Do I chose therapst or does the Insurance company? Urrgghhh!!!!

[debbiej]

I had a good friend recommend a therapist in the closest area of any great population (85,000) and I was excited about seeing him. He doesn't specialize in transgender issues but he's gay so I thought he'd have some sensitivities to gender issues. So now we have called the insurance company and he's not on their list.

So, living in a rural area, I may have to go to someone that the insurance company choses for me all because he or she is less expensive. (I'm reminded of the astronaut who, while waiting for the countdown to lift of to be completed, suddenly realized that the giant roman candle he was sitting in was built by the lowest bidder). I doubt very much that there are many other therapists with that will meet my needs in this conservative area of the country. Urrgghhh!!!

Has anyone fought the insurance company over their "preferred" list of providers? Was it successful? Or did you just get bloodied and wish you had not spent so much energy swinging at windmills (or "pure evil" as I like to call the insurance industry)?

I'll follow the link that Julie left in another topic and see what I can find.

But still, I'm in a fighting mood and would like to know if anyone has had any luck fighting this.


Debbie

[Kate]

I had a good friend recommend a therapist in the closest area of any great population (85,000) and I was excited about seeing him. He doesn't specialize in transgender issues but he's gay so I thought he'd have some sensitivities to gender issues...

Don't be so sure. Gays are happy with their physical sex, so they don't necessarily have any more empathy or understanding for us than heterosexuals. I swear some of them dislike us MORE somehow even.

Insurance... I had the same problem. I went through my list of therapists in the network, and only found one who had some experience with gender issues. After one meeting, I wasn't entirely comfortable with him, so I started looking again.

I then got lucky and found someone out of the network who ended up costing about the same as my deductible... and I've been with her for over a year now.

Shop around. Some will negotiate on price a bit, especially if you commit to going more often. And maybe even call the ones IN the network and ask if they have experience in treating GID... you might stumble upon someone you like!

Kate

[Robyn]

Take a look here:

https://www.susans.org/Medical/Therapists_and_Counselors/USA/

[Melissa-kitty]

Yes, you can fight them very effectively. See, you aren't looking for a generic therapist, you are looking for one that help for Gender Identity Disorder, the diagnosis that will probably be billed. There won't be one on their list, I betcha, unless you are in an area with a special clinic. So, you will probably be able to push it through, if you have one picked out, by saying that they are specially qualified. You may have to talk with the company's medical director. Good luck, and persistence pays dealing with insurance!
Blessings, Tara

[debbiej]

Thanks everyone,

I now have the list from the insurance company and, of course, none of the names match up with what I've found on the websites that list therapists for transgendered persons. And of course the ones listed on the web sites are at least 90 minutes to two hours or more away from me. No big surprises there. It would have been nice if this would have been easy.

I guess I have some phone calls to make.

Debbie

[LynnER]

Just a quick question, is your insurance an HMO or PPO?  and according to the deductable levels whats the cost diffrence between in and out of network theripists...  on my old insurance it was the same reguardless, though I would have had to pay out of pocket and be reimbursed later *Shrugs*  youd have to obtain a coppy of your specific policy and look aroud....

Also watch it, allot of insurance companies will refuse to pay anything if they find out that your seaking treatment for GID, this includes theripists, endos, ad HRT... <though allot of these will pay for atleast part of the final surgery if you bully them enough>

[debbiej]

Lynn,

Well, its not an HMO so I guess its a PPO. My wife, God bless her, has been jumping the insurance hurdles for me. She did say something about if I go "out of network" it would have to be someone on the doctoral level so that must mean there is some compensation if I go out of network.

The cats out of the bag with my issue. The insurance company has been told that it is a transgender issue and they still sent the list of "in network" therapists (The list was for "individual" therapist as opposed to another list of "family" therapists for our marriage counseling). I'm not willing to think, in any serious way, past seeing a therapist at this point so we haven't asked about HRT or operations yet.

Thanks -

[Leen]

 ^-^You write beautifully. You need to write a book about your experience through this and your love of God which has always been inspiring to me. Leen

[debbiej]

You're too kind Leen!!! I might get a big head and take you up on your suggestion. 

Debbie
Update:

After some foot dragging on my part and dreading taking another step down a long road I have set an appointment with a Therapist for next Tuesday. We spoke briefly over the phone. She seems nice enough and has experience with TG. She is in our network so the cost should be minimal. I googled her and found she is active in her church on the national level so we will have that in common.

Here we go....

Debbie

[BeverlyAnn]

I've been looking through my insurance the last couple of days and even in a city of several million, they don't have anyone listed in network for gender issues.  Gay/Lesbian issues they cover and there are a lots of therapists listed as in network but nothing for gender.     Of course if I go out of network they will cover 20 sessions per year after a $1000 deductible and then cover 50% of costs with a maximum of $25 per session.  In other words, if the therapist charges more than $50 per session, I would make up the difference.  

By the way, I have heard the way most therapists do it if the insurance doesn't cover GID is list it under Adult issues.

Beverly

[debbiej]

Beverly,

It sounds like I'm more fortunate than I thought!! I have two other possibilities for therapists that are listed by my insurance company that are also 90 minutes away. They are also on the Indiana University GLBT page for gender issues so they would be worth talking to if this first one is not a good fit. I wish it was closer but then again, living in a smaller community (250 souls live in my town), traveling to a larger town where no none knows me gives me some comfort at this point in my journey.

Debbie

[seldom]

Ahh insurance.
Generally speaking insurance companies will cover the therapy.

As it was said, be careful.  GID is something that insurance companies will not cover normally. 

[Lisbeth]

I've been looking through my insurance the last couple of days and even in a city of several million, they don't have anyone listed in network for gender issues.  Gay/Lesbian issues they cover and there are a lots of therapists listed as in network but nothing for gender.    

That's the main reason I have gone back to school to become a therapist.

Of course if I go out of network they will cover 20 sessions per year after a $1000 deductible and then cover 50% of costs with a maximum of $25 per session.  In other words, if the therapist charges more than $50 per session, I would make up the difference.  

I haven't even tried to turn in any of my receipts to the insurance company.

By the way, I have heard the way most therapists do it if the insurance doesn't cover GID is list it under Adult issues.

That's an issue I want to take up with some of my instructors.  It isn't just trouble with the insurance company.  If the insurance is through your employer, what are the risks of them finding out that you have a 302 diagnosis?  Especially in states where transgender is not a protected class for employment descrimination.

[debbiej]

It isn't just trouble with the insurance company.  If the insurance is through your employer, what are the risks of them finding out that you have a 302 diagnosis?  Especially in states where transgender is not a protected class for employment descrimination.

I don't think I have a problem with my employer but you raise an interesting point. It gave me pause to think that the guy on the other end of the phone, as we were figuring out insurance coverage, now is one of the few people that knows who I am and what I am. I suppose I need to learn how to share this information but this society and the insurance companies in particular have access to way to much personal information. Yikes!!

BTW - i just came back from my second session with my therapist and am very impressed with her as a caring person, and her knowledge and her experience with Transgender issues. I am very hopeful that this relationship will be very helpful to me.

Debbie

[Robbie]

I totally ditched the insurance company for my therapy.  I found that most of the therapists that have the most experience don't take it anyway.  I went thought three before I found one I liked.   That just didn't put me on the fast track to GRS.   By giving me the minimum they had to to get me my letters. I pay for it all out of pocket 150 an hour.  The bulk of my transition money goes to therapy.  Happiness is the most important part.  Not getting GRS in two years.  So basically you get what you pay for.