Human growth hormone (HGH) is a hormone that is naturally produced by the pituitary gland. As we age, our HGH levels decline, which can lead to symptoms like decreased muscle mass, increased body fat, lower energy levels, and more.
Some people take synthetic HGH injections to try to counteract the effects of aging. However, HGH injections can be very expensive, often costing thousands of dollars per year without insurance.
Whether or not insurance covers HGH injections depends on several factors:
- The specific terms of your health insurance plan. Most plans do not cover HGH for anti-aging or athletic performance purposes. However, some plans may cover it for specific medical conditions.
- Your diagnosis. If you have been diagnosed with growth hormone deficiency or other conditions that cause low HGH, insurance may cover treatment. These diagnoses usually require confirmation with blood tests.
- Your age. If you are an adult with age-related HGH decline, insurance is less likely to cover treatment. Coverage is more common in children with legitimate growth or developmental issues tied to low HGH.
Some scenarios where insurance may cover HGH:
- Documented growth hormone deficiency in children and adults, confirmed by stimulated blood tests. This is an FDA-approved reason for HGH therapy.
- Short stature or growth failure in children. HGH can be used to treat genetic conditions or idiopathic short stature to help reach normal height.
- Chronic kidney disease resulting in low HGH levels. Replacing HGH may help reverse protein loss.
- HIV/AIDS wasting syndrome, where HGH helps combat significant weight loss.
- Short bowel syndrome, which can impair growth and development.
In contrast, reasons insurance typically does NOT cover HGH:
- Normal aging in adults. Age-related decline in HGH does not meet medical necessity criteria.
- Improving athletic performance, endurance, or muscle gain in healthy individuals. This is a non-approved use of HGH.
- Anti-aging purposes or to improve body composition in middle-aged or older adults.
The process for getting insurance coverage for HGH:
- Get evaluated by an endocrinologist or hormone specialist to document a legitimate medical need and deficiency of growth hormone.
- Undergo stimulated blood tests to confirm the hormone deficiency. Random blood tests are often inconclusive.
- If a true deficiency is found, the diagnosing doctor can write letters of medical necessity to submit to your insurance requesting prior authorization.
- Be prepared to try medications like somatostatin analogs first, before moving to more expensive HGH injections.
- Use an in-network specialty pharmacy approved by your insurer, to control medication costs.
At Vitality Hormone Clinic, we have extensive experience working with insurers to obtain coverage for medically appropriate HGH treatment. Our physicians will conduct thorough testing to determine if you have a treatable HGH deficiency before designing customized treatment plans utilizing high quality
Omnitrope® or Norditropin® brand bioidentical growth hormones. We handle prior authorizations and appeals to maximize insurance coverage on your behalf. Contact us today for a consultation to discuss your treatment options.
I hope this overview has helped explain the key factors in determining whether insurance plans will cover HGH therapy! Let me know if you have any other questions.