What is growth hormone testing?
Very little growth hormone is typically made during the daytime. Therefore, we must provoke the body to release growth hormone by giving medications. Levels of growth hormone are periodically measured during the testing to determine the body’s response to these agents, and determine if growth hormone levels are appropriate (or deficient).
Scheduling the test and Insurance Benefits for testing:
- The front office staff will do the following:
- Verify benefits for the testing (including the office visit, collection of blood samples, medications given). There is no one “procedure code” for the test. Therefore, the insurance company will NOT tell us what it will pay until we submit the claim; we will only get an estimate. We do this as a courtesy, and it is ultimately your responsibility to know your benefits.
- You will be responsible for paying a portion or the full amount of the test due to copay, coinsurance, or deductible. That amount will be collected prior to the testing. Once the claim has been submitted any remaining amount will be due.
- The cost of the lab processing is a separate cost that will be billed by the lab (LabCorp or Quest) that runs the assay.
- Once insurance benefits are verified, we will call you to schedule the test. The test will be scheduled when your portion of the cost of the testing has been paid. We will attempt to call you twice to schedule the testing. If we are unable to reach you, we will assume you no longer want the testing or it will be done at another Endocrinology office. If you still want the testing after 2 phone calls, it will be your responsibility to call the office to schedule the appointment.
Preparations for the test:
The following preparations will ensure that the test will be as easy as possible to complete and that the results will be accurate.
- One week prior to test:
- Stay hydrated – drink 6-8 glasses of water/fluids per day and continue this until the night before the test. This will make it much easier to place the IV. During the summer months, please add even more fluid to this amount if your child is active outside and perspiring.
- EAT LOTS OF CARBOHYDRATES – (including cereals, breads, pastas, starchy vegetables, fruits, and fruit juices)
- No caffeine – No caffeine the week before testing.
- The evening prior to test:
Have a large bedtime snack around 10 PM and nothing to eat after midnight.
- The morning of test:
- The patient may brush teeth and drink plain water, but NOTHING TO EAT!! Please bring a lunch/snack for your child to eat after the test. They will be hungry and may need it after several blood draws.
- If the patient takes any medications in the morning, please check with the doctor or nurse prior to the test date. ADD/ADHD medications are okay and encouraged the morning of the test.
- Due to the small testing room, only parents may accompany your child. Siblings cannot be accommodated. Don’t forget to bring a snack!
The Actual Test: Growth Hormone Stimulation Testing and Preparation
- Testing for growth hormone deficiency is done in our office and will last 3-4hrs. An adult must accompany the child. Please bring books, a DVD player, or other sources of entertainment. We provide Wi-Fi access.
- An IV will be inserted from which multiple blood samples will be drawn at specified times. These samples (drawn at least 5 times over a 3 hour period) will measure the growth hormone levels in response to two medications. The first agent is an oral medication. The second agent will be administered by injection into the muscle. These agents are generally well tolerated, but can be associated with a brief period of nausea.
- When the test is complete, the snack you bring may be given to your child.
- Once the test is complete, you will make a follow-up appointment in 2-4 weeks with the front desk to review test results. Test results will not be given over the phone.
Follow up visit to review results:
- If test results indicate that your child is growth hormone deficient, we will discuss the risks and benefits of growth hormone supplementation. If you feel it is in your child’s best interest to be treated with growth hormone, we will begin assembling the medical records necessary to request growth hormone approval from your insurance company.
- In addition, if your child is growth hormone deficient we will order an MRI to evaluate the part of the brain that produces growth hormone. The MRI must be performed prior to submitting the complete application for growth hormone to your insurance. The MRI may require precertification by your insurance company.
GROWTH HORMONE APPROVAL
Initial growth hormone prescription:
- If the results of testing indicate that your child is growth hormone deficient, the physician will submit a prescription for growth hormone to a specialty pharmacy that can dispense growth hormone. Medical records will be submitted to your insurance company for medical review in order to obtain approval for growth hormone coverage.
- The medical review process may take up to 90 days for approval, depending on your particular insurance plan. If the growth hormone is denied, the appeal process can take another 6 months. The brand of growth hormone that will be prescribed, the length of time required for the medical review process, and the pharmacy that will dispense the growth hormone are determined by your insurance company and not up to your physician.
After growth hormone approval:
- You may need to fill out paperwork and register with the mail order pharmacy. You must be there to sign for shipment (drug requires refrigeration).
- Growth hormone is administered by injection every night before bed. Teaching on proper administration of growth hormone can be done by your dispensing pharmacy, drug manufacturer, or can be done at our office. If you wish us to teach you how to administer growth hormone, you must schedule an appointment and your child must be present for the teaching.
Remember, this is a lengthy process. Your child will not be started on growth hormone until all of these procedures have been completed. Please be patient!
Determination of Growth Hormone Coverage
Regardless of the results of growth hormone testing, your insurance company may decide not to approve growth hormone for your child. Your physician will do his/her best to explain to your insurance why growth hormone is a medically necessary intervention for your child, but this does not guarantee coverage for growth hormone.
We request that you personally contact your insurance company to determine if growth hormone is a covered benefit. Your insurance may direct you to your PBM – pharmacy benefit manager (the particular pharmacy that will dispense the growth hormone). If they request diagnosis codes (ICD-9 codes), please offer the code below that best applies to your child. Please circle below the preferred brand(s) of growth hormone and circle or note the preferred pharmacy that will dispense the growth hormone. Bring this information to your stimulation testing.
Questions for Insurance:
- Are self-injectable drugs covered?
- If so, is growth hormone covered?
- Circle the formulary preferred brand(s) on right.
- Is it covered by pharmacy benefits or major medical?
- If it is covered under major medical, what are the benefits:
- Out of pocket?:
- Annual cap?:
- If it’s covered under pharmacy benefits, what are the benefits:
- Flat copay or percentage covered?:
- Annual cap?:
- If it is covered under major medical, what are the benefits:
- Where must patient obtain growth hormone? Does growth hormone have to be obtained from a specialty pharmacy (PBM) or can growth hormone be obtained through local pharmacy?
- If specialty pharmacy, please circle or note on right.
- .Who does the authorization (PBM, major medical, other) and what is their contact information?
DIAGNOSIS CODES (ICD-9 CODES)
253.3 (Growth Hormone Deficiency)
758.6 (Turner Syndrome)
GENERIC: SOMATROPIN (J2941)
PBM (SPECIALTY PHARMACY)
Aetna Specialty Pharmacy
Cigna Specialty Pharmacy
Please remember it is a long process, often times frustrating, to get growth hormone approval from your insurance company. If your benefits change at any time during the process, or after growth hormone is approved, this process MUST be started over. We must be a team and work together. Not being supportive or courteous to our support staff is unacceptable. They care deeply about your child and are working hard to obtain growth hormone coverage. Feel free to call and check in every 4 weeks to get an update on the process. You should receive notification by mail from your insurance as we receive it by fax.