getting my insurance to pay for my spiro and E

[Umiko]

seriously, i need to know now. imma get my meds through callen-lorde becuz the wait to see my endo is to long and becuz of my body masculinzation in stage 2, i wont last much longer, but i need to know if my insurance would pay and if not how to get around them. i could scrap up money if i need to but that if i exhausted everything. any advice on this before i go any further

[LordKAT]

Talk to Callen-Lorde and ask if they code it as a hormone imbalance. Most insurance will cover that.

[Umiko]

Talk to Callen-Lorde and ask if they code it as a hormone imbalance. Most insurance will cover that.

i have horizon nj though and callen-lorde is in ny. the pills i would need are on their approved list but still, i'll see what they say but i rather not spend money if i dont have to

[LordKAT]

It doesn't matter where you get the script, if the doctors will code it right, it will usually be covered. You can still fill it anywhere your insurance allows.

[Christine Eryn]

When I do have insurance (BCBS, Aetna, etc) , they cover whatever the doc perscribes, from Estrodiol to cough medicine no questions asked. I've never got any pushback from anyone either.

[Ltl89]

As Lordkat said, this usually depends on the coding and or the policy.  If the policy allows transcare, it doesn't matter how it's coded; however, if they deny coverage for transgender care, then you need to make sure it is coded as something different like a hormonal imbalance.  As for Callen-Lord, I was going to go there myself when I started my transition, but choose to go through an endocrinologist.  The good thing about them, though, is that they have an in-house pharamacy, and I've heard they are lenient for those with low income. 

In any event, I recommend you read up on your policy and see what you have.  And to play it safe, ask the people to code it right, they are an lgbt clinic, so they will likely be okay with that. 

[Umiko]

As Lordkat said, this usually depends on the coding and or the policy.  If the policy allows transcare, it doesn't matter how it's coded; however, if they deny coverage for transgender care, then you need to make sure it is coded as something different like a hormonal imbalance.  As for Callen-Lord, I was going to go there myself when I started my transition, but choose to go through an endocrinologist.  The good thing about them, though, is that they have an in-house pharamacy, and I've heard they are lenient for those with low income. 

In any event, I recommend you read up on your policy and see what you have.  And to play it safe, ask the people to code it right, they are an lgbt clinic, so they will likely be okay with that.

i would of gone through my endo but her wait list right now is june 30 so imma go through callen until my endo appointment, of course i'll give them permission to contact one another but right now, i wont last that long if i have to wait a month lol

[Ltl89]

i would of gone through my endo but her wait list right now is june 30 so imma go through callen until my endo appointment, of course i'll give them permission to contact one another but right now, i wont last that long if i have to wait a month lol

I hear you.  Neither method is better than the other.  And I've heard nothing but great things about Callen-Lorde.  Oddly enough, it was quicker for me to go through my endo than through the clinic, so that's why I did it that way instead (that and it was closer).  I lucked out though because most people have a huge wait to get in with an endo as a new patient.  In fact, June 30th is actually sort of quick compared to the waiting period other people have. 

[Umiko]

where can i find the coding for hrtf for horizon nj? i read the site and apparently i get 3 month supply every time, free next day delivery and i can order them with my script refill online so i dont have to leave my house. its super convent really though i would still need to see my endo for testing

[Ltl89]

where can i find the coding for hrtf for horizon nj? i read the site and apparently i get 3 month supply every time, free next day delivery and i can order them with my script refill online so i dont have to leave my house. its super convent really though i would still need to see my endo for testing

Well, the coding is really only a diagnosis or the explanation for why you are taking a medication.  The code explains to the insurance company why you are being treated.  I believe the codes are standard. What's important is to find out what your insurance company covers and doesn't cover.  If they don't cover treatement for gender dysphoria, make sure they code it in an acceptable way for the insurance company.  As for finding the policy, I'm sure the insurance company must have your policy online for you to look up.

[Umiko]

Well, the coding is really only a diagnosis or the explanation for why you are taking a medication.  The code explains to the insurance company why you are being treated.  I believe the codes are standard. What's important is to find out what your insurance company covers and doesn't cover.  If they don't cover treatement for gender dysphoria, make sure they code it in an acceptable way for the insurance company.  As for finding the policy, I'm sure the insurance company must have your policy online for you to look up.

well i'm sure they can get around insurance codings.

[Ltl89]

well i'm sure they can get around insurance codings.

Yes, it's been done for a lot of people here, and bet you won't have an issue with that when going to Callen-Lorde.   Usually, the insurance companies don't look too far past the code itself.  Sadly, my endo will only treat me for "gender dysphoria" so that hurt me when I was under a more discriminating plan.  It's easier to play it safe by mentioning this your doctor on the spot rather than going back and forth with the insurance companies in some battle. 

[JoanneB]

I haven't had any prob with my meds even though the insurance excludes trans related anything. Most of the insurance policies I've had for a long time now use a third party processor for prescriptions. Unless if it is something expensive and/or not on their preferred list they will balk. The pharmacy always tend to check first. Plus you can always ask them to if they don't.

They only time I've anything bounced was for a blood pressure med for my wife. They didn't want to hear how ONLY this one out of like a dozen they tried actually works.