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Author Topic: will the affordable care act ( obamacare ) help make companies cover srs ?  (Read 4106 times)

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Offline angelfaced

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ive been reading and looking for the answer for like 3 hours and the whole thing is very confusing. It says that it will help transpeople gain health insurance but it doesnt define what that means in benefits. can someone explain this ? id be pretty pissed off if im forced to pay 3k a year in insurance but it isnt going to cover anything i actually need, like srs. i can pay for doctors and my 50 dollar a month perscriptions on my own.

Offline BillieTex

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Don't have an answer, i know now mine will not cover mammograms due to gender
Be true to yourself, even if no one else will...

Jamie D

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Don't have an answer, i know now mine will not cover mammograms due to gender

Regarding mammograms, have your doctor use the IDC code 611.1, gynecomastia.

Offline The Passage

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Regarding mammograms, have your doctor use the IDC code 611.1, gynecomastia.

What does that do, exactly? Force the insurance companies to insure mammograms for mtfs?
"Magic is just science we don't understand yet." - Arthur C. Clarke

Offline Joelene9

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  No, that code tells the insurance company that your chart says male and the gynecomastia is an actual condition that does happen in males and it is developed enough to require mammograms.  Gynecomastia occurs in adolescent males, but usually goes away.  But it occurs in males over 50 more often than not when their natural T levels goes down.  I should know, I was in a shower situation at a camping event with the other 55+ and my intentional B cups didn't stand out! 
  SRS, no.  It is considered an elective.  Only a few insurance policies may cover it, but those premiums are high and available to mainly the executive types in a corporate plan.  Even some of those coverages are victims of the cutbacks you read about.
  Joelene



Offline NekoKoNeko

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Quote
Pre-existing condition exclusions. Beginning in 2014, health insurance plans cannot refuse to cover you because you have a pre-existing condition, including because you are transgender. For people 18 years old and under, this protection is already in effect. Until 2014, the ACA provides for temporary pre-existing condition insurance plans (www.pcip.gov), which make health insurance available to people who have been denied insurance coverage due to a pre -existing condition and have been without health insurance for at least the last 6 months.

Can my insurance plan exclude coverage for transition-related care?
Your plan may exclude coverage for transition-related care in the fine print of your plan documents. An exclusion may be worded very broadly or may be worded narrowly to exclude only hormones and/or surgeries. There is currently no explicit federal legal requirement for group or individual insurance plans to cover transition-related care. While we are working to change this in the future, for now you should check your plan documentation.

http://transequality.org/Resources/HealthCareRight_March2012_FINAL.pdf (page 2, 3)

So, insurance companies cannot deny you general insurance coverage by saying you have a pre-existing condition (transgender), but they can specifically exclude coverage for transgender treatments (therapy, hormones, SRS, etc.) in your plan.  The AMA is putting pressure on insurance companies to cover transgender treatments, but until they do that, your insurance has to specifically include transgender treatments (you can find lists of companies that do include it) or you pay out of pocket.

Jamie D

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What does that do, exactly? Force the insurance companies to insure mammograms for mtfs?

If a policy contains a clause that disallows payments for transition-related expenses, using the gynecomastia diagnostic code, as a "hormonal imbalance," will often be approved.

Offline TheresaS179

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As the ACA begins to become more clear it would appear that it is a mixed bag for transgender individuals. This is what I believe to be accurate at this point, if anyone knows differently and can point to a reliable authority for better information please share. You often have to listen very carefully when promoters of the plan talk about it. There is a lot of "happy talk" about the ACA, but not a lot of clarity.

The Good:
Many transgender people have been blocked from getting coverage for pre and post transition related care, including blood tests, gender therapy, HRT, etc. These things should all be covered without any issues under ACA, since to fail to cover them would be discriminatory. Meaning if a modality of treatment is covered for any insured, then that same modality of treatment cannot be denied to a person just because they are transgender. For example, if an insurer covers psycho-therapy for other conditions, they will not be able to refuse to cover gender therapy, and if an insurer covers HRT for a menopausal CIS-Gendered woman, it will have to cover HRT for a TRANS woman.

The Bad:
Many large corporations with the better insurance plans have in recent years been increasingly signing up for the HRC CEI (Human Rights Campaign's Corporate Equality Index) standard which requires at least a $75k lifetime benefit for transition expenses, which can be used for SRS, FFS, and other transition expenses. In 2012 the HRC reported that 189 large employers were fully supporting these costs, and in 2013 that number grew to 254. The problem is that these tend to be the so-called "cadillac" health insurance plans, many of which are going to be dropped as a result of the increased expense under the ACA, forcing their employees into the ACA exchanges, and at this point the ACA has not committed to the HRC CEI coverage standards or anything close to it. My employer has already announced that we will be losing our current very generous health insurance in 2015 when the deferred employer mandates kick in. If you were to hire on to a company who currently does support the HRC CEI, hoping to get FFS and SRS coverage, you could be disappointed to discover that coverage being dropped.

So while more transgender people may get some some health insurance coverage, many may lose the ability to get transition related surgery coverage which they already had. ACA tends to look good for the un-insured or poorly insured, or those with other insurance challenges, and not so good for many folks who already have good insurance.
Theresa Scott

Jamie D

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ive been reading and looking for the answer for like 3 hours and the whole thing is very confusing. It says that it will help transpeople gain health insurance but it doesnt define what that means in benefits. can someone explain this ? id be pretty pissed off if im forced to pay 3k a year in insurance but it isnt going to cover anything i actually need, like srs. i can pay for doctors and my 50 dollar a month perscriptions on my own.

Yep - you would do better staying away from it altogether.  You won't get SRS, or FFS, or an orchie, or voice therapy, or anything else, except maybe prescription coverage.

Offline kariann330

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Eh with any luck people will realize how big of a train wreck Obummercare really is and it will be repealed before it's too late to save our nation. (In Ted Cruz i trust)
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Offline kathyk

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Re: will the affordable care act ( obamacare ) help make companies cover srs ?
« Reply #10 on: October 22, 2013, 11:37:34 am »
Eh with any luck people will realize how big of a train wreck Obummercare really is and it will be repealed before it's too late to save our nation. (In Ted Cruz i trust)

Totally agree with Kariann. 

If you enlist for a lower monthly cost insurance plan be prepared to pay most of your prescription and medical costs until your out of pocket expense reaches your annual deductible, and this could be $5K.  Depending on what state you live in the low cost insurance policies might have some increased participation with a slightly lower co-pay from the insured person.  But you still have that big annual deductible before full coverage kicks in, so we're still gouged.  And be prepared when you want surgery because your insurer will not cover surgery unless your individual state mandates surgical coverage by law, but even then you're still liable up front for the total deductible cost. 

In short Obamacare (ACA), isn't going to help in the trans community any more than it will benefit (or hurt)anyone else.  And if you have insurance that wasn't cancelled because of Obamacare you should probably keep it until you can really investigate the options.  And none of the options sound good unless we pay a lot in monthly insurance premiums.  But then in 2018 for what they called Cadillac insurance, you may also get a penalty equal to 40% of the insured medical cost, and that is applied directly to your income tax.   

Unless you're unemployed with no earned income you're not going to get much relief out of Obamacare.  In most cases you’ll loose money or only stay even in this fiasco.

This is just a warning so be careful what plans you choose.
A happy old lady in California

Offline PrincessDayna

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Re: will the affordable care act ( obamacare ) help make companies cover srs ?
« Reply #11 on: October 24, 2013, 03:37:32 am »
Be aware medical billing/coding in 2014 is pretty much doubling its numbers. It'll be way more than six digits.
"Self truth is evident when one accepts self awareness.  From such, serenity". ~Me  ;)




Offline Alaia

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Re: will the affordable care act ( obamacare ) help make companies cover srs ?
« Reply #12 on: October 24, 2013, 04:30:47 am »
The problem is that these tend to be the so-called "cadillac" health insurance plans, many of which are going to be dropped as a result of the increased expense under the ACA, forcing their employees into the ACA exchanges, and at this point the ACA has not committed to the HRC CEI coverage standards or anything close to it. My employer has already announced that we will be losing our current very generous health insurance in 2015 when the deferred employer mandates kick in. If you were to hire on to a company who currently does support the HRC CEI, hoping to get FFS and SRS coverage, you could be disappointed to discover that coverage being dropped.
Great, now you have me a bit worried. My employer is top rated by the HRC CEI and provides insurance that covers the therapy, HRT, SRS, and even some secondary traits. I probably won't be qualifying for SRS for at least another 18-24 months as I have to be full time for at least a year and I'm not sure I'll be comfortable with that until I've been on HRT for at least 6 months or so. Anyway, that puts my time frame well into 2015 or even 2016.

So far there has been no word that they will be dropping the coverage, and actually as I think about it, I don't think the employer mandate will have a huge impact on us. Most of our employees are full-time with benefits anyway. But still, it is a scary thought, and a very valid concern for those currently with trans benefits and working in a sector where part time jobs are common (retail, travel, entertainment, etc.)

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