The Cost of Hormone Testing and Your Insurance

A lesson learned.....I tend to be one of those people who will research a subject to death, way in advance of if, or when, it may ever happen. In this case, my “always wanting to be prepared” cost me a bundle.

So when I first started reading and researching all of the options regarding hormone replacement therapy, I noticed it was often recommended that women have some kind of initial testing for hormones in order to establish a baseline for treatment. This seemed to make sense because every person’s hormone levels are different, and if you don’t know where your “normal” range is when you start having issues, then your doctor can only compare you to the wide “range” of “normal.”

I had decided that since I never reacted well to synthetic drugs (especially birth control pills), I would take the Bioidentical route. The doctor I selected to pursue my interest in Bioidentical Hormone Replacement Therapy (should I ever need it) favors blood testing above saliva testing, so my first question was, “what is this going to cost me?” I was told, “Well, your insurance should pick up some of the cost, although they won’t pay for everything.” The nurse suggested that I use a lab (like Quest) instead of having the blood drawn in their office, because the lab they use charges much more.

Like many people who have insurance I have a co-pay in addition to a huge deductable in order to save premium costs. So whatever the charge, I would be paying it in full because my deductable had not yet been met. In addition, I would be paying for the doctor’s consultation fee of $375 out-of-pocket, because this type of doctor is not covered by my insurance.

One thing that wasn’t explained to me prior to having my blood tested (and should have been), was that most of the lab work ordered would not be covered at all, because insurance considered it to be “outside of the standard lab testing.” I say “most of” because since I had never had general tests done for such things as Cholesterol, Vitamin D, etc.

I almost had a heart attack when I logged into my insurance account and saw the bill from the lab was $1,772.24! Now I know most initial charges from doctors and labs to insurance companies are inflated, but this is ridiculous! Once my insurance company rejected the claim, I was billed directly from the lab for $704.22 – still way out of my budget.

So my advice to you is that if you are going to have any blood testing done, then find out the costs in advance, ask the doctor, ask the lab, and ask your insurance company. And be prepared to pay for it all yourself in the event you cannot get any commitment in writing.

As for the doctor’s consultation fees – do not be embarrassed (like I was) or afraid to ask up front what the initial consultation fee is and what they will be charging for follow-up fees whether you see them in person, or consult over the phone. After all, this is where they make their money. It is a shame, but until insurance companies approve of bioidentical hormone replacement therapy, you are pretty much on your own.

Finally, it is not my plan to use hormone replacement therapy – only a last resort, if symptoms get so bad that it interferes with the ability to function or feel human.