Endocrinology, Diabetes and Metabolism
Growth Hormone Therapy and Insurance: Frequently Asked Questions
Will my insurance cover growth hormone therapy for my child?
Growth hormone therapy needs insurance approval. Your treating physician must submit your child's medical records to your insurance carrier for review and approval.
Insurance carriers have specific policies about growth hormone coverage. They may not cover all FDA-approved medications for growth hormone therapy, despite your doctor's recommendations. Please check your policy for more details.
Certain insurance carriers limit the choice of growth hormone to certain preferred brands. This is regardless of the original brand prescribed by the physician. If you switch insurance carriers during growth hormone therapy, you will need new insurance approval.
How do I obtain insurance approval for growth hormone therapy for my child?
Our Division will file a request for growth hormone therapy with your insurance carrier. Growth hormone manufacturers have customer support services that also help with the approval and provide growth hormone for a certain period or until your case is approved. You will have to sign a release of information if we refer your case to a growth hormone customer support service representative.
How often do I need to obtain insurance approval?
Most insurance carriers require re-certification and re-approval on an annual basis. Our office will do these re-certifications by submitting the necessary medical documentation, such as medical notes, laboratory results or letters to your insurance carrier. Please let us know a month in advance when your case is coming up for re-certification.
What can I do if my child is denied growth hormone therapy?
You can appeal your insurance carrier's decision to deny growth hormone coverage. The Division of Endocrinology is not responsible for filing these appeals. Manufacturers' customer service departments offer great assistance in this process. It is the parents' responsibility to conduct and oversee the appeals process, such as making sure that papers are filed on time.
During appeals, our office will provide you or the designated customer service representative that you authorize, the necessary medical documentation, such as medical notes, laboratory results or letters.
Staying in touch with the customer service representative about details of your case (i.e., denial letters, status of your application or pending paperwork) is very important.
Growth hormone companies may provide free growth hormone supplies during the period that your case is being reviewed. If so, during this time, growth hormone will be requested through the manufacturers' customer service department and shipped to your home by contracted pharmacies.
Some companies continue to provide growth hormone at a reduced price after an insurance denial based on individual cases and financial qualifications. Please check with your customer service representative for how long you are entitled to free growth hormone and what the subsequent cost will be for you.
Growth hormone therapy has been approved. What do I need to do now?
Insurance carriers contract with specific mail-in pharmacies. Once growth hormone therapy is approved, supplies will be shipped directly to your home. Your mail-in pharmacy may change from year to year based on your insurance contracts. You need to provide the Komansky Center with your current pharmacy name and fax number during each visit. We will fax a prescription to your pharmacy at the end of the visit. Please note if the pharmacy name is incorrect, this may result in delays or interruptions of your child's treatment. Growth hormone supplies are usually dispensed monthly. Please become familiar with your pharmacist. You may need to notify your pharmacy ahead of time that your supplies are low and arrange for new shipment. This is important to avoid interruptions of your child's treatment.
