Author Topic: Electrolysis and Independent Health Association Inc.  (Read 393 times)

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Offline LexiDreamer

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Electrolysis and Independent Health Association Inc.
« on: March 05, 2019, 12:20:49 pm »
Has anyone here had to deal with Independent Health Association health insurance?
I think they primarily serve western New York.

They have denied both my facial electrolysis even though it was submitted with a letter of medical necessity and they just recently denied my surgical prep genital electrolysis submitted by Dr. McGinn's office.

I'm planning on opening a can of lawyers on them, but I want to know if anyone else here has been denied anything by them so we can gather some forces. ; )

*** Any suggestions I make should never be used as a substitute for licensed medical advice ***
*** All of my personal pharmaceutical experiences I share, have been explicitly supervised by a licenced medical professional ***

Offline Dani

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Re: Electrolysis and Independent Health Association Inc.
« Reply #1 on: March 05, 2019, 06:45:55 pm »
Good luck.

Please read the list of exclusions in your policy before taking legal action or you may be wasting your time.



Offline LexiDreamer

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Re: Electrolysis and Independent Health Association Inc.
« Reply #2 on: March 05, 2019, 07:59:04 pm »
Good luck.

Please read the list of exclusions in your policy before taking legal action or you may be wasting your time.

Oh, I have. The problem is the exclusions are not legal in the state of New York.

This is the press release for another New York state health insurance company (EmblemHealth) that was fined $250K and made to pay  back all the members (by the New York State attorney general's office) because of it's exclusions to trans folk.
https://ag.ny.gov/press-release/ag-underwood-announces-settlement-emblemhealth-ensure-health-insurance-coverage-gender

Here is EmblemHealth's new updated transgender treatment policy (updated 2 days after the settlement announcement):
https://www.google.com/url?sa=t&source=web&rct=j&url=https://www.emblemhealth.com/~/media/Files/PDF/_med_guidelines/MG_Gender_Reassignment_Surgery.pdf&ved=2ahUKEwi-md_Zs-zgAhWBdd8KHWrzA6AQFjAAegQIARAB&usg=AOvVaw3XZmFXf1gBYHP8IOu2W9-n

The transgender treatment policy my insurance company (Independent Health) sent to me is much more restrictive then EmblemHealth's new policy.

So, I'm going to give them an ultimatum.... "change your policy now, voluntarily, or I'm calling the New York State AG's office and have them tell you to change your policy and get fined in the process" ; )

Either way, they're going to pay!

They can have all the exclusions they want... New York has a mandate to cover transgender care and they are enforcing it.
*** Any suggestions I make should never be used as a substitute for licensed medical advice ***
*** All of my personal pharmaceutical experiences I share, have been explicitly supervised by a licenced medical professional ***

Offline DawnOday

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Re: Electrolysis and Independent Health Association Inc.
« Reply #3 on: March 05, 2019, 08:07:50 pm »
Our medical system is not what it was only three years ago.
Dawn Oday

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Offline LexiDreamer

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Re: Electrolysis and Independent Health Association Inc.
« Reply #4 on: March 05, 2019, 08:30:44 pm »
Our medical system is not what it was only three years ago.

What do you mean?
*** Any suggestions I make should never be used as a substitute for licensed medical advice ***
*** All of my personal pharmaceutical experiences I share, have been explicitly supervised by a licenced medical professional ***

Offline LexiDreamer

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Re: Electrolysis and Independent Health Association Inc.
« Reply #5 on: March 05, 2019, 08:38:46 pm »
I think one of the most interesting parts about that press release:
Out of 79 requests for prior authorization for GRS procedures only 22 were denied... they weren't doing a blanket denial program... and New York state still came down hard on them.

I'd say this is very promising for the New York trans community.
*** Any suggestions I make should never be used as a substitute for licensed medical advice ***
*** All of my personal pharmaceutical experiences I share, have been explicitly supervised by a licenced medical professional ***

Offline LexiDreamer

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Re: Electrolysis and Independent Health Association Inc.
« Reply #6 on: March 07, 2019, 10:56:23 pm »
I have written an appeal to my insurance company. It really is more a professionally written thinly veiled ultimatum demanding they cover my electrolysis and change their shitty policy for treating gender dysphoria.

I wish I could be a fly on the wall when they read it. Not only am I sending a copy to their appeals department, I'm mailing certified copies to both the CEO and VP of member services.

I'm giving them 2 weeks to approve my treatments and 30 days to update their policy.... But I said it nicely. ; )
*** Any suggestions I make should never be used as a substitute for licensed medical advice ***
*** All of my personal pharmaceutical experiences I share, have been explicitly supervised by a licenced medical professional ***

Offline LexiDreamer

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Re: Electrolysis and Independent Health Association Inc.
« Reply #7 on: March 23, 2019, 07:47:02 am »
I am ecstatically pleased to report that after 8 days from the delivery of my ultimatum, I received a call from my health insurance and they have approved both my facial and genital electrolysis and they want me to submit my receipts for electrolysis I have already paid out of pocket for so they can give me full reimbursement!!!!

I am on top of the world right now!

It was a good bit of work, but being a tenacious bitch really paid off!

Now I celebrate! Yay!
*** Any suggestions I make should never be used as a substitute for licensed medical advice ***
*** All of my personal pharmaceutical experiences I share, have been explicitly supervised by a licenced medical professional ***

Offline LexiDreamer

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Re: Electrolysis and Independent Health Association Inc.
« Reply #8 on: March 25, 2019, 07:23:02 pm »
I have to say, I'm very surprised no one has made a comment on my last post.
I feel like I did the near impossible.

They told me their policy does not cover electrolysis, and I told them "ok then, your policy sucks and it needs to be changed"... and they did it!

I "denied" my insurance company's denials!

Oh well, I thought it was pretty awesome.
*** Any suggestions I make should never be used as a substitute for licensed medical advice ***
*** All of my personal pharmaceutical experiences I share, have been explicitly supervised by a licenced medical professional ***

Offline Laurie

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Re: Electrolysis and Independent Health Association Inc.
« Reply #9 on: March 25, 2019, 10:59:46 pm »
  Congratulations on the positive results Lexi. Your persistence definitely paid off for you. Perhap it will also help others with that insurance.
  Good Job, Girl!!!  :icon_dance: :icon_dance: :icon_dance: :icon_geekdance: :icon_geekdance:
April 13, 2019 switched to estradiol valerate
December 20, 2018    Referral sent to OHSU Dr Dugi  for vaginoplasty consult
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May 11, 2018 I am Laurie Jeanette Wickwire
May   3, 2018 Submitted name change forms
Aug 26, 2017 another increase in estradiol
Jun  26, 2017 Last day in male attire That's full time I guess
May 20, 2017 doubled estradiol
May 18, 2017 started electrolysis
Dec   4, 2016 Started estradiol and spironolactone




Offline LexiDreamer

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Re: Electrolysis and Independent Health Association Inc.
« Reply #10 on: March 26, 2019, 12:18:16 pm »
  Congratulations on the positive results Lexi. Your persistence definitely paid off for you. Perhap it will also help others with that insurance.
  Good Job, Girl!!!  :icon_dance: :icon_dance: :icon_dance: :icon_geekdance: :icon_geekdance:

THANK YOU!

That's what I am hoping for by posting this here.

If anyone gets denied for Transgender Treatment in the state of New York,  by their Insurance company, they should know they have recourse here.

Once the terms of my appeal/ultimatum have been satisfied by my health insurance company, I will post my letter on here so hopefully others can benefit.

I gave them 2 weeks to reverse their denials to my claims (they did it in 8 days) and I gave them 4 weeks to update their gender dysphoria treatment policy as a whole, so the next poor soul doesn't have to go through what I went through.
They still have a couple of weeks left to comply with the latter.

I resume my facial electrolysis on Thursday and start my surgery prep electrolysis on Friday. Two days in a row of poking, zapping and pulling!
But with only a $10 copay each day, it will be sooooo worth it!
*** Any suggestions I make should never be used as a substitute for licensed medical advice ***
*** All of my personal pharmaceutical experiences I share, have been explicitly supervised by a licenced medical professional ***