Let’s Start The Conversation...
Preventing Menopause
For ourselves… for our daughters… for our granddaughters
Let’s start by talking
about insurance coverage. Often insurance policies will not cover menopause or the hormone prescriptions to treat it because menopause is listed as a normal physical condition for a woman after age 40. If the insurance company were to use only medical terms to describe menopause they would be unlikely to deny coverage. At any age, menopause creates a medical condition called hypogonadism (hi-po-gonad-ism). From a medical standpoint, there is nothing normal about hypogonadism and there is no medical reason not to treat it.
By definition, hypogonadism
is the medical condition created by lower than normal levels of sex hormones. Hypogonadism begins as the ovaries start to fail (peri-menopause) and continues after they have completely failed (menopause). The symptoms of menopause are the symptoms of hypogonadism. There is not one medical text that says having lower than normal levels of sex hormones is normal for an adult of any age. So if hypogonadism (the medical term for menopause) is not normal, why is its treatment generally not covered by insurance, and what can you do to get it covered?
Your insurance company
covers illness. Menopause is not considered an illness. However, when you describe menopause medically as hypogonadism it is generally covered by insurance! Medically speaking, menopause
and hypogonadism are the same thing, so forget the words menopause and peri-menopause when you go to see the doctor and you bill your insurance. If your insurance company covers hypogonadism as an illness for men it must also cover hypogonadism as an illness for women. Remember there is not one medical text that would say hypogonadism is normal for any adult at any age.
I, like many, many other
women, have been denied insurance coverage for the prescriptions I needed to treat the symptoms of hypogonadism. When I went to my doctor I complained of low sexual function and that is how it was billed. Because my insurance company did not cover treatment for low sexual function I was denied coverage. I fought back and wrote this letter to my insurance company. A couple of days later I received a letter that said upon review my prescriptions would be a covered benefit.
To Whom It May Concern:
My name is Beth Rosenshein and I a requesting a reversal of the denial of my claim. As I understand it, my claim is being denied because it has to do with treatment of low sexual function. Our policy does not cover the treatment of sexual dysfunction per se however it does cover treatment for ovarian failure (menopause). It is my understanding that our policy also covers treatment related to organ failure. Ovarian failure is organ failure and the loss of sexual function is an expected outcome. My symptoms
are a direct result of organ failure resulting in hypogonadism, which is covered on our plan. Therefore, I am requesting a reversal of the denial of my claim as hypogonadism is a covered diagnosis for women and men.
Thank you for considering my request.
So forget the word
menopause and you will likely get insurance coverage. Your insurance company recognizes hypogonadism as a very real and very unhealthy medical condition in men. This is because hypogonadism also affects men with the very same symptoms; hot flashes, profound loss of sexual function, sleep problems, depression, etc. As a woman ‘in menopause’ you have the very same condition and are entitled to the same insurance benefits. All of the symptoms of hypogonadism are the same for women and men.
So the next time you go
to the doctor for relief of your symptoms ask your doctor to use the medically correct words to describe why you are there. The symptoms of hypogonadism are very real and very unhealthy and your insurance company knows it. Also, ask your doctor to circle hypogonadism as a diagnosis instead of menopause. Remember there is nothing normal about organ failure!
In short, replace the word menopause with hypogonadism. By doing this simple thing you are empowering your doctor to medically treat a very real ailment and at the same time you get the relief and improved health you deserve.