Insurance does not cover "bioidentical HRT"

[ImagineKate]

I was looking at my company's insurance coverage and one of the exclusions is "Bioidentical hormone replacement therapy."

So this means they won't cover it for anybody? Not even cis people?

[Devlyn]

Sounds that way, sorry, hon.

Hugs, Devlyn

[ImagineKate]

Thankfully hormones aren't terribly expensive. Our prescription plan is awful anyway. They tried to deny my kids asthma medicine at one time. I had to fight them really hard, eventually they relented. At least they should cover spiro as it's blood pressure medicine. It's something at least.

Not sure what my wife's plan covers, but the future of me being on that is yet uncertain.

[Jenna Marie]

It does sound that way, but "bioidentical" is generally an issue with pills, I believe. So you might still be able to get, say, HRT by cream or patch; I'd be shocked if they didn't cover what a menopausal cis woman might need in ANY way whatsoever. Also, sometimes, "bioidentical" is used to mean "made by a compounding pharmacy," which it's not uncommon for an insurance company to reject. You need to find out specifically what it is they mean by this exclusion.

You can also sometimes have a doctor appeal an exclusion, since arguing that it's medically necessary - that non-bioidentical types don't work well for you - will sometimes get you an exception. (Speaking of asthma medication, my wife had to do that once to prove that a brand-name albuterol inhaler worked better for her than the generic, and it's a rescue med so you want it to work! Getting a doctor to claim it was medically necessary convinced the insurance company to pay for it even though it was "non-formulary.")

[Jill F]

My insurance won't cover my compounds, but I'd rather pay $1/day than take the pills that they do cover.  I'm hoping that since my gender marker was switched to "F", that I can get it prescribed by a gynecologist as they would to any menopausal woman.

[ImagineKate]

  I'm hoping that since my gender marker was switched to "F", that I can get it prescribed by a gynecologist as they would to any menopausal woman.

That's interesting. Do you have to be post op for this? I do plan on SRS but not right now, not for a couple of years.

[Jill F]

That's interesting. Do you have to be post op for this? I do plan on SRS but not right now, not for a couple of years.

I'm in California, and the rules likely differ from those in NJ, but because I've had an orchi and am recognized by insurance as female now, I don't need to get hormones as a MTF seeing an out-of-network endo now. (They cover pills, not compounds.)  Because I am legally female, I can see an in-network gynecologist as any other woman can and get the compounds covered.  It's an on-label/off-label/in-network/out-of-network nitpicking thing that insurers pull all of the time.

[missymay]

I'm surprised they won't cover those meds, as they are better for your health, and inexpensive.  Are you planning to take injections as part of your HRT regimen?

[Randi]

If you are taking Estradiol pills, you don't need insurance.  Walmart, Target and others have Estradiol on their generic list.

$4 for a month or $10 for 90 days.

[ImagineKate]

I'm surprised they won't cover those meds, as they are better for your health, and inexpensive.  Are you planning to take injections as part of your HRT regimen?

I don't know. I have to talk to the endo first.

I was hoping to do something like an implant for E and just take spiro orally, or maybe injections. Pills... eh, I'm not so thrilled about because I might forget to take them or the possible liver effects.

[Shantel]

I was looking at my company's insurance coverage and one of the exclusions is "Bioidentical hormone replacement therapy."

So this means they won't cover it for anybody? Not even cis people?

My spouse has what is referred to as "Cadillac" health insurance where all medications are free, however not so bio-identical hormones however they reimburse her 75% of the cost with a check in the mail. The reason they are never covered is because the big pharmaceutical companies continue to make denigrating remarks about the effectiveness of bio-identicals because they are extracted from naturally occurring plant hormones which are compounded and are not chemically manufactured so they are unable to patent and maintain proprietary control over them. Bio-identicals are very effective and much safer than the one size fits all chemically produced pills dispensed by pharmaceutical manufacturers, so it amounts to a case of sour grapes by Big Pharma.. The FDA is effectively run by these manufacturers and so they are not approved for coverage by insurers. Meanwhile there are millions of cis women as well as trans women who are enjoying the effects of bio-identical HRT and have no qualms about paying out of pocket for it, after all why would anyone subject their healthcare needs to the whims of others?

[ImagineKate]

If you are taking Estradiol pills, you don't need insurance.  Walmart, Target and others have Estradiol on their generic list.

$4 for a month or $10 for 90 days.

Yeah wow. Ok then nothing to worry about.

[Sydney_NYC]

I'm in California, and the rules likely differ from those in NJ, but because I've had an orchi and am recognized by insurance as female now, I don't need to get hormones as a MTF seeing an out-of-network endo now. (They cover pills, not compounds.)  Because I am legally female, I can see an in-network gynecologist as any other woman can and get the compounds covered.  It's an on-label/off-label/in-network/out-of-network nitpicking thing that insurers pull all of the time.

The insurance company is going to list your gender as whatever it is on your ID. In NJ, for Driver's license, it's only a DMV form signed by a doctor to change your gender marker (No SRS or surgery required.) I had mine changed in June and now my insurance (Horizon BCBS) has me as female with my new name. (Except for their stupid online login which won't update and they don't know why. All my bills and forms I print has the correct gender and name, but the online customer profile has my old name and gender.)