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

[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.

[BillieTex]

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

[Jamie D]

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.

[The Passage]

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?

[Joelene9]

  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

[NekoKoNeko]

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 ([url=http://www.pcip.gov]www.pcip.gov[/url]), 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]

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.