

> company

>

> Here's a question for

> everyone in a way. I have just been denied a

> second time and have to appeal for insurance

> coverage on my Androgel.

> Talking with two different pharmacists I have heard

> this is a very

> common problem, not just with my insurer,

> Anthem-BC-BS. Anyone else

> had this problem? Sounds like a class action sexual

> discrimination

> lawasuit waiting to happen. If I was a women

> prescribed estrogen there

> would be no problem getting it filled and covered.

>

> Thoughts? Success stories. Prepared to send the

> appeals department a

> fed-ex package with a 5 inch stack of medical

> articles to go through

> since there is no established " normative "

> statisical range to

> reference. All the tests to date have been flowed,

> small sample size,

> unhealthy men etc. A new study is underway but the

> results are at

> least ten years away.

>

> Alan

>

>

>

>

>

>

>

>

> [Non-text portions of this message have been

> removed]

>

>

>

>

>