Looking at your website I am unclear what you folks mean by “We are able to offer the prices we do because we do not work with insurance companies. You will not find a normal doctor who does & will provide the same service we do at this cost. If you have insurance & would like to try to use it for your medication, we can have your local pharmacy fill your plan & you will be able to work with them.” Does this mean you would write a script and patient could then purchase test from local pharmacy ? If so what are monthly costs for this arrangement? Please elaborate on this FAQ item from your site.

AlphaMD's Answer

This is an incredibly complex topic, so I am going to list some articles in an effort for you to get the basics of the health insurance industry in the US.

Article 1

Article 2

Article 3

The most important things to know about the health insurance industry are:

1. Prices for services are negotiated between a healthcare provider and the health insurance company. You, the patient, do not get to be involved in that negotiation.
2. Once a price has been settled on in those negotiations, it is a "contracted rate", meaning, the medical provider is under contract to charge the price that was agreed upon.
3. It is considered breach of contract to charge a different rate to someone with health insurance. This means it is illegal in the United States to provide a discount to a patient. Practices can be fined and there are currently doctors in jail today for providing discounts and not collecting co-pays.
4. Insurance companies, believe it or not, encourage medical providers to charge higher prices. The reason for this seems counter-intuitive. After all, why would the insurance company want to pay more? Health insurance is like going to an all you can eat buffet where the more you eat, the more money the restaurant loses. In this case, health insurance is the restaurant. Insurance charges $400-$800 a month per member and generates profits by minimizing losses aka reducing the amount of healthcare being used. Because the insurance company does not actually kick in until a deductible is met, and even after it is met, the insurance company only covers 80%, leaving you, the patient, on the hook for the additional 20%. Ultimately, health insurers know that the average American can't even afford their own deductible, so they are less likely to visit the doctor in the first place.
5. Most health insurance plans come with a deductible of $2000-$6000. According to a study by the American Action Forum, 80%-90% of Americans will never reach their deductible. This means you are responsible for 100% out-of-pocket for most services in a given year. All while you pay your monthly premium.

So, to sum all that up, it is ILLEGAL for a medical practice to give a discount to someone with health insurance. Medical practices are expected and even encouraged to increase their prices when they partner with health insurers. You, the patient, are cut out of the payment process despite the fact that 90% of Americans pay 100% of the cost of their medical care without their insurers paying a single dime.

Also, perhaps the most important aspect of why we do not partner with health insurers; the health insurer gets to decide whether or not they will cover a treatment. The treatment protocols for hypogonadism are outdated and exclude most men who actually need this treatment. You need to read this article about Cigna and how they deny hundreds of claims a second without even having a real person review their case.

Alpha MD does not want to be a part of this corrupt and immoral system. We work one on one with patients. We determine whether or not they would benefit from TRT, and we dont have to ask permission of some AI algorithm made by some multibillion dollar corrupt health insurers to get them to cover TRT for a man whose level is 360, which is above the threshold on their protocols.