Author Topic: Anthem BC Coverage  (Read 160 times)

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Offline TK9NY

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Anthem BC Coverage
« on: April 01, 2018, 07:13:50 pm »
Okay, does anyone have any experience with Anthem BC health insurance, and getting it to cover top surgery?

I'm having a hard time figuring out if my plan will cover it and I'm getting conflicting answers depending who i ask. My GP and endo says it's a good plan and should cover most if not all of it, and the surgeons i made consult appointments with didn't say that it wouldn't (i gave them my card number and info over the phone and assume they would have said outright if they didn't work with or accept Anthem or if my plan didn't cover it), but when i emailed Anthem to double check and ask what they would need from me (i know some need referral letters and such and my endo suggested contacting them to ask before my consults) i was told "gender reassignment procedures are not covered under your plan."

But if i log in and go to Benefits - Medical - Surgical i see "gender reassignment" and it says covered. And further digging, top surgery is considered "medically necessary - gender reassignment" so by that alone it should be covered... right?..... I emailed back asking for an outline of my plan so i can see where it says it isn't covered, but no response yet. I'm really hoping that i don't have to fight them for this.

I have my first appointment in two weeks. I might just wait until i see the surgeon and see what he says about insurance and Anthem. Maybe he knows how to file it to get coverage, or he can tell me what i need to do. I just figured i would see if anyone on here knows anything about Anthem BC while i wait.

Any tips on getting it covered? Anything i can do? I'm a little bit worried, now.....

Offline Pao

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Re: Anthem BC Coverage
« Reply #1 on: April 21, 2018, 09:22:38 pm »
I don't have direct experience.  I did want to mention that it may depend on your state, and your company. I have heard that both those can make a policy more restrictive if they want too.