If you’ve tried unsuccessfully how to get health insurance to cover human growth hormone (HGH) treatments, you can still appeal. However, you should research the policies of your insurance company and state’s laws to determine if you can receive coverage for HGH.
How To Get Health Insurance To Cover Human Growth Hormone Treatments
Change The Diagnosis To Growth Hormone Deficiency – Adult
During a routine medical and medicaid checkup, a doctor may make a change in the diagnosis to human growth hormone deficiency – adult. A doctor might use an MRI scan to see whether the patient’s tumor has affected the production of growth hormone. The MRI may be used to monitor the treatment of the tumor. If growth hormone levels are low, the doctor may order a therapy for human growth hormone deficiency.
In adults, growth hormone deficiency may be caused by a childhood process or be an acquired condition. The most common form of growth hormone deficiency is known as idiopathic. Some childhood causes are developmental defects of the pituitary gland, genetic abnormalities affecting growth hormone production, or damage to the pituitary area due to surgery or irradiation. Most often, however, growth hormone deficiency in adults is caused by tumors in the hypothalamus or pituitary gland.
The deficiency in growth hormone in adults can affect the levels of cholesterol and glucose in the blood. A deficiency of this hormone leads to an overall increase in cholesterol levels, and the level of “good” cholesterol (HDL cholesterol) is reduced. In addition, an increased risk of developing cardiovascular disease and central fat deposition is associated with the condition. Fortunately, growth hormone replacement can alleviate these symptoms. And since adult growth hormone replacement is often lifelong, it is best to consider lifelong growth hormone therapy.
Request That Your Doctor’s Office Send An Appeal
A denial of growth hormone therapy is not the final word. There are numerous reasons for a denial and some may be automatic. However, if your plan has denied coverage for growth hormone therapy, you can request that your physician’s office send an appeal. This appeal is part of the normal work in a healthcare office, and it may take some time. However, there are also second-level appeals and peer-to-peer review procedures for those who have been denied.
Once your physician has completed the appeal, he or she will notify you and ask you to submit any additional information. Additional information will not be considered once the appeal has been made. You should know that you have up to three appeals to get your insurance program to cover the treatment, so it is important to review the guidelines of your insurance plan and state laws before filing one.
Appeal The Denial
Appeals for human growth hormone therapy can be challenging, but they are certainly not impossible in states. You should know that every denial has a specific reason, and some are automatic. Your appeal should be detailed, address specific areas of the denial, and state the reasons for your approval. Once the denial is made, the appeal goes before a review committee, which makes its decision based on the information that you provide.
Health insurance services will usually cover growth hormone treatment if it is deemed medically necessary, but some will deny coverage for off-label use. This is because the FDA only approves drugs, not how they are prescribed. Therefore, growth hormone is an expensive drug, and insurance companies don’t want to pay out of pocket for it. Hence, patients can appeal the denial to get health insurance programs to cover human growth hormone.
The number of prescriptions of growth hormone among U.S. youth increased from 5.1 per 10,000 beneficiaries under age 18 in 2001 to 14.6 in 2016. However, insurers’ restrictions on growth hormone coverage have lowered the total cost of treatment, but the savings have not been passed on to the patients. The potential costs for treating idiopathic short stature is $40 billion, and it’s estimated that about 1.2 percent of U.S. children have this condition.
How to get health insurance to cover human growth? In conclusion, HGH may be covered in family health insurance if you select it in your insurance plan. Provided you have any questions or need our assistance about this, search on our website. Many new articles are posted every day.