Topic: Which health provider is best?

[Magnolia88]

I’m choosing my 2021 health plan for work and My options are blue cross blue shield and Aetna. This is the year I plan to start HRT  so I don’t want to make the wrong decision.

[Rakel]

Both companies are very well respected.

You must read what each plan specifically covers. Some plans differ in their coverage depending on which state you live in, so any specific company may be a good company, but your particular plan may not cover your particular medical needs.

Which plan you decide on also may or may not let you go outside of preferred providers network for care. Since providers for transgender care are not all that common, I recommend a plan that lets you go outside of network. This will cost you a bit more money, but it may be well worth it.

No matter what, be sure to get prior approval before any surgeries. Without prior approval you will run into the infamous delay, differ, deny routine insurance companies are famous for.

[Gertrude]

I work for the state and our choices are BCBS or United Healthcare. They have to carry the same things and have the same deductables, out of pocket, network, etc so the difference comes down to what my providers take in my case. For instance, my therapist doesn't take United Healthcare, so they are out. YMMV.

[sarahc]

It really depends on the specific state and the specific plan. What could be a good carrier in one state could be a lousy carrier in another. The best thing to do is see if your care team is in-network in either plan.

Sarah

[RandyL]

Also note that you won't likely find HRT per se listed as a covered service. But they cover medical necessities, and your doctors will probably regard your need for HRT as a necessity.

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[Jessica_Rose]

I am with Aetna. As others mentioned, the plans you have available may differ depending on which state you are in. My plan covered GCS, and a few months ago they added coverage for breast augmentation if recommended by a doctor. Unfortunately, FFS and permanent hair removal is typically not covered. Good luck!

Love always -- Jessica Rose

[Jane.Shannon]

I would recommend calling the insurance providers.  Make sure you let them know your state and your employer.  Different employers can "opt out" of some coverages for certain conditions, so a insurance provider that might normally have great coverage for trans health might not cover what you need.  For example, I could have Kaiser, and I seriously looked into because I would like to get electrolysis covered.  However, my employer doesn't cover that procedure.  Another thing I would think about is what exactly are your transition goals for the next 12 months.  I decided I would wait until 2022 for GCS, and my current insurance is less expensive, my kids doctor is AWESOME, and it covers everything I am doing now.  So I didn't get the more expensive insurance that covers GCS. 

I guess that is the long way to say, figure out what you want your insurance to do for you and call them.

[sarahc]

I would recommend calling the insurance providers.  Make sure you let them know your state and your employer.  Different employers can "opt out" of some coverages for certain conditions, so a insurance provider that might normally have great coverage for trans health might not cover what you need.  For example, I could have Kaiser, and I seriously looked into because I would like to get electrolysis covered.  However, my employer doesn't cover that procedure.  Another thing I would think about is what exactly are your transition goals for the next 12 months.  I decided I would wait until 2022 for GCS, and my current insurance is less expensive, my kids doctor is AWESOME, and it covers everything I am doing now.  So I didn't get the more expensive insurance that covers GCS. 

I guess that is the long way to say, figure out what you want your insurance to do for you and call them.

Just one heads-up on this approach. There are a couple of heavily in-demand GCS practices at research hospitals (e.g., Mount Sinai, NYU-Langone), that may require an insurance check  for the surgical procedure prior to making an appointment for the surgery. No insurance = no surgical appointment, unless you demonstrate ability to pay out-of-pocket.

Sarah

[RandyL]

I just checked my claims history and can confirm that Medicare is covering my HRT and blood tests. I have a $20 or $30 copay on doctor visits but not on injection visits. Also because my therapist is a PhD psychologist and takes Medicare, that is covered as well ($30 copay per visit).

None of these providers is "in network" with my Advantage plan (BCBS/Anthem) but because they take Medicare, Anthem pays them the same as it would in-network providers.

Medicare Advantage plans are a little different than Medicare Supplemental plans. With Advantage the provider only bills the plan, never Medicare (they never even look at your Medicare card). Anthem tells me that they cover whatever Medicare covers -- they don't use any different criteria. I have no idea if any surgeries would be covered.

[ChrissyRyan]

You have to compare plans to see if any specific services that you “must have” is covered, and to what extent.  In addition, see their limitations for allowing you to choose providers.

Remember that even if it will be awhile for anyone for deductibles and out of pocket limits to be met, the contracted rates with providers may save you money for specific services as the providers are NOT allowed to be in network unless they agreed to accept the contracted amount as full payment for services. They must write it off.

Regardless of your insurance or lack of it, providers may have you sign a document that says you are fully financially responsible for services provided. I have not had any yet that tried to charge me though for this amount they were required to write-off.

Pharmacy, dental, and vision can all be under separate insurance plans than medical.  There may be separate deductibles and out of pocket limits for each of these plans. 

Employers may provide you with detailed “summary plan descriptions” for insurance coverage, which can be helpful.  They can get rather thick and boring to look through.  Calling companies is good to do, but people at telephone banks can make errors just like we can.  Most reps seem to be trained well.

You might find this transitioning cost resource helpful:  https://www.susans.org/forums/index.php/topic,243279.0.html


Chrissy