Can I use my Health Insurance for Hormone Replacement Therapy?
Yes. If you have health insurance, there are many FDA approved bioidentical products that can be prescribed to you to alleviate menopause symptoms.
I'm not sure why, but I always assumed my insurance, which is a benefit to me from my full-time employer wouldn't cover the cost of HRT. I was wrong. For four years I paid out of pocket for my HRT because I never did any homework or looked into how that might work.
Hormone Replace Therapy covered by Insurance
The most difficult part of getting your hands on HRT products that your insurance will cover is finding an HRT specialist or Hormone Replacement Company who accepts insurance and know which products insurance will cover.
The good news is that as of today, there are two super-great on-line HRT companies that accept insurance and will write prescriptions for HRT that are known to be covered by prescription insurance. Those two companies are Midi Health and MyMenopauseRx.
MyMenopauseRX and Midi Health have a lot in common, but one is the clear winner at the end of the day as it pertains to your out-of-pocket costs. So, keep reading.
Hormone Replacement Therapy Initial Consultation Cost
The first thing you have to determine is whether your insurance would be considered in-network or out-of-network. Both of these providers accept some of the biggest names out there like, Aetna, BlueCross BlueShield, Cigna, Humana, United Healthcare, blue California, Athem, Health net and TriCare. If your insurance is one of these providers, then you are likely golden and can move on to the next step. Your out-of-pocket cost for the initial consultation will be based on where you are with your annual deductibles and any co-pays that you are responsible for. It will work just like it would with any other doctor visit that is in-network.
If you learn that your Health Insurance is out-of-network, which is what happed to me when I became a patient of Midi Health, my insurance provider informed me that the $250 for the initial 30-minute consultation would be considered out-of-network and that the $250 would be applied to my out-of-network deductible, meaning even if I submitted the claim, the $250 would go towards the deductible and I wouldn't see any money reimbursed to me.
Midi Health offers first time patients a 30-minute consultation for $250.00. They will bill your insurance, and you'll learn at a later point what your expected cost will be, based on your co-pay and deductible. MyMenopauseRx offers 20-minute consultations and if you don't have insurance or if you learn your insurance is considered out-of-network, they have a self-pay option that only costs you $99 for the first visit vs. the $250 with Midi Health. In either case you can contact MyMenopauseRx or Midi Health to determine your out-of-pocket costs before you commit to one company or the other.
Once you make a decision on which provider works best for you, you will create an account and provide the needed medical information and history. The'll send you a link to their patient portal where you can schedule your initial consultation.
Hormone Replacement Therapy Prescriptions covered by Insurance
The Clinicians at both Midi Health and MyMenopauseRx are very familiar with what prescriptions health insurance will cover. They are aware of the FDA approved formulations and the dosages that have been approved. This is one of the biggest differences between a company who accepts insurance compared to an on-line provider who expects you to pay out of pocket. In many cases the companies who offer self-pay products are prescribing meds in dosages that may not have been approved by the FDA.
At the time I met with my clinician, I was on an estrogen patch and a progesterone pill. I was paying out of pocket and was curious and hopeful that if they could prescribe the same formulations and dosages or something similar that my insurance would cover the cost, and it did! I shared with my HRT specialist the patch dose I was on and the dosage of progesterone pill, she was in agreement and duplicated the prescriptions and sent to my local pharmacy for me to pick up.
I initially used my Express Scripts prescription insurance. The average per month cost for the estrogen patch and progesterone pill were $69.38. After doing some research, I realized that when I use a GoodRx coupon, the cost is even lower than when I used my prescription insurance. The GoodRx coupon takes the average monthly cost down $33.58, not including any consultation or visit fees.
Can they help with Weight Loss?
If you are like me, menopause brought on the dreaded night-sweats, hot flashes and 25 pounds that I couldn't seem to get rid of. Both of these providers can write prescriptions for Wegovy or Ozempic to help with the midlife weight that seems to creep up on so many of us during this stage of life. They also offer skin care products, hair loss products and products to help with sexual health.
Menopause doesn't just affect one part of our bodies; it affects our entire body, and it impacts each of us in different ways. No two of us are alike in how menopause hits us.
MyMenopauseRx Vs. Midi Health, which is more affordable?
There is so much similarity between these two providers, but there are a few ways that they differ.
1) Midi Health Consultation Fee is $250 and if you are paying out-of-pocket because your insurance is out-of-network, that's a hefty fee. If this ends up being your situation, you can go to MyMenopauseRx and ask to be charged as a self-pay patient, and the cost will only be $99. However, if you've experienced a year where you've met your deductible and your insurance is in-network, your cost for the initial consult will be minimal if anything.
2) Consultation Visits with MyMenopauseRx are 20 minutes. Midi Health offers their first-time patients a full 30-minutes for that initial visit. When was the last time you were afforded 20-30 minutes with a healthcare professional to discuss your medical needs and questions?
3) Midi Health, from what I can tell employs mainly Physican Assistants and not so many real doctors. So, it's likely you won't be seeing a real MD and maybe that doesn't matter so much to you. On the other hand, MyMenopauseRX has MD's CNP's and RN's, so regardless of your needs they have a full staff to serve you and your menopausal needs. They even have a physical location in Wheaton, Il, if you happen to live in that area.
Based on the way they practice; the only real differentiator is the cost of the initial visit. Based on that alone, MyMenopauseRx is more affordable, specifically as it pertains to the initial consultation fee to get your Hormone Replacement journey started.
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