Regarding Insurance & Cost

[ClaireXO]

Hey guys, I have a question regarding costs of HRT and lab work. Okay, so I called my insurance a few days ago (UnitedHealthCare) I asked them "What is the copay I'd have to pay for prescription/office visits/lab-work etc." They said your prescription should be no more than $5 of copay. I then asked her how about office visits/lab-work. She said "that should be fully covered and like i said if there is copay no more than $5". This is my first step to adult hood and understanding insurance. I asked the clinic that I am going to "How much would it cost without insurance for the first appointment" They said $120. From a lot of articles and forum post I read. People paid way more for appointments and prescriptions without insurance. I asked them "how much would it be for the second visit" the clinic said "$80". Then he continue to explain to me for prescription you'll only pay a couple of dollars. I've been on this website and other website where individuals have said "I paid $300 total" or I paid "$600". The guy at the clinic was telling me "We came a long way to get trans services and want to make it affordable".

[Deborah]

My Dr. costs $130 per visit.  The lab work though is separate and is somewhere around $400.  I have to pay for the visit but get my lab work done elsewhere at no cost. 

Without insurance the HRT is pretty cheap.  Depending on the dose it's around 10 to 20 dollars for the estradiol and 30 to 50 dollars for spiro.  Progesterone is more expensive at around 80 dollars.  I get my prescriptions now at no cost also.


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[jill610]

Also, a lot of people don't realize that sometimes the pharmacies can give bigger discounts than you would get through insurance. I have really very good insurance, and I just filled my Spiro today for $5.77 at wegmans, which was less than my insurance generic copay. Sometimes it doesn't hurt to ask to see if there's a better deal. My finesteride is not covered by insurance as "potentially cosmetic" (I am too lazy to fight that one), and wegmans again is charging me $12/mo, the retail is $78.

If you live near a big city or university, their health programs often have a sliding scale as well. My dr apt charges insurance $120, but I know on a sliding scale some folks get it free or near free.

[Devlyn]

Also, a lot of people don't realize that sometimes the pharmacies can give bigger discounts than you would get through insurance. I have really very good insurance, and I just filled my Spiro today for $5.77 at wegmans, which was less than my insurance generic copay. Sometimes it doesn't hurt to ask to see if there's a better deal. My finesteride is not covered by insurance as "potentially cosmetic" (I am too lazy to fight that one), and wegmans again is charging me $12/mo, the retail is $78.

If you live near a big city or university, their health programs often have a sliding scale as well. My dr apt charges insurance $120, but I know on a sliding scale some folks get it free or near free.

Exactly. Last year my doctor prescribed Viagra for me but said she would have the pharmacy call me. They called,  and through my insurance the 5 tablets were $190, and wouldn't be covered so I would have to pay....or I  could  buy them directly from the pharmacy and the 5 tablets were $60.

Obviously there's more to it like your deductible and out of pocket expenses, but prices are going to vary wildly.

Hugs, Devlyn

[ClaireXO]

I understand what you all are saying, but I am assuming it depends on area too? I am from Pennsylvania and the clinic seems to be reasonably understanding to our needs. The guy said that they worked very hard to make things affordable because they understand the struggle of gender identity. Made me feel happy and good inside that we have people working hard for transgender individuals.

[Maddie86]

unfortunately the insurance I get through work is a private plan and it doesn't cover anything transgender related. Apparently that's the only way insurance can discriminate against you in New York, for private plans they can pick and chose what's covered. They won't cover my prescriptions but I'm on a medium dose of HRT meds and I pay a little less than $30 a month at Rite Aid, they gave me a store discount that really helped me out. They're being taken over by Walgreens soon and idk if that's going to change. So far my insurance has covered my doctor visits, therapist, and blood work, so I lucked out on that but I get the feeling that they might not pay close attention to that, my friend is nurse and she said that blood work rarely gets audited, but my labs definitely say gender dysphoria on the papers so I could probably be denied pretty easily, and if insurance doesn't cover it I would have to pay hundreds of dollars per visit, ew.

[TonyaW]

One odd thing with spironolactone is that it's cheaper to buy larger quantities of the 25mg tablets than to get the 50 or 10pmh tablets.  If you have a straight dollar amount copay it doesn't matter but if you pay a percentage or it goes to deductible it will save you some money.

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