Can I get all of the same treatment for much less money by going to see my PCP and using my health insurance?
The short answer is absolutely no you can’t.
Unfortunately it is not possible to obtain the level of medical care and expertise that we provide while working with in-network providers while they accept your health insurance.
The fundamental reason that this is the case is because health insurance was not conceived with prevention of a decline of your health or with optimization of your health as its primary objectives. Instead, it was conceived with prevention of serious disease and maintenance of a serious disease-free state in mind. This is just how conventional medicine works. It makes sense when you consider the purpose of other types of insurance, such as homeowner’s insurance. It’s all about what consumers are willing to pay to insure their home against the event of a catastrophe of some sort with the probability of that event in mind. In this case the asset to insure is a home, but our health is also an asset that requires insurance – health insurance.
Can my PCP just bill my health insurance for everything?
They can try their best, but in the end the short answer is absolutely no they cannot.
With this in mind most conventional doctors within this conventional system are not willing or able to evaluate you for testosterone deficiency and treat you with testosterone replacement therapy because doctors who are in-network with health insurance plans are not able to bill health insurance plans enough to be sufficiently compensated for this. What ends up happening is that they are forced to provide a lot less comprehensive evaluation and management of your testosterone deficiency with a lot less time. For example, our patients usually have four or five comprehensive follow up appointments per year with another comprehensive phone consult to review labs and discuss ongoing treatment after each of these appointments for a total of usually 8 – 10 appointments per year. A doctor who is in-network with your health plan would only be able to afford to provide you with one to three office visits and zero phone consults per year since phone consults are almost impossible to get reimbursed for.
The in-network doctor would be forced to work too many hours and see too many patients at the sacrifice of their work-life balance and overall health and happiness in order to provide you with the expertise and time required to provide you with safe and effective testosterone replacement therapy. This is because the in-network doctor has spent many years of their life in school including medical school and then post-school training and they have lots of student loan debt to pay in addition to all of the other expenses of life. Based on a free-market / capitalism society it is necessary for doctors to be highly compensated in order to justify their incredible and lengthy sacrifice.
Does my health insurance cover the cost of testosterone replacement therapy?
The short answer is again no, but there is a lot of fake news out there that makes this one hard to believe.
From a free-market / capitalism perspective there is no way that health insurance companies could afford to pay doctors enough for this ongoing evaluation and management without charging consumers significantly more for their health insurance. This is because in a free-market / capitalism setting health insurance companies have to earn a certain rate of return for their shareholders to justify the risk they take with their capital investment in order to stay in business, and this bottom line requirement naturally incentivizes health insurance companies to make it difficult for you to qualify for testosterone replacement therapy because they know that ultimately consumers are in general not willing to pay for this through increased monthly premiums. It’s just reality.
But wait – what if my regular doctor says he can get this for me and it’s covered by my health insurance?
I’m sorry to say but the short answer is still no.
Let’s assume for the sake of argument that you could find an in-network doctor who states they’re willing to evaluate and manage your testosterone deficiency. Sounds great, right? Wrong. Be suspicious. Why?
Because if they knew what it takes in terms of expertise and time to provide you with safe and effective testosterone replacement therapy then they would not be willing to do this for you – because as explained above it would not be a good deal for them. I did this for a couple of years and I had to see 35 – 40 patients per day and work literally all day (6 a.m. to 7 p.m.) five days per week to make this make financial sense – while it made absolutely no sense otherwise.
That the doctor doesn’t realize this means the doctor is not an expert in testosterone replacement therapy. The easiest example of this is the fact that most of these doctors would simply consider your severe hormone deficiency to be a completely normal part of your aging process, and would not be willing to treat you for this anyway even if you did pass the very strict requirements established by health insurance companies for diagnosis, and even if you were seriously suffering from symptoms, such as poor sex drive and erectile dysfunction.
But wait – what if my regular doctor says he will prescribe testosterone for me?
Even if they were willing to prescribe you testosterone it is almost certain that they would prescribe a method of testosterone replacement therapy that is inherently less safe and effective for you (for example a less safe and effective topical cream or gel rather than a safer and more effective regimen consisting of injections or periodic subcutaneous implants) and at a dose that is not going to help you anyway. To make matters worse it is almost certain that they would not be willing to test your estrogen levels or prescribe anastrozole or anything else to control your estrogen levels or symptoms of higher estrogen levels. To make matters even worse as if that weren’t bad enough or as bad as it could get – it is even more certain that they would not be willing to prescribe you any HCG to preserve your testicular size and therefore your fertility and ability to make your own testosterone, which is extremely important for men who may want to have children in the future or who may not be able to afford testosterone replacement therapy in the future. I could go on and on but I’m sure I’ve made my point that if you have testosterone deficiency that it is of the utmost importance that you see a doctor who is an expert in testosterone replacement therapy.
Okay – but what would it cost for me to get expert testosterone replacement therapy from my PCP and get it covered by my insurance?
For the sake-of-argument – what would it actually cost for you to get expert testosterone replacement therapy from an in-network provider while using your health insurance? I’ll use myself with my own health insurance which I’ll have next year in 2020 as an example, assuming I went to another clinic that provides the same quality of medical care and customer service that Full Potential HRT Clinic provides.
The initial process of evaluation and discussion of my treatment options and getting started with treatment immediately would cost me about $1,800 in the first month which would all go towards my individual $5,000 deductible. After that it would cost me about $300 per month including ongoing office visits, medications, and blood tests which would all go towards my deductible for the first year. I would pay just over $5,000 for TRT during my first year of TRT, and then I would pay about $3,600 per year for TRT thereafter. This is why I used to charge patients $300 per month for the concierge testosterone replacement therapy program.
Everyone’s health insurance plan and health scenario is different and these differences will definitely affect these numbers for others, but in my case I would rather save $100 per month and have a much simpler interaction with a medical clinic and the whole billing process in general and go to Full Potential HRT Clinic to get expert medical care and more friendly and devoted customer service.
Over time I realized that I could charge less while working out-of-network with a cash / direct model and in 2016 I was able to lower the price for our patients to only $200 per month which is what we’ve been charging ever since. Knowing what I know as a doctor and successful small business owner with a degree in business finance and economics I made this a ridiculously good deal for my patients on purpose, while at the same time making sure it made great financial sense for my business. And we all lived happily ever after.
If you have any questions at all about any of this please call the clinic and we’re happy to answer them for you.