Author Topic: GRS and Insurance  (Read 73847 times)

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Offline KristinaM

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Re: GRS and Insurance
« Reply #140 on: February 19, 2017, 08:47:47 pm »
BCBSNC is covering surgery this year.  Most of their plans anyways, from what I hear.  I know that the State Employee's Health Plan (which is with BCBSNC) is covering it.  I'm scheduled for this summer!

Offline EmmaLoo

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Re: GRS and Insurance
« Reply #141 on: April 16, 2017, 01:06:49 pm »
This might be helpful for billing codes and general GCS coverage information. It's the link to the Aetna BCBS insurance guidelines for Sex Reassignment Surgery. Your company would still need to add this coverage specifically to the policy for coverage if you have Anthem BCBS so you would need to check on those details.

https://www.anthem.com/medicalpolicies/guidelines/gl_pw_a051166.htm

It's current and valid for 2017. At least in Indiana. Verified it myself.  ;D

Emma
Seriously, I'm just winging it like everyone else. Sometimes it works, other times -- not so much. HRT 2003 - FFS|Orch 2005 - GCS 2017 - No Regrets EVER!

Offline Brooke

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Re: GRS and Insurance
« Reply #142 on: May 20, 2017, 12:24:42 am »
I'm a bit confused on how the 55970 and 55980 are applicable to individuals who are transgender but not intersex. Are insurance companies treating them as the same diagnosis?


~Brooke~

Offline TaraJo

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Re: GRS and Insurance
« Reply #143 on: November 01, 2018, 11:01:16 pm »
Yes, absolutely, insurance will cover SRS.  A lot of BCBS plans will cover it, but since each state (and sometimes individual cities) has their own BCBS, it varies depending on your plan.

For the past year, I've been working for BCBS for TX, IL, OK, MT and NM doing preauthorizations.  I've learned a lot about insurance, how it works and how it applies to us as trans people and I'm using that knowledge to get surgery taken care of this coming summer.  Honestly, I've been tempted to do a bit of an AMA  on it.

As far as the CPT codes, they aren't that big a deal.  In all honesty, the specific CPT codes aren't generally that important.  I mean, if you have a doctor who has you set up insurance yourself, absolutely, you want to find out what codes they use.  But when you look at the CPT codes, some of them are so similar to the next that it's really hard to tell the difference (on occassion, we actually have to change CPT codes when setting up preauthorizations). 

If you do have to set up the insurance yourself and you REALLY want to surprise the person on the other end of the line, I can tell you exactly the information they're going to need for a preauthorization.  First, best thing you can do is make sure all the providers are in network; if you have a PPO policy and a provider is out of network, call them up and ask about a waiver and you might be able to get them in network.... eventually.  Besides the CPT codes (which are codes for the specific procedures or treatments), you're going to need diagnosis codes (or DX codes, which in our case would probably be gender dysphoria) and lastly you would need NPI numbers for both the doctor and the hospital where they're operating (NPI number is just a simple identification number for healthcare providers).  The preauthorization will probably pend and you'll probably have to do a predetermination and to get that approved, they'll need clinical documentation that this procedure is medically necessary; for us that means the therapist letters.  Generally you have to fax those in. 

Sorry if it sounds a little complicated.  I spend 8 hours a day doing this (sometimes longer).  It's not complicated for me because of experience.  But if anyone is having issues with insurance or has any questions, I'd be happy to help.

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