Does insurance cover growth hormone shots?

#BestBubby

Tue, Feb 13 2024, 11:30 pm

My DD took 9 y.o. grand DD to endocrinologist as
Grand DD is 1% percentile height.

endocrinologist said grand DD doesn't have a medical condition, so not eligible for growth hormone shots.

I thought if less than 3% on height, insurance would pay.

They are on Jersey Care.

Any information?

amother

Cerise

Tue, Feb 13 2024, 11:37 pm

We are covered with private insurance but we had to prove growth hormone deficiency.

amother

Cerise

Wed, Feb 14 2024, 12:14 am

You can pay out of pocket not get covered. We had to do a ton of tests a few them twice. It’s not a fun process to get approved.

amother

Cerise

Wed, Feb 14 2024, 1:43 am

Is this in Lakewood? Jersey shore hospital doctors? They really dragged the testing out there is more testing they can do to show more accurate results.

amother

Tangerine

Wed, Feb 14 2024, 1:47 pm

#BestBubby wrote:

Cerise, thank you for information.

Do you know name of more accurate test?

It's call a stim test, it's not a pleasant experience but it's the only way to accurately test growth hormone levels. She also should have had a bone scan.
Jersey Care does approve growth hormones for children without a GH deficiency but anyone I know who was approved in those cases had dropped to less than 1% and their bone scan wasn't showing a delay. Also many kids are denied first time around, you have a to have a doctor that helps appeal.

amother

Blush

Wed, Feb 14 2024, 1:47 pm

I would imagine that if she is not growth hormone deficiency then it is not medically indicated. Why would insurance pay for medication not medically indicated.

(Even if you want /believe it would help, insurance shouldn’t pay for it, just as they shouldn’t provide me with Ozempic if I am 35lb overweight with no co-morbidity)

TS22

Wed, Feb 14 2024, 1:47 pm

If she is not growth hormone deficient then the shots are not going to help at all.

amother

Blue

Wed, Feb 14 2024, 3:37 pm

TS22 wrote:

If she is not growth hormone deficient then the shots are not going to help at all.

Of course they can help. They can also help somebody who's projected to be 6 ft but wants to be even taller. I wouldn't recommend it but it will still work.

#BestBubby

Wed, Feb 14 2024, 4:22 pm

amother Tangerine wrote:

Thank you for the information.

Grand DD is 1% percentile and a year delay in bone growth.

I will check if they did a stimulus test.

#BestBubby

Wed, Feb 14 2024, 4:25 pm

TS22 wrote:

If she is not growth hormone deficient then the shots are not going to help at all.

The shots help Even if not deficient.

Parents whose kids had normal GH levels paid out of pocket and proved the shots helped.

I heard now insurance will pay if less than 3% percentile, but a poster said one has to be less than 1% percentile for height.

amother

Amber

Wed, Feb 14 2024, 5:01 pm

My 11 year old son isn't gh deficient not on the charts for his height doctor said he won't get approved. I'm looking for a second opinion . Anyone knows a doctor who would fight for insurance to cover?

amother

Tangerine

Wed, Feb 14 2024, 5:26 pm

#BestBubby wrote:

Thank you for the information.

Grand DD is 1% percentile and a year delay in bone growth.

I will check if they did a stimulus test.

A year delay is going to work against her for GH approval but it’s a good thing for a shorter child it means she’ll hopefully grow more than expected.

Bleemee

Wed, Feb 14 2024, 5:49 pm

amother Tangerine wrote:

A year delay is going to work against her for GH approval but it’s a good thing for a shorter child it means she’ll hopefully grow more than expected.

Can you please explain this?

amother

Foxglove

Wed, Feb 14 2024, 6:34 pm

As far as I know, In the UK they don't give GH to kids who aren't deficient because the risk of side effects outweighs the benefit.
Did she have any genetic tests done? Specifically SHOX micro deletion and and Russel silver syndrome. They cause short stature but normal growth hormone levels. Growth hormones have been proven to help. Also did she test for celiac? It can cause short stature as the only symptom. My son had this. We only found out due to his tiny size. But he is also growth hormone deficient.

amother

Amethyst

Wed, Feb 14 2024, 6:36 pm

amother Foxglove wrote:

How’d you find out? It’s a test?
No other uncomfortable symptoms from him?

amother

Tangerine

Wed, Feb 14 2024, 6:37 pm

Bleemee wrote:

Can you please explain this?

If she’s 9 but her bones are measuring as an 8 year old it means she will likely grow longer than the average 9 year old because her growth plates are scheduled to close at an older age.

amother

Foxglove

Wed, Feb 14 2024, 6:41 pm

amother Amethyst wrote:

How’d you find out? It’s a test?
No other uncomfortable symptoms from him?

No he never had stomach aches etc... He was just tiny. It's a simple blood test. Celiac is an autoimmune disease whereby the immune system attacks the gut when gluten is consumed. The gut gets damaged and cannot absorb enough nutrients to grow properly. Once you stop eating gluten and the antibodies go down, the gut can repair itself but it can take up to a few years to be fully healed.
And Btw nobody in mine or my husband's family has it. I didn't really know what it was...