Author Topic: Top Surgery Denied  (Read 388 times)

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Offline EZ Linus

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Top Surgery Denied
« on: August 22, 2020, 02:00:01 pm »
I don't have the full information yet, but I've been checking my insurance status every hour since my doctor submitted the referral, and just at 5:PM on Friday, my claim for top surgery said it was denied. I won't have any more information until Monday, but I am upset. I don't know why it would get denied because we submitted both letters with the referral (one from my doctor and one from my psychologist), so I don't know what's going on. It's a mystery. They are supposed to cover it and I picked a surgeon that is within the network.

Offline FloralAlyssa

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Re: Top Surgery Denied
« Reply #1 on: August 22, 2020, 02:10:21 pm »
Sorry to hear that.  Health insurance can be so frustrating.  Make sure you understand the policy and they live up to the terms of it - and be ready to contact the Insurance Department of the state government if they won't. (I'm assuming you are in the US here, because it sounds like a US health insurance issue).  Most people don't realize it, but the Insurance Department can be quite helpful in getting through the red tape and getting a clear answer to why it was denied or fixing it if it shouldn't have been.

Offline Devlyn

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Re: Top Surgery Denied
« Reply #2 on: August 22, 2020, 03:08:02 pm »
Insurance companies are great at "The Three D's": Defer, Deny, Delay.

Do you have an advocate?

Are your identity documents changed? If there's a mismatch between your gender of record and the treatment, it can trigger a rejected claim.

Most likely this can be rectified with a call on Monday, best of luck!

Hugs, Devlyn
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Offline Sophiaprincess2019

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Re: Top Surgery Denied
« Reply #3 on: August 22, 2020, 07:00:12 pm »
Pop some popcorn and sit back. Insurance denials are the most common barrier to our surgical needs. There are people who go through several denials but they remain persistent. Eventually insurance gets through but the process can be extremely frustrating.
I'm currently in the process of fighting my insurance for FFS I desperately need. I've been battling them for close to a month and we are just getting started. The good luck is I have the University of California, Los Angeles on my side to advocate for my care. I know I'll eventually get approved but it's a huge let down each time my insurance company says no, it's cosmetic. I have to remain strong and keep the faith. It's the only hope I have because I cannot afford $ 60,000 to $80,000 out of pocket.

Wishing you strength....

Sophia
1968 Assigned male at birth with feminine mannerisms
1978 Dolls and dresses
1988 Experimental stage, limited makeup and clothes
1998 Denial continues, unsuccessfully tried living as a man
12-8-2018 time for a change....
2-21-2019 Started HRT
2-21-2020 One year HRT
2-21-2021 Two years HRT

Offline EZ Linus

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Re: Top Surgery Denied
« Reply #4 on: August 24, 2020, 12:44:07 pm »
THANK YOU ALL!

I called first thing this morning and now they are saying that it may not be fully denied yet. They will let me know in the next 24 hours, or so. They said they didn't get my doctor's letters until the day after the referral was first submitted. Maybe that's all the issue is (hopefully).

IF it is a full denial, I will appeal, (depending on their reason), and contact the Gender Law Center to get the info I need to move forward. I'm pretty darn determined, so I don't see what will stop me.

Thank you for all your responses. Very inspiring! :)

Offline LunatheaEvergreen

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Re: Top Surgery Denied
« Reply #5 on: September 03, 2020, 02:34:09 pm »
Keep fighting it. Insurance is like that.

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