SRS and Cigna *Panicked*

[gray]

I apologize if this is the wrong board for this topic, but I'm feeling quite overloaded and disoriented. Again, apologies.

Anyway, getting on with it...

I've been in transition for several years and have been living full time MTF for about three of those. During that time, I've been saving toward SRS, ans never thought I'd ever be able to use insurance for it.

However, I just started a new job and they are offering me Cigna coverage. This is very overwhelming, as over the past few years I've deliberately avoided thinking or reading too much about SRS--it felt out of reach and depressing--but now I'm put on the spot, and have a short time to make a decision.

All that said, here's sort of what's rushing though my mind...

• Is it possible that my particular Cigna plan wouldn't cover SRS? How do I go about making sure it does before I sign up?
• Are there even doctors that will accept this? Are there good ones that will accept it? How do I know which doctors will take this?
• I know there are a few different SRS techniques, but don't really know what they are or the pros/cons of each.
• I may need to pay out of pocket and be reimbursed? I've been saving money, but don't actually have even a ballpark idea of what the cost would be.
• Has anyone here used insurance and gotten good results? Cigna especially?

Oh--also, I'm completely terrified.

Okay... okay. I'll stop there. Sorry if I'm throwing a lot of questions/thoughts in one place. I just felt like I had to put them somewhere so that I can start figuring out what I need to do next (if anything.)

[angiegurl]

Have you tried talking to the plan administrator or calling Cigna and asking? Also, talk with the surgeons they would tell you if they will take the insurance or not. That would be my first thought. I can not comment on the rest as I am not at that point yet.

[gray]

Our company isn't huge--the main point of contact is generally the receptionist, who I don't want to discuss this with. So, I've scheduled some time with the HR director on Friday. Being a very new employee, I worry that disclosing the need for an expensive procedure, or that at some unknown time it the future I'll have to take at least a month off for recovery may leave a bad taste it the mouth of the company.

I like the idea of calling Cigna, and I'll see if I can find a number for questions.

[LordKAT]

When you see the HR person, simply ask if you can see the details of the plan options to better make your choice.

[Jamie D]

Gray, you should be able to get a copy of the policy, and should be able to look up the exclusions.

[Constance]

My employer is switching to Cigna as of January 2014. While Cigna automatically covers anything medically indicated by WPATH for individual policies, employers are still free to shaft their employees exclude things such as this from their benefits.

Check with your HR folks.

[gray]

Thank you, Constance. I was totally unaware of that. I asked our receptionist today for a list of exclusions, but she was only able to give me a partial one. I intend to press HR for a full list when I speak with them tomorrow.

[Constance]

I got so excited for a while there. I went to Cigna's site and did a search on "transgender services" and found out that SRS/GRS would be covered. But when I double-checked to see if it was excluded, it certainly was. Then that law was passed in CA banning discrimination against trans persons for health care, so I contacted the Transgender Law Center. But "self-insured" plans are not governed by that law, which allows to employers to exclude pretty much whatever they feel like.

So, I'm back to saving or getting a medical loan ... or being non-op.

Hopefully, you'll face a better situation!

[gray]

When I asked for the policy details and exclusions, HR told me they didn't have a copy yet. But, they're suppose to be giving me a phone number for questions like this. Maybe Monday?

I certainly hope it works out. I mean... I'm used to trying to save money for this, and if at the end of the day I'm still in the same boat, then so be it. But, it will be disappointing (even though I'm trying to stay prepared that possibility) and I'm finding it particularly stressful. It would be great if something came of it.

All that said, if this does work out I'll still need to find a doctor. I been vaguely under the impression that I would go to Dr. Suporn. But, that may be dreaming big, and it seems doubtful to me that Cigna would cover doctors outside North America. Although I honestly haven't looked in to it, and may just be a pessimist. :/

[Knowltey]

I got so excited for a while there. I went to Cigna's site and did a search on "transgender services" and found out that SRS/GRS would be covered. But when I double-checked to see if it was excluded, it certainly was. Then that law was passed in CA banning discrimination against trans persons for health care, so I contacted the Transgender Law Center. But "self-insured" plans are not governed by that law, which allows to employers to exclude pretty much whatever they feel like.

So, I'm back to saving or getting a medical loan ... or being non-op.

Hopefully, you'll face a better situation!

I did insurance quoting to healthcare providers for Blue Cross Blue Shield of Minnesota for a while back. And yeah, what was said is correct. It's an unfortunate loophole, but if a particular insurance policy is "self-funded" by the group administrator they don't have to comply with local state laws, only federal insurance regulations. I guess it has something to do with the fact that on self-funded plans the employer is basically just "forwarded the bill" so to speak for any healthcare costs from their employees. The insurance companies just handle the claim process, everything else is paid for by the company.