With hormones serving as chemical messengers in the body, their importance cannot be overstated. Thyroid, adrenal, and sex hormones are just a few of the hormone categories that play key roles in helping us to function at our peak. Whether due to normal changes in our natural lifecycle (such as menopause or andropause) or as the result of a disease process (such as a thyroid disorder), hormonal fluctuations and imbalances can greatly impact multiple body systems and overall quality of life.
Bioidentical hormone replacement therapy (BHRT) is a personalized treatment preferred by many patients over conventional hormone replacement therapy—and interest is growing. But while you may be intrigued by the possibilities of BHRT, you may also be wondering if it’s covered by insurance.
Examining the Benefits of Hormone Replacement Therapy
Hormones play a key role in the health of our urogenital, muscular-skeletal, and nervous systems. As a result, BHRT has the potential to produce life-changing results by addressing the many symptoms of hormonal imbalance and decline.
Hormonal states that cause symptoms in the short-term may also serve as a warning of long-term health consequences. Medical researchers have begun to view menopause symptoms as signals of impending health problems and are increasingly recommending treatment for symptomatic women, not only to improve current quality of life but to minimize the risk of future consequences like cardiovascular disease, type 2 diabetes, osteoporosis, and dementia. Likewise, the long-term effects of low testosterone may predispose men to weight gain, depression, and loss of bone density. Meanwhile, untreated hypothyroidism may cause obesity, joint pain, heart disease, and depression. It is clear that hormone replacement therapy has both immediate and future implications for symptoms you recognize as well as preventing underlying health conditions you may not.
A hormone health specialist understands the nuances of hormone fluctuations, as well as the potential benefits of bioidentical hormone replacement therapy. These practitioners have seen successfully treated patients reclaim their health and their peace of mind—and they are well aware of the potential BHRT creates for optimal quality of life as you age.
Bioidentical hormone replacement therapy begins with a consultation with a practitioner who specializes in hormone health. They will take a thorough medical history, assess your symptoms, discuss your health goals, and help you understand your treatment options. You will also undergo comprehensive laboratory testing to measure hormone levels in blood, urine, or saliva.
Once measurements have been obtained, your practitioner will design a personalized treatment plan tailored to your individual needs and preferences. This treatment plan may involve standardized bioidentical hormone replacement products or custom BHRT prepared by a compounding pharmacy. Custom-compounding ensures that your dosage is precisely what your body needs. You can also choose from a range of administration methods to make treatment as simple as possible.
After you begin treatment, you will attend follow-up appointments and undergo testing approximately 3-4 times per year to track your progress and make any adjustments to your treatment plan.
Is Bioidentical Hormone Replacement Therapy Covered by Insurance Coverage?
Insurance coverage is often contingent on medical necessity, but the question of medical necessity is complex. Hormonal fluctuation or imbalance, though typically not life-threatening, may signal an end to life as you knew it. Between the uncomfortable physical symptoms, the distressing mood changes, and the long-term implications for your overall health and well-being, your quality of life may be severely compromised. While current medical standards recognize and support the use of hormone replacement therapy for symptom relief, insurance plans and their associated coverages will differ.
Talking to your insurance provider will help you to determine which bioidentical hormone products and services are covered. In general, there are three major components involved:
In-Network vs. Out-of-Network
In-network providers are practitioners who have a contractual relationship with your particular insurance company to provide services for a negotiated fee; out-of-network providers do not. Working with an out-of-network practitioner generally means you will pay more out of pocket for your physician’s services.
Depending on your coverage and diagnosis, laboratory testing for hormone levels and assessment of general health may be covered by insurance. This coverage will, however, be subject to your deductible and any plan co-payments. Additionally, certain specific tests may not be covered, so it is best to check beforehand.
Prescription Drug Coverage
While some bioidentical hormone preparations are covered by insurance, others may not be. Typically, medications prepared by a compounding pharmacy are not covered, but standardized bioidentical products often are. Reviewing your prescription drug coverage with an insurance representative will help you to understand what your costs will be.
|Follow Up Visit
|Prescription Drug Coverage
- ✔ Depending on the type of insurance policy and coverage, the patient can submit a claim to their insurance as an out-of-network claim and a reimbursement may be possible
- ✔ Compounding pharmacies must generally be part of the insurance policy coverage
- ✔ Most insurance can be billed for labs
- ✔ Accepted
It’s important to recognize that what your insurance does or doesn’t cover isn’t necessarily an indication of what is best for your individual situation. Whenever possible, your health care decisions should ideally be guided by your needs and the wisdom of your practitioner, not by an insurance company.
BHRT Is an Investment in Your Health
BHRT practitioners often specialize in bioidentical treatment options because they have seen a failure of conventional care to meet the needs of their patients, and they strive to find a better way. They believe strongly in BHRT as part of a comprehensive plan that includes personalized dosing along with lifestyle recommendations to help you feel your best. As such, choosing BHRT is an immediate investment in your quality of life. Within days to weeks, patients commonly experience relief from the physical and emotional symptoms of hormonal fluctuation and imbalance, paving the way for enhanced overall well-being.
BHRT can also be a preventive investment in your future health. Untreated hormone-related conditions can take a significant emotional, physical, and even financial toll. By limiting the development of the serious sequelae of long-term hormone imbalances—such as depression, cardiovascular disease, type 2 diabetes, hypertension, and osteoporosis—you will be improving your outlook for continuing good health.
High-quality, individualized care that includes regular monitoring will ensure that an appropriate risk-to-benefit balance is maintained. This means finding an experienced, hormone health practitioner who can customize the best dosage, route of administration, and treatment duration for you—and track your progress over the long-term.
Being Your Own Advocate
Downplaying the seriousness of hormone changes or imbalance as a normal effect of aging does a disservice to people experiencing what are often challenging, or even devastating, symptoms. Only you know your limits, including what you can live with and what you can live without. And yet, sometimes patients accept inferior or suboptimal care dictated by the limitations imposed by insurance companies.
Each of us must advocate for ourselves and decide on the quality of life we desire and demand. Your insurance company may recognize one standard treatment path that does not align with what your provider deems best for you. Sometimes wanting more and desiring a greater standard of care means paying additional out-of-pocket fees. With proper treatment, you can anticipate symptomatic relief and an enhanced sense of well-being. And when that treatment is customized for your unique body and its systemic needs, you can optimize your chances of success.
If you are considering bioidentical hormone replacement therapy, BodyLogicMD can help. The BodyLogicMD network is comprised of expert practitioners who will work with you to create a customized plan based on your current hormone levels and your future goals. Contact a local practitioner to schedule your first appointment, or take the BodyLogicMD Hormone Balance Quiz to gain more insight into the impact of hormones on your everyday life.