Doctor appointment for Hormone Replacement Therapy (Advice needed, Thanks :)

[shaiya]

Hi
I am a 24 year old MTF, I have been living full time for 5 months so far. (Jacksonville, FL)
I have full support from my boyfriend and my mom.

Today I called a local doctor regarding hormone replacement therapy for transgender and she says she does it. She said she doesn't require no prior consultation with a therapist which I was very happy about :) (that will save time)
She said she charges a one time fee of $625 for initial testing which I would be able to pay half now half later and then monthly payments for hormones of about $40 per month which sounds like a great price :)

She told me that the money I pay I would be able to then get reimbursed by my insurance company.
I have MMSI Health insurance(Mayo Medical Plan SXC Health Inc.) (Mayo Universal Florida) (Plan Type: Medical/Pharmacy).
Is that true that they would reimburse me the money and how much would I get back and what would the insurance company cover?
If anyone knows or has the same medical insurance, please let me know.
Thanks a lot in advance for all your answers, I appreciate it :)

I am so excited to get started :)

[Aprilrain]

I pay about $24 for estradiol and progesterone. I was buying my Anti T on line because you can't get it here in the states so it was more expensive than what I assume Spiro would be with a prescription.
insurance pays $2 of the over all cost for both estrogen and progesterone so a grand total savings of $4 with insurance.
I dont recall what i pay for Dr visits and labs.
her deal sounds OK except for the meds, wouldn't she just write you scripts and then you take them to the Pharmacy??

[Bree-asaurus]

That sounds a little odd to me, but I could be wrong.

The initial testing cost seems kind of expensive. Running a couple blood tests shouldn't cost that much. Maybe she's running a lot more tests than I had to do...

Also, you might want to check with your insurance company FIRST to see if they will actually cover it. Most insurance companies won't cover transgender/transexual care. The main ones that I know of that do are the big banks who pay extra so their employees are covered by this kind of insurance. Then again, I know a friend of mine gets some of her hormones covered by Blue Cross... so who knows?!

Again, I'm not saying this sounds BAD, I am just unsure about it, so I would recommend you get some facts first.

The monthly cost doesn't sound terrible... was she just giving you an estimate of the costs? Or are you actually getting the physical medication handed to you by her? If it's the latter... that's kind of weird.

[shaiya]

Thanks for reply.
Only $4 dollars they cover, wow. that's little to nothing.
How much did they cover for your initial tests if anything?
I don't mind paying for it but if insurance can reimburse the cost or even part of it, that would be sweet.
Yea she said I would get a prescription from her with which I would go then get hormones at any pharmacy. maybe even online if i get a better deal.
the $40 that she said I believe is just the general cost for HRT per month. it might be less for me. Have yet to see. :)

[Aprilrain]

Like Bree said it doesn't necessarily sound bad it just sounds a little strange to have your Dr handing you your meds.
Insurance covers very little if anything related to transgendered health even if the Endo puts in the code for miscellaneous endocrine medicine or whatever insurance doesn't cover that either LOL

[Bree-asaurus]

Thanks for reply.
Only $4 dollars they cover, wow. that's little to nothing.
How much did they cover for your initial tests if anything?
I don't mind paying for it but if insurance can reimburse the cost or even part of it, that would be sweet.
Yea she said I would get a prescription from her with which I would go then get hormones at any pharmacy. maybe even online if i get a better deal.
the $40 that she said I believe is just the general cost for HRT per month. it might be less for me. Have yet to see. :)

Now THAT sounds about right... lol.

I've only been tested a few times and back then, I was afraid of my insurance company finding out I'm transexual so I didn't even tell them. And I haven't had bloodwork done in a while... (shame on me)

I've tried to apply my insurance to my hormones and they won't cover it at all.

[Julia_in_Pa]

Shalya,

First off congrat's on going full time. That's fantastic.

I do not use my insurance for my HRT.

My spiro costs me around 20.00 a month and because I purchase a five month amount of injectable estrogen it works out to be 11.00 a month for that through a compounding pharmacy.


Julia

[shaiya]

Thanks for your answers. :)
I just called my insurance company and asked them if they cover hormone replacement therapy for transgender. The worker checked the data and found it as an exclusion so looks like they don't cover it. that's too bad :(
Maybe the doctor will list my medical checkup as something else, maybe she will state a reason for my checkup as something that is covered by the insurance and same for hormones. And that might get it covered then.
The cost of hormones anyway, isn't much so that wont be no big deal.
I wonder if she will also charge me for later testing when she will be observing if everything is going well with my hrt?
Hope for the best. maybe call some other doctors to see if they offer cheaper pricing.

[Bree-asaurus]

Thanks for your answers. :)
I just called my insurance company and asked them if they cover hormone replacement therapy for transgender. The worker checked the data and found it as an exclusion so looks like they don't cover it. that's too bad :(
Maybe the doctor will list my medical checkup as something else, maybe she will state a reason for my checkup as something that is covered by the insurance and same for hormones. And that might get it covered then.
The cost of hormones anyway, isn't much so that wont be no big deal.
I wonder if she will also charge me for later testing when she will be observing if everything is going well with my hrt?
Hope for the best. maybe call some other doctors to see if they offer cheaper pricing.

Yes, do talk to your doctor about how they classify the checkup. Usually they can word it differently without lying. If you're depressed, talk to your doctor about that, and anti-depressants... with a side note of hormones :P

[shaiya]

hehe, thanks for suggestion Bree.
Yes I will definitely ask her how can she manage to get it covered, and hope for some good news. :)

[Jessinthesprings]

My first visit with the initial injection was just over $200. I pay about $130 every three months for the hormoes. I don't have insurance so I get to pay full price. The Estrodial costs me $20 and the Spiro hits me for $110. Not sure why that is so high, but I do get a 3 month supply. I visit doc twice yearly for labs. Expect haveing to pay on those. Of course if your insurance covers it you are in the clear.

[EnglishRose]

My Endo quoted $600 for the initial visit too so I'm not surprised at the high figure. Awesome thing for me was my insurance covers her work and also all lab testing, even with a diagnosis of GID (literally).


My first visit with the initial injection was just over $200. I pay about $130 every three months for the hormoes. I don't have insurance so I get to pay full price. The Estrodial costs me $20 and the Spiro hits me for $110. Not sure why that is so high, but I do get a 3 month supply. I visit doc twice yearly for labs. Expect haveing to pay on those. Of course if your insurance covers it you are in the clear.

$110? Wow. I use Rite-Aid which is easily the cheapest in my area. They charge $16 for 90 days x 1. I've found most pharmacies only go up to 25mg for their generic Spiro.

[StaceyJane]

I've got Blue Cross. I pay a 20 dollar co pay for Dr visits and hormones costs about 20 dollars a month. Labs cost a bit until I reach the yearly deductable.

[Bree-asaurus]

I've got Blue Cross. I pay a 20 dollar co pay for Dr visits and hormones costs about 20 dollars a month. Labs cost a bit until I reach the yearly deductable.

That's good to know it's not just a fluke with my friend. Looks like Blue Cross might be a good option for transgendered and transexual individuals looking for assistance with HRT costs...

[CharleneT]

It strikes me as unusual that the doc is selling you hormones. The price for the initial visit is not out of line if it includes labs ( a specialist visit alone is going to be $200 or more). Depending on how she codes the visits, you insurance may cover it because they do not know it is for a trans patient. Careful with that stuff....

[sandra-leigh]

Those numbers feel so strange to me here in Canada. All of my tests and consultations have been no (direct) cost, covered by provincial medical insurance. The hormones have not been very expensive for me, but I could not name a cost at the moment. The associated medication costs are adding up a bit, though -- anti-depressants, anti-cholesterol. My medical plan at work is covering about 80% after the yearly deductible.

[Pamela Kay]

Congratulations Shaiya!

I went to a trans friendly endocronologist about a week and a half ago with my GID letter in hand for my initial consult. She stopped dealing with insurance at the first of the year but they do turn it in for you. It cost me $260 for the initial visit including an examination and blood tests. I left with prescriptions for Spirolactin and Estrodiol, took them to Walmart pharmacy and turned it in on my Blue Cross insurance. It cost me less than $11 dollars for a 30 day supply of both. I'll have to see if they deny it or not but I don't think they will. Hopefully I'll even get some back for the visit or at least get it applied to my deductible.

The Blue Cross policy does say they do not cover any expenses related to gender change issues but there is another transwoman in my support group who has had her visits and prescriptions paid for too. I think it depends on how it is turned in and if they catch it. I'd turn it in, they will deny it if they don't want to cover it.

[Stephanie-L]

An initial consultation in the $600 range does not sound to far off, especially if all labs are included, of course fees vary by location. If the doc is willing to work with you they can code the visit as something besides Trans issues and get your insurance to pay. The meds being $40 a month is not too bad either, depending on which meds, etc. What is odd is that you would be getting them directly from the doc. This may be a doc that does the "bio-identical" hormone thing, which costs a lot more, but the discussion of those is a whole new thread. One thing to consider is that even if you can't get the doc visits covered you might be able to get the meds covered, just don't say anything to the insurance company about it, mine usually doesn't even check beyond the facts that the med is on the list and the perscription is written by a licensed provider, whether one of theirs or not. Good luck, I am in a similar situation and trying to work it out myself............Stephanie

[AnnaCalliope]

I had the benefit of going to a therapist and doctor that both knew how my insurance company (Cigna) worked, and exactly how to phrase things: "Adjustment Disorder with Social Anxiety" vs Gender Dysphoria, "Fixing Endocrine Irregularities" vs Hormone Replacement Therapy, to ensure that my coverage was accepted.

All three therapists appointments were completely covered by my company's health
insurance. My first doctor's appointment cost $10 (I just started HRT 4 days ago).
My total prescription cost for 30 day supplies of Estradiol and Spiro - $19.

Of course, my coverage pretty much ends there. My health insurance documents explicitly state no coverage will be provided for any kind of surgery related to GID.

[Traci Elizabeth]

The initial testing cost seems kind of expensive. Running a couple blood tests shouldn't cost that much.



My first visit cost me $125.00 (much higher for the first than subsequent visits) just for the office visit alone, and he arranged for me to have all my baselines checked with blood and urine tests before subscribing ant HRT meds. The damn Estradiol test broke the bank as well as having the Total and Free Testosterone checked with my blood. So my first visit INCLUDING all the blood work cost me about $550.00.

[Traci Elizabeth]

As far as my monthly costs for HRT...sit down...it's free... thanks to Uncle Sam and my military career.

[Hope]

My visit to see my endo is $150 out of pocket. Now that I have insurance, i have no idea what it will cost. I see her every 6 months now, but will drop to 1X/year shortly.

On my first visit, she sent me home with orders for blood-work... lots of blood-work. something like 5 out of 6 tests were pretty reasonably priced, all of them together were about another $200.00 The last one however, the free Testosterone... unholy hell... $350 for the one test alone... So the next time I went in to see her, I asked if we could drop that test... she agreed, and now my costs are MUCH more manageable...

So my point is this - $600 for an initial visit, including lab work - feels right.

[shaiya]

Thanks again, for all your answers.
So, today I called another bioidentical doctor, who as a plus is just a 5 minute bike ride away from were i live. perfect :)
She told me that she does accept my insurance, and told me to call my insurance company to see how much they cover me.
Called the insurance company and they told me that I would only get charged $25 for the consultation with the specialist and they would cover 10% of the cost of all tests I have to go through.
I called the doctor again and asked her about the cost of the tests and she said they would be anywhere in the range of $100 - $300.
I was very happy to hear that. That is going to be way cheaper than with the other doctor that I called. :)
I was also pleasantly surprised that all the doctors that I called so far didn't require no therapist recommendation letter. Are the requirements changing? maybe
Seems so much easier than I thought.
Anyway, now I can go on and schedule an appointment for this week and get the whole thing started. yay! :GD: