EmpireBlue(Cross Blue Shield); Does it/would it cover T?

[NXTransit]

So,

I've been doing extensive research, and I can't find one thing that mentions EmpireBlue (New York Blue Cross Blue Shield) covering testosterone. Now, when looking at their page for hormonal replacement treatments, it mainly mentioned menopause and testosterone deficiency.  It had said the menopausal estrogen pill for old, female-bodied people was not covered- they said it wasn't "medically necessary", which basically means, they won't cover T for me, right? Is there like, some sort of loophole for this? Is anyone with EmpireBlue on T? It would really if you told me how you got it.

Thanks, 
Nick

[JohnAlex]

I also would like to know the answer to this.  It might be different depending on where you live.

Right now, I'm with Kaiser, and where I live they will cover T, but I've heard of some places where they won't.
It's possible that in 2013 I will be with Blue Cross Blue Shield.  So I'm wondering that if I start T with Kaiser, and I've been on T for a year, and got my Driver's license gender changed, then when I have to switch to Blue Cross Blue Shield, will they be forced to continue to cover it for me?
I hope that's a loophole of theirs.

[NXTransit]

and where I live they will cover T, but I've heard of some places where they won't.

That's the thing, I don't think New York covers it in general. if only I could get Canadian insurance, they have the best, and like, a 6 month supply is $50!

[Arch]

It usually depends on the plan. I had the option of BCBS through my ex, but it was a federal plan and very conservative. Nothing trans-related was covered. Other BCBS plans might be different. Look up the plan booklet (should be available online) and find the exclusions section.

[Liam K]

That's the thing, I don't think New York covers it in general. if only I could get Canadian insurance, they have the best, and like, a 6 month supply is $50!

My insurance doesn't cover T, but I use Stroheckers pharmacy and get a 5 month supply for under 60 dollars. Other compounding pharmacies are similarly priced.  T can be very affordable even if your insurance doesn't cover it, as long as you're looking in the right places.

[NXTransit]

It usually depends on the plan. I had the option of BCBS through my ex, but it was a federal plan and very conservative. Nothing trans-related was covered. Other BCBS plans might be different. Look up the plan booklet (should be available online) and find the exclusions section.

I'll do just that. Thanks~

[Lee]

Arch, I have federal BCBS at the moment.  Is there anything related to transitioning that they would cover?

[Nygeel]

Pro-tip: your insurance can say male before your ID does. My doctor said that I should be able to mark off T if my gender is listed as male because then I would have a major testosterone deficiency (if I don't take T).

[Arch]

Arch, I have federal BCBS at the moment.  Is there anything related to transitioning that they would cover?

Bear in mind that I was investigating this back in 2008, and all I did was read the exclusions section of all of the different plans. I was trying to find one plan, no matter how expensive, that would cover transition, especially surgery. I figured that an extra hundred a month would be worth it for a year or two, if I could get pricey procedures covered.

The exclusion clauses were pretty much all the same: Variations of "Expenses relating to sexual reassignment are not covered." I took this to mean that hormones and surgery were both uncovered unless they could be shown to be unrelated to transition. So if they don't know you're trans, you should be able to get hysto or top surgery if you can prove that you have a genuine health issue with that part of the body. You might be able to get a very small dose of T covered if you have low T for a female and your doctor thinks T will help you. But once they know you are trans, that can throw a monkey wrench into the whole works, even if you do have major plumbing problems or major back issues from your cleavage.

You might do some digging of your own. Recheck the plan booklet, call them, ask questions. Maybe I'm paranoid, but I would avoid identifying myself. Or ask a doctor to do some investigation on your behalf--he or she will likely have someone in the office make some calls, and nobody has to know that you are the patient in question.

[Lee]

Thanks for the suggestions Arch.  I will only be with them for about half a year more, so maybe I can get therapy and T covered before finding something that will work for surgery. 

[supremecatoverlord]

If you have a really good Endo, sometimes they will bill your testosterone to your insurance company in a way that he/she is sure your insurance company will cover it.

[Arch]

Thanks for the suggestions Arch.  I will only be with them for about half a year more, so maybe I can get therapy and T covered before finding something that will work for surgery.

Good luck with the therapy. I was thinking about having my therapy covered by insurance (not BCBS) and found out that they have a nice racket going. First of all, they require a copay of $30 per session. Fair enough. But they only pay the therapist partial compensation--$30, which is ridiculous. My therapist's regular fee is $135 a session, but he was giving me a break and charging me $90. At that rate, he would have been losing a further $30 a session unless he charged that amount to me, in addition to the copay.

Nevertheless, he did this for another trans client before me. The insurance company requires full disclosure after ten sessions, so they covered the first ten sessions. But they refused to cover other sessions as soon as my therapist disclosed that the client was getting gender therapy. Nice, huh?

[Nygeel]

A $30 co-pay? Mine are $50 and on paper I have no income. Plus, my meds might not be covered (I have Oxford). It's less expensive if I don't have insurance.

[Arch]

A $30 co-pay? Mine are $50 and on paper I have no income. Plus, my meds might not be covered (I have Oxford). It's less expensive if I don't have insurance.

The copay would have been thirty bucks, but my therapist said he would only accept the insurance if I ponied up the extra thirty I mentioned because they were rooking him. He had already reduced me by $45 a session, and that was as far as he would go. He already has other clients who pay hugely reduced rates, and I'm not one of them.

Oxford doesn't sound like a great plan, but my ex was paying a pretty healthy premium on our plan; a higher premium usually translates to lower out-of-pocket, to a point. My plan was an HMO...what is yours? If you have no income, have you looked into non-insurance alternatives? For example, the LGBT center in my town charges a lot less than fifty bucks for therapy, and they refer people to therapists who take low-income clients for very low fees. I think we must have a very good center.

My friend gets his therapy nearly free through some program (county?) because he is low income and bipolar. He pays an annual fee of twenty bucks or so, and he gets a therapist and a psychiatrist. He gets other medical services through a community clinic that is very low cost as well.

[Nygeel]

Arch, I'm being added onto my mom's plan. What I was using was sliding scale at the LGBT health clinic. My yearly costs if I stuck without insurance and went on patches like I wanted to would be roughly $300 while with insurance it would be $5,000.

This isn't for therapy, it's for hormones and my check ups.

[Paul]

That's the thing, I don't think New York covers it in general. if only I could get Canadian insurance, they have the best, and like, a 6 month supply is $50!

My suggestion would be to call your insurance company and explain the situation and ask what they do cover and ask them to send you a packet.  I live in New York as well, but through work I'm going to have CDPHP (counting down the days until Feb 1st when it kicks in).  They DO cover surgery and they said T varies case by case.  I'm a Clinical Assistant work so I'm sure the case by case means; are you listed as Male on insurance to justify needing T and how the doctor writes the script.  They sent me a packet though which was helpful for me to take to my therapist so that I can make sure I have everything needed for their criteria for them to cover surgery. 

[Felix]

I have CareOregon contracted through state insurance. They specifically do cover transgender health care, but only in years when the government budget is doing really well. Which lol is when exactly?

I pay out of pocket.

[Arch]

Arch, I'm being added onto my mom's plan. What I was using was sliding scale at the LGBT health clinic. My yearly costs if I stuck without insurance and went on patches like I wanted to would be roughly $300 while with insurance it would be $5,000.

This isn't for therapy, it's for hormones and my check ups.

Then I guess I'm confused. We don't seem to be talking about the same things. I was talking about therapy copay, not copay for other (medical rather than psych) services. And you said you were on Oxford, so you seemed to be talking about your insurance copay, not clinic charges...? At any rate, I just want to reiterate that insurance companies will avoid playing fair; they're in it for a profit, so don't expect them to cover any procedure or service, even therapy, once they find out that you are trans. So I think it's best to keep a low profile.

[Paul]

Then I guess I'm confused. We don't seem to be talking about the same things. I was talking about therapy copay, not copay for other (medical rather than psych) services. And you said you were on Oxford, so you seemed to be talking about your insurance copay, not clinic charges...? At any rate, I just want to reiterate that insurance companies will avoid playing fair; they're in it for a profit, so don't expect them to cover any procedure or service, even therapy, once they find out that you are trans. So I think it's best to keep a low profile.

I think it depends on the insurance.  CDPHP in NY is very good with support.  The co-pay for surgery is the same as any other in-patient surgery (although there is a list of criteria first; which the list really isn't bad--pretty normal).  I know a few people that have it and have had great success with Transitioning with them. 

[Arch]

I think it depends on the insurance.  CDPHP in NY is very good with support.  The co-pay for surgery is the same as any other in-patient surgery (although there is a list of criteria first; which the list really isn't bad--pretty normal).  I know a few people that have it and have had great success with Transitioning with them.

I should have been clearer. I'm talking about insurance policies with a trans exclusion.