Insurance reimbursement for compounded stuff.

BigJimCalhoun

Member
Long story here, but my prescription for T costs $95 + $15 shipping from the compounding pharmacy. I need to fill out a form, send crap in and then get reimbursed.

The insurance company rejected my complete claim because I said the one 10 ml bottle (smallest there is) lasts me about 18 weeks which is about all you can get out of a theoretical 20 week dosage due to loses, oil dripping out, etc. (Part of the form needed to know days supply, etc) They said they will only pay for a month's worth which is $24.32 according to them.

Now I need to write them a letter disputing it, etc.

Imagine if I said one bottle lasts me on month (500mg/week) they would be up in arms about that too.

To make things even more interesting, I get letters in the mail from them telling me I need to use their mail-in pharmacy but then when I call they tell me they don't ship testosterone cypionate and to get it on my own and get reimbursed. Then, they send the letter again and cycle repeats.

My insurance company is Premera BCBS and Medco is the mail order subcontractor.
 
Sounds about right. They will generally reject these claims at least twice to see if you are serious. Try putting the day supply as 30 but filling any info about dosing in correctly. They can't reject it due to the package size when that is the only available size. It's likely they are just testing to see if you will continue to follow up.
 
I hate insurance companies. Prescription Solutions is the worst. Everytime I'd send in a script for mail order the jerk of a pharmicist would call me asking if I really needed to take that much! I told her that's my doctor's job to worry about and not hers and to just fill the prescription. The nerve of these people! Trying to save a buck by getting you to take less medication. Man I lost my cool on that call. :)

RPHMark said:
Sounds about right. They will generally reject these claims at least twice to see if you are serious. Try putting the day supply as 30 but filling any info about dosing in correctly. They can't reject it due to the package size when that is the only available size. It's likely they are just testing to see if you will continue to follow up.
Click to expand...
 
I recently submitted some claims (including Test Cyp) to see what they would cover (it was denied while filling it at Walgreens).

On a side note, my insurance CO, Aetna, would not cover HcG, but did cover Arimidex. They said I would have to go through some Male Infertility program in order to get covered for HcG.
 
The insurance company called back today with a resolution. The claim will be reprocessed and a flag put on my account allow future claims in the future.
 
BigJimCalhoun said:
Long story here, but my prescription for T costs $95 + $15 shipping from the compounding pharmacy. I need to fill out a form, send crap in and then get reimbursed.

The insurance company rejected my complete claim because I said the one 10 ml bottle (smallest there is) lasts me about 18 weeks which is about all you can get out of a theoretical 20 week dosage due to loses, oil dripping out, etc. (Part of the form needed to know days supply, etc) They said they will only pay for a month's worth which is $24.32 according to them.

Now I need to write them a letter disputing it, etc.

Imagine if I said one bottle lasts me on month (500mg/week) they would be up in arms about that too.

To make things even more interesting, I get letters in the mail from them telling me I need to use their mail-in pharmacy but then when I call they tell me they don't ship testosterone cypionate and to get it on my own and get reimbursed. Then, they send the letter again and cycle repeats.

My insurance company is Premera BCBS and Medco is the mail order subcontractor.
Click to expand...

Just so you know.
You can get compounded Testosterone Cypionate.
Original have cotton seed oil.
Compounded have sesame oil.
Compounded 200mg/mL, 10mL $47.50
Compounded 200mg/mL, 30mL $99.75

Possibly you would worry less about insurance reimbursment.
 
Insurance co's are bastards. I got denied an MRI of my pituitary even though bloodwork clearly showed an LH and FSH deficiency at 23 yrs old. Something's not normal...be nice to know I'm not in danger of dropping dead ya know.
 
JanSz said:
Just so you know.
You can get compounded Testosterone Cypionate.
Original have cotton seed oil.
Compounded have sesame oil.
Compounded 200mg/mL, 10mL $47.50
Compounded 200mg/mL, 30mL $99.75

Possibly you would worry less about insurance reimbursment.
Click to expand...

As high as most people's brand and non-formulary copays are, it is often not worth messing with to file insurance. If you don't, they also can't hold those drugs against you later to raise rates, deny converage, etc because they don't know about them.
JanSz- sesame seed is common but many do use cotten seed oil
 
RPHMark said:
As high as most people's brand and non-formulary copays are, it is often not worth messing with to file insurance. If you don't, they also can't hold those drugs against you later to raise rates, deny converage, etc because they don't know about them.
JanSz- sesame seed is common but many do use cotten seed oil
Click to expand...

Cotton seed oil
Sesame seed oil

probably does not make a difference keeping blood T levels

but

is there enough difference in their viscosity to impact drawing them thru 31ga needle?

Invalid Link Removed

Specific Gravity and Viscosity of Liquids

Sesame seed oil
39.6 centistokes at 100F
23.0 centistokes at 130F
----
Cotton seed oil
37.9 centistokes at 100F
20.6 centistokes at 130F
----

so sesame seed oil is
39.6/37.9=4.5% thicker at 100F


Not sure if that would make much difference in doing shots or in their working thru fat or muscles to the blood stream.
 
Not sure if it makes any real world difference, but I know that working with them the cotten seed oil seems slightly less viscous. Probably not enough to matter much when we are using such small needles; any oil is just going to take a while to draw and shoot (esp at room temp.).
 
RPHMark said:
Not sure if it makes any real world difference, but I know that working with them the cotten seed oil seems slightly less viscous. Probably not enough to matter much when we are using such small needles; any oil is just going to take a while to draw and shoot (esp at room temp.).
Click to expand...

so sesame seed oil is
39.6/37.9=4.5% thicker at 100F

if I recall correctly, the flow change is to fourth power,
if I am right then what now on cottonseed oil takes 4 minutes to draw, it should take

4*(1.045^4)=4.8 minutes

when sesame oil is used.

I guess not much difference, I may try to save some dough next time.
=====================================================
Save $100, well $50 going from generic to compounded.
pay with time, say one minute for each shot.

10mL vial = 2000/150=13 shots ~~ 13 minutes

so I will make $50 in 13 minutes

$50/(13minutes/60minutes/hour)=$230/hr

could be worst.
 
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