Bio-identical Hormones: FAQ
There are so many places advertising BHRT. How do I make sense of all the choices?
The amount of information regarding BHRT can be overwhelming. Today's educated patient spends a great deal of time researching BHRT before they step foot in our office. We are glad they have done their homework!
You can go to our recommended reading list for this information. Based on our experience, we feel we can reach and sustain optimal hormone levels consistently through creams, troches, pellets and oral progesterone.
I understand treatment options for BHRT, but how do I choose a provider?
First, a patient must understand that there are two primary ways for physicians or clinic to deliver BHRT. The first, and most common, is the cash-for-service model. The other is the traditional insurance model (insurance reimbursement for the office visit and lab work). We primarily operate under the insurance model in an effort to alleviate a significant portion of the cost to our patients.
Why do we treat BHRT under the insurance model instead of the cash-for-service model?
First, we are a gynecology office specializing in women's health. BHRT is a natural extension of what we were trained to do. Many BHRT practitioners or clinics are classically trained in other medical specialties like family practice, internal medicine, emergency medicine or pharmacy. Our experience has shown that these practitioners are well suited to handle BHRT. The difference is we specialize in treating all areas of women's health through traditional medicine and hormones, as well as through BHRT. It is this comprehensive approach to women's health that often includes related GYN issues that sets us apart. We are prepared to take care of all your needs, such as birth control, evaluation/treatment of menstrual disorders, incontinence, prolapse, vaginal infections and pap smears. Frankly, we would be talking out of both sides of our mouth if we treated our GYN patients with their insurance while at the same time asking them to go out-of-network and pay a significant cost out of pocket to treat with BHRT.
Second, patients recognize there can be a significant out-of-pocket cost difference between the two models. Patients tell us that their out-of-pocket costs can be several hundred dollars less through our office. From a comprehensive perspective, we believe it is the right thing to do for our patients.
With that being said, we believe the main reason that practitioners choose the cash-for-service model over the insurance model is a simple matter of business survival. Evaluation and treatment of hormones is a time consuming process! Office visits and lab results require significantly more time by the practitioner than the traditional annual wellness exam. It is not uncommon for our typical BHRT patient to have multiple office visits, each lasting 30 minutes or longer. It is a challenge for a practitioner to be an in-network insurance provider and provide the time necessary to provide the level of care that patients deserve when being treated with bioidentical hormones. Cash-for-service providers can more easily factor their time commitment into the fee structure.
Considering the challenges of being an in-network BHRT provider, how do you make it work?
The answer here is simple. Our BHRT program is primarily administered by our mid-level practitioners. Mid-level practitioners are commonly known to patients as Physician Assistants, Nurse Practitioners, or Mid-wives. Dr. Brenner spends a significant portion of her time in surgery and, therefore, is constrained in providing the proper amount of time required with the typical BHRT patient. Our BHRT appointments are scheduled with the practitioner in 30-minute increments to allow for an adequate amount of face-to-face time.
Can I see the doctor exclusively for BHRT?
Some patients just want to see the doctor. We get it. We don't take it personally. While we try to do everything we can to accommodate our patients, we know we cannot consistently grant this request. If cost is not a concern and you desire consistent physician handling of your BHRT, a cash-for-service provider may be a great solutions for you. We will be happy to recommend local practitioners that we enjoy working with.
So what types of costs am I looking at to achieve hormone balance?
There is not a charge other than your deductible/copay for the office visits. Your visit will be billed to your insurance company. If you do not have insurance, the office visit is what a typical insurance company reimburses for a new or established patient visit. Blood tests are also billed to your insurance company and deductibles/copays apply. Most patients opt for saliva testing of estrogen, progesterone, testosterone and cortisol. Hormone testing can be performed with blood testing but we believe that this is not an accurate assessment of your overall hormone levels. Therefore, we recommend saliva testing. Insurance carriers view saliva testing as experimental in nature and, therefore, do not cover this test. However, there are exceptions, and your insurance carrier may be different. We will let you know at your appointment if your insurance carrier is the exception to this rule. Saliva testing generally represents a $263 cost. Testing is performed before therapy is initiated and then approximately every six months thereafter. If we are unable to manage dosing based on symptoms, then more frequent testing may be required.
Office Visit: $125/one-hour consultation
Supplements for Adrenal Dysfunction
$150-$250 per month
Bioidentical Hormones Compounded Rx
$60-$70 per month
Pellet and Bloodwork Testing
Cortisol/Adrenal Saliva Test
Repeated in 6-12 months
Sex Steroid Saliva Test
Needed 1-2 times a year to assess
Repeated to assess response
GI Pathogen Test
(Insurance may cover a portion)
How do I get started?
Simply call the office at 513-777-0787 for your initial consultation. Your appointment will be scheduled with one of our mid-level practitioners. You will be asked to enter your medical history online via the DigiChart secure patient portal.
What happens at the first appointment?
Our mid-level practitioner will review your medical history and perform a physical exam, when indicated. She will then discuss which tests are indicated based on your age, symptoms, history and exam. Many of the common symptoms can be due to the sex steroid (estrogens, progesterone, testosterone), thyroid, cortisol imbalance or vitamin/nutritional deficiency. The only way to know which is the culprit for your particular symptoms is to test. Thyroid studies (free T3, free T4, TSH, antithyroglobulin antibodies, thyroid peroxidase antibodies), iron levels. Vitamin D, Vitamin B12, insulin, lipid panel, NMR lipoprotein panel, hemoglobin A1C are all tests that are performed with blood tests. A patient needs to be fasting for a full evaluation. We will discuss testing hormones via bloodwork if we decide pellet therapy may be best for you. We will draw your blood or have you return fasting for these tests. These results return in three weeks and you will be able to view your results online through the DigiChart patient portal. Our practitioners will review your results at the follow-up visit to explain the results.
Estrogens, progesterone, testosterone, DHEA and cortisol levels are checked with a saliva kit. You will be given the saliva test kit at the first appointment. The results are available three weeks after you send in your kit.
How do I collect a saliva sample? View Video Here
What happens at the second appointment?
The second appointment is made for 3-4 weeks later to review the blood and saliva tests and discuss your individualized treatment plan. This visit lasts about 30 minutes with our mid-level provider.
Are my visits with Dr. Brenner?
Our BHRT practice is run by our mid-level providers. Customized dosing and testing of hormones is a time-consuming process. The office visits are extensive and we want to be able to spend the appropriate amount of time with you. In order to continue in an insurance-based practice, our BHRT patients see the mid-level providers. Dr. Brenner is always available to them, should the need arise.
What is a compounding pharmacy?
A compounding pharmacy is the oldest type of pharmacy in the world: an apothecary with a pharmacist trained in formulating prescriptions on the order of a physician. This allows for a customized dosage strength made just for you. We work with several compounding pharmacies in the area:
Hills Compounding Pharmacy
Biomed Specialty Pharmacy
I already went through menopause? Do I need bioidentical hormones?
You may be done with menopause, but you are never done with hormones. If you have any symptoms such as hot flushes, night sweats, decreased libido, fatigue, insomnia, inability to lose weight, or mood symptoms, you may benefit from BHRT.
Do you treat men?
No. We specialize in gynecology and women's health care.
How long will I be on BHRT?
As long as you want to experience the benefits of hormonal balance. With cessation of therapy, original symptoms will return.
Will you prescribe vitamins and supplements?
Absolutely! BHRT is only one piece of the puzzle for optimal health. We will recommend foundational supplements (multivitamins, Omega 3's, and probiotics) for everyone. Additional supplements such as iron, B vitamins, Vitamin D and adrenal support vitamins are used only based upon individual testing and needs.
Dr. Brenner, MD & Associates - Women's Health Care and Gynecology - is pleased to serve patients from the following towns: Anderson, Blue Ash, Cincinnati, Fairfield, Finneytown, Hamilton, Harrison, Hyde Park, Indian Hill, Landen, Lebanon, Liberty Township, Loveland, Madeira, Mariemont, Mason, Middletown, Milford, Monroe, Montgomery, Norwood, Sharonville, Springboro, Trenton, West Chester.