Insurance Company Does Not Want To Pay For HGH

  • Posted by a hidden member.
    Log in to view his profile

    Mar 06, 2009 6:31 AM GMT
    So, my doctor went and prescribed rhGH for me, as my IGF-1 levels were very low, per a stimulation test (it took forever).

    I went to fill the Rx and was told it required pre-authorization. Okay, whatever.

    The pharmacy calls me the next day and tells me that the authorization was denied.

    I call my doctor, who calls my insurance company, and they send an auth form to fill out.

    My doctor filled it out and sent it in, and despite meeting the criteria they set forth, it's denied again!

    So, I'm about to file an appeal.

    Has anyone had a similar experience?

    Am I wasting my time?


    I detest most insurance companies.
  • Posted by a hidden member.
    Log in to view his profile

    Mar 06, 2009 9:12 AM GMT
    So many posters posting only once in the last week with nothing in their profile asking all sorts of questions. Makes me think they are the same person for some reason...

    But to answer your question. Insurance companies don't want to pay for anything. They are a business and want money and they definitely don't want you cured.
  • Posted by a hidden member.
    Log in to view his profile

    Mar 06, 2009 11:49 AM GMT
    Actual human growth hormone is an injectable and can cost 500 to 1000 dollars a month. True deficiencies occur from damage to the pituitary gland such as tumor, radiation and certain diseases. It can also be congenital as in certain forms of dwarfism. An insurance company should have no problem paying for HGH, if used for an accepted medical purpose. If you want to take it to prevent aging that is another issue. HGH is not yet accepted by mainstream medicine as being beneficial for aging. It is doubtful that any insurance company would pay for it to be used only as an aging aid. A low HGH level may not be a bad thing. Males with naturally high levels of HCG have more prostate cancer and shorter life spans than individuals with low levels. The same occurs with women and breast cancer. In one of the few clinical studies done on healthy older individuals that included women, significant side effects occurred. One third or more of the treated participants developed carpal tunnel syndrome, swelling (edema) and joint pain. Twice as many men on HGH developed pre-diabetes or diabetes as compared to those not treated.
    If one wants to use HGH to increase muscle mass, reduce body fat and lessen skin wrinkles, he needs to weigh the benefits against the complications and cost. You need a prescription for HGH. Since HGH is a protein it would be digested before entering the blood stream. Like insulin, an oral form is not available. If everyone over the age of forty took HCG to slow the aging process, the health system would go bankrupt. Your health insurance premiums would soar to cover the cost. I think the money could be better spend for HIV treatments and other devastating diseases.
  • Posted by a hidden member.
    Log in to view his profile

    Mar 06, 2009 2:56 PM GMT

    In my experience, you are not wasting your time. If there is a medically sound reason to be prescribed an expensive treatment, and your doctor is willing to stand behind his/her decision, you will usually prevail. I;m not sure where you live but in some states (e.g. Massachusetts where my business buys health insurance), there is a state appeals board which tends to be pretty tough on insurers.
  • Posted by a hidden member.
    Log in to view his profile

    Mar 06, 2009 5:17 PM GMT
    growingbig saidSo many posters posting only once in the last week with nothing in their profile asking all sorts of questions. Makes me think they are the same person for some reason...

    But to answer your question. Insurance companies don't want to pay for anything. They are a business and want money and they definitely don't want you cured.


    You're free to make all the assumption you want. Most of us are familiar with the saying about assumptions. FYI, this is the first time I've ever come across these forums and the very first time I've ever registered or posted a single thing here.

    Maybe something in your prior experiences tends to make you automatically suspicious of most things.,

    To the other posters that responded, thank you for your feedback.

    And yes, we are appealing the decision yet again. Part of the reason I posted this is I was hoping to get some sort of sense that's it a worthwhile expenditure of time and energy, and so far, you make it appear to be so indeed.

    Thank you.

  • Mikeylikesit

    Posts: 1021

    Mar 06, 2009 5:23 PM GMT
    I've had the same thing happen to Cholesteroil medication. I can not take any Statin drugs. The insurance company denied my claim also.

    Now i'm tring an alternative route....see if it works.......icon_evil.gif

    I would suggest take your script and get it from Canada, Its a hell of alot cheaper & same crap......lol
  • Posted by a hidden member.
    Log in to view his profile

    Mar 06, 2009 5:37 PM GMT
    Have you tried taking GABA, an OTC supplement before bed? Several studies have shown that this can result in a signficant increase in HGH release. I have no idea about the cause of your low HGH release and whether or not it would work in your case, but it would be worth looking into, at least until you get something done with the insurance company.
  • Posted by a hidden member.
    Log in to view his profile

    Mar 07, 2009 9:06 AM GMT
    Mikey, I've checked into the Canada route, because I have a friend who's a health care professional in Toronto, and he basically told me it's even more difficult to get Canadian approval for, through private insurers (yes, there are private insurers in Canada), and especially via the national health care service (where you have to be a citizen and coverage for prescription meds is not so generous).


    Yng, you are correct. GABA, DHEA and Linoleic acid all encourage natural GH production, and I've looked into taking them.

    SARM (Selective Androgen Receptor Modulator) can be purchased OTC, and it's a secretagogue that encourages both tesosterone and GH production.

    Thanks to everyone for their helpful responses.

    I'll know soon enough whether my insurer is going to cover this expensive protocol or not.
  • kinetic

    Posts: 1125

    Mar 07, 2009 9:14 AM GMT
    Um, not to sound rude but why would you think your insurance would cover HGH at your age? Is there a serious medical need for it?
    If there isn't and the end result is something aesthetic, then I'm not at all surprised. Again, really not trying to be rude! icon_confused.gif
  • Posted by a hidden member.
    Log in to view his profile

    Mar 07, 2009 12:01 PM GMT
    Hey Razzles...I'm curious about the secretagogues for growth hormone. Do they stand up to scientific scrutiny? When I Google the topic, all I can find are articles from web sites selling the stuff. There is a lot of bias here since they make money when you purchase it. What they sell are supplements not certified by FDA as effective. I'm not saying they don't work. I just want some scientific evidence before spending money. I did find one VA hospital study that found ghrelin taken orally will increase growth hormone levels . Is ghrelin available over the counter? I know that arginine given intravenously will increase HGH levels (endocrinologist use this as a test to measure pituitary function). Does it work when given orally? Thanks ahead of time for any science supported information you can supply. You appear very knowledgeable on this topic.

    These were the stimulators of HGH release that I could find
    * growth hormone releasing hormone (GHRH) from the arcuate nucleus
    * ghrelin
    * sleep
    * exercise
    * low levels of blood sugar (hypoglycemia)
    * dietary protein
    * arginine
  • Posted by a hidden member.
    Log in to view his profile

    Mar 07, 2009 9:47 PM GMT
    kinetic saidUm, not to sound rude but why would you think your insurance would cover HGH at your age? Is there a serious medical need for it?
    If there isn't and the end result is something aesthetic, then I'm not at all surprised. Again, really not trying to be rude! icon_confused.gif


    I am not HIV/AIDs +, in which case I'd be covered for wasting symptoms.

    But I am 6'1, and weigh 168, and was getting some abnormal lipid profiles, despite being slender and nearly a vegetarian.

    My doctor decided to do a full physical with full blood panels, and my IGF-1, TSH, LH, testosterone all came back abnormal.

    One of the common side effects of having abnormal pituitary gland function, whereby not enough GH is produced, are abnormal lipid profiles.

    So, he sent me to an endocrinologist to confirm everything, who ran more tests, including a GH stimulating test that took 1/2 a day, and he confirmed the pituitary gland malfunction diagnosis, and recommended recombinant human growth hormone injections.

    I run, I played soccer in high school and college, and eat very sensibly, but my lack of energy the last couple of years along with my abnormal lipid profile despite my good diet (lots of clean food, vegetables), was the warning sign.
  • Posted by a hidden member.
    Log in to view his profile

    Mar 07, 2009 9:50 PM GMT
    kneedraggen saidHey Razzles...I'm curious about the secretagogues for growth hormone. Do they stand up to scientific scrutiny? When I Google the topic, all I can find are articles from web sites selling the stuff. There is a lot of bias here since they make money when you purchase it. What they sell are supplements not certified by FDA as effective. I'm not saying they don't work. I just want some scientific evidence before spending money. I did find one VA hospital study that found ghrelin taken orally will increase growth hormone levels . Is ghrelin available over the counter? I know that arginine given intravenously will increase HGH levels (endocrinologist use this as a test to measure pituitary function). Does it work when given orally? Thanks ahead of time for any science supported information you can supply. You appear very knowledgeable on this topic.

    These were the stimulators of HGH release that I could find
    * growth hormone releasing hormone (GHRH) from the arcuate nucleus
    * ghrelin
    * sleep
    * exercise
    * low levels of blood sugar (hypoglycemia)
    * dietary protein
    * arginine


    I just started looking into them, to be honest.

    SARM seems to be the newest one, and has sort of replaced tesamorelin and sermorelin as the flavor of the day, as far I can tell.
  • Posted by a hidden member.
    Log in to view his profile

    Mar 07, 2009 10:06 PM GMT
    Razzles1 saidMikey, I've checked into the Canada route, because I have a friend who's a health care professional in Toronto, and he basically told me it's even more difficult to get Canadian approval for, through private insurers (yes, there are private insurers in Canada), and especially via the national health care service (where you have to be a citizen and coverage for prescription meds is not so generous).


    Yng, you are correct. GABA, DHEA and Linoleic acid all encourage natural GH production, and I've looked into taking them.

    SARM (Selective Androgen Receptor Modulator) can be purchased OTC, and it's a secretagogue that encourages both tesosterone and GH production.

    Thanks to everyone for their helpful responses.

    I'll know soon enough whether my insurer is going to cover this expensive protocol or not.


    Yes there are private insurers here that augment the provincial programs that are in place. Most of these are part and parcel of a person's employment package.

    In a lot of cases, Phx companies will comp drugs that are deemed experimental or not approved for treating a particular disorder. I have personal experience with this and here, if your Dr goes the extra mile, you get what you need.
  • Posted by a hidden member.
    Log in to view his profile

    Mar 27, 2009 7:08 PM GMT
    Insurance company is going to have a decision in 5-7 days for me.

    If it goes through in my favor, the monthly co-pay will be $35 per month.