What if you could get some or most of your testosterone pellets covered by your insurance provider?
Over the past few weeks, we have been working closely with a handful of patients to get their testosterone treatment covered.
What we’ve discovered is many insurance providers will cover a significant portion of your treatment.
There are a few keys.
1. You need to get pre approval and authorization from your insurance provider.
2. Your provider will pay to you directly, after you have paid for your procedure. Our practice is not set up to receive payments from the insurance providers.
3. If you need documentation from the clinic, we will gladly provide the right paperwork, provided you qualify for treatment.
Take a look at the list below. If our staff can be of service to you, please call and ask for Chris Carlson.
Medical Claims Pre-Authorization & Claims Process (major carriers)
BCBSNC – Pellet Insertion Claim Process (CPT 11980)
- We need to call and verify Benefits Coverage for members – (Providers 888-333-8594; members 800-705-7050)
- Then call Utilization Mgmt @ (800) 672-7897
- Obtain a Prior-Authorization # for claim form
- Claim Form to be filled out by patient/provider and put the Prior-Auth code on it
- give customer an itemized receipt with Diagnosis & Treatment codes on it
- Submit form to BCBSNC per instructions along with itemized detailed receipt
- Blue Cross Blue Shield of North Carolina, PO Box 35, Durham, NC 27702
USHealth – Pellet Insertion Claim Process (CPT 11980)
- Determine if the Benefits are provided by Freedom Life or National Foundation Life
- Freedom Life – (800) 387-9027 to verify member’s benefits
- National Foundation Life – (800) 221-9039
- Or navigate to https://provider.ushealthgroup.com and verify member’s benefits
- Patient to submit a Claim Form & Itemized Bill with the proper diagnosis & treatment codes
- Patient is reimbursed an amount minus their co-pay portion for the procedure
Aetna – Pellet Insertion Claim Process (CPT 11980)
- Check Pre-certification website to verify coverage
- Aetna Pre-Certification instructions
- Bi-identical Testosterone is NOT on the Aetna list requiring pre-certification from reading the above documentation
- Fill out an electronic Claims Form
- Found here for Health Care Providers https://www.aetna.com/health-care-professionals/claims-payment-reimbursement/electronic-transaction-tools.html
- Found here for Members
Cigna – Pellet Insertion Claim Process (CPT 11980)
MEDICAL CLEARINGHOUSE — TELEPHONE NUMBER — WEBSITE
Change Healthcare (Formerly Emdeon) 877.469.3263 changehealthcare.com
OptumInsight 800.341.6141 optuminsight.com
Availity 800.282.4548 availity.com
Trizetto (Formerly Gateway EDI) 800.969.3666 gatewayedi.com