HRT and cheap New Jersey medical insurance

[novumdiex9]

My friend really wants to start HRT, but if he tries, his parents will probably remove him from their insurance (not kick him out, just remove him from insurance). Does anyone have any experience with insurances of any type in New Jersey that cover HRT and/or gender therapists? He is 18, and will probably continue to live with them. Anyone have any experience or ideas? Or maybe a sliding-scale model clinic in Jersey near Manhattan?

[JessieBirdie]

From my experience, I haven't had issues dealing with coverage for myself (with providers located in NY, NJ, and PA) for therapy with a psychologist/social worker (assuming psychological appointments are actually covered by the provider) or with seeing an endocrinologist.  If there is, speaking with other folks, I've found that these people can simply get around the problem by submitting a different diagnosis to the insurance company.

However, drugs are another story.  I'm currently on this whacko obscure Japanese Provider that uses Aetna's network for billing purposes called Nippon Life Benefits through my mom's employer (...yep).  With them in particular I've never had issues with them covering my appointments so far for about 3 years, but once they did decline to pay for estradiol...of all things due to "sex incorrect for treatment" (still need to change my legal sex...kinda don't know why I haven't at this point).  Mind you, they were still covering the spironolactone and the progesterone (both far more expensive drugs...so yeah, what?!).  We just dealt with it by disputing the matter and it went through.

Just check the health exchange otherwise I guess.  Oh, and make sure whatever provider you go to (endocrinologist and gender therapist) is in your insurance's network.

[KittyKat]

If she's near manhattan she can look up called lorde. They operate on a sliding scale if someone doesn't have insurance.

[Sydney_NYC]

I'll second Callen-Lorde as a great source. My first HRT pre-session and session was $60, my blood test was $117 and first months prescriptions was $26. (No insurance and on a sliding scale.)

It was cheaper than my wife's last regular doctors appointment (she had 3 weeks of being sick with no energy and wanted to find out what it was) with insurance (HBCBSNJ). She paid $30 copay, $76 prescriptions and her blood work was $700 (insurance would not cover it, because it was the 2nd blood test within a year and she had not met her deductible, but we are fighting it). We are changing to Obamacare for insurance so we are both covered and it will cost less than her existing policy that doesn't pay hardly anything.

[KarynMcD]

My friend really wants to start HRT, but if he tries, his parents will probably remove him from their insurance (not kick him out, just remove him from insurance).

They can't remove him. It's against the law.
http://www.state.nj.us/dobi/division_consumers/du31.html

The federal Patient Protection and Affordable Care Act, enacted March 23, 2010, requires that dependent children be covered under group and individual plans at least until age 26

[LordKAT]

Maybe they can drop a child.

A young adult may be removed from his or her parent's plan – if it is a "grandfathered" health plan – before reaching age 26 if the young adult could be covered through a group health plan as an employee or an employee's spouse.  Generally, "grandfathered" plans are health plans that were in effect on or before March 23, 2010.

from the same site.

[KarynMcD]

Maybe they can drop a child.

Only if the child has a job with insurance or is married to someone with insurance where the spouse can be covered.

A young adult may be removed from his or her parent's plan – if it is a "grandfathered" health plan – before reaching age 26 if the young adult could be covered through a group health plan as an employee or an employee's spouse.