Under My Parents Insurance (Cigna) til Dec, How Do I Find Out if Top is Covered?

[KamTheMan]

Hey everyone. I'm hoping to get on T within the next two months. I was seeing a therapist for 1.5 years but that ended 1.5 years ago. So I'll probably need to find a new one. Anyways, I'm covered under my parents until I turn 26 this December and I want to find out if I can get some if not all the cost of surgery taken covered because I heard Cigna sometimes does that. How would I go about finding that out? Do I just call and ask if my plan would cover gender reassignment?

[DriftingCrow]

Most insurance companies send you paperwork that tells what is covered under your particular plan, or you can log-in to your parents on-line account if they have one to view the policy.

[Bimmer Guy]

Hey everyone. I'm hoping to get on T within the next two months. I was seeing a therapist for 1.5 years but that ended 1.5 years ago. So I'll probably need to find a new one. Anyways, I'm covered under my parents until I turn 26 this December and I want to find out if I can get some if not all the cost of surgery taken covered because I heard Cigna sometimes does that. How would I go about finding that out? Do I just call and ask if my plan would cover gender reassignment?

You're making a smart decision to check into this.  Yes, simply call "member services" on the back of your insurance card and ask them the question.

Often there is an expectation that you have been on testosterone for a year before your insurance will pay for the surgery.  I would suggest that if they tell you on the phone that there is a possibility that it may be covered, that you go to your parents and have them help you look up the policy and then you can go from there.

You may be one of the lucky ones who has insurance pay!

[aleon515]

I'd start now, you are going to get a refusal, which you then appeal.

--Jay

[Ayden]

I worked with insurance companies daily a few years ago. I did pharmacy but it's pretty similar. Call them and ask about "voluntary surgery". If they say in theory they cover your type of surgery, then go ahead and start the paperwork to get it covered. When (and if) you get a rejection, appeal it immediately. A lot of companies have an auto system for acceptance and rejection. Through Cigna I was able to get medical equipment and a lot of "superficial improvement" medications approved by being persistent. It helps if you have a doctor that is willing to go to bat for you. A lot of my patients from the pharmacy had tried on their own to get things covered, were denied and after I argued my but off were granted coverage.

[Arch]

My old policies had online handbooks that discussed what was and wasn't covered. The first thing I did when I was looking into top surgery was to find the online handbook and look for the "exclusions" section, which in my experience is always listed in the table of contents. If you can't find the section but the handbook is searchable, you might look for the word "sex" because I often saw the exclusion phrased as "changing of sex" or something similar. But if it's specifically NOT covered, it will likely be in the exclusion section. If you don't find an exclusion, then call.

Most insurance that doesn't cover trans stuff tends to go out of its way to make sure you know about it up front.

[Alexthecat]

Even if you call and they say yes it may be excluded in your individual plan. You need to submit a formal document which usually the surgeon's office does. That takes 6-8 weeks to hear back.

[Bimmer Guy]

Even if you call and they say yes it may be excluded in your individual plan. You need to submit a formal document which usually the surgeon's office does. That takes 6-8 weeks to hear back.

They will be able to tell him if his personal plan will cover it or not when he calls.

[Alexthecat]

They will be able to tell him if his personal plan will cover it or not when he calls.

Yeah they did that for me then I got a big fat denial.

[KamTheMan]

Thank you everyone for the replies. I want to make the call cause I need to know but I'm nervous about it. I don't know how to just ask. And if I have to be a year on T I'm kinda screwed. Unless I can find a way to extend my time on my parents insurance.