Will hysto no longer be covered by my insurance because I changed gender marker?

[androidnick]

IAfter all these years of contemplating transition and all this research I never gave this thought. My name and gender marker have been changed. Does this mean a hysterectomy will no longer be covered by my insurance?

[PepperedIssy]

*Sneaks in...* That's a pretty good question, but that would be complete BS if that was the case. Hope it's covered, for your sake!

[androidnick]

Yeah it is crazy that I had never given this any thought. Considering I have ovarian cysts and I'll probably need to take care of this soon. I'm just kind of shocked I'd never really seen a video or heard anyone talk about this before.

[Arch]

I don't know the specifics of your situation, but I have heard of guys who got hysto covered after the gender marker change. Unfortunately, I don't know the specifics of their situations, either, but I do know that you might need to appeal a few times.

So it's not completely unheard of.

Did you have a documented history of the cysts before you began HRT?

[mm]

I think  if you have a uterus, tubes and ovaries and have a problem with any or all of them it should be covered as having a F or M in the computer or paper doesn't change what organs you physically have.

[campenella]

IAfter all these years of contemplating transition and all this research I never gave this thought. My name and gender marker have been changed. Does this mean a hysterectomy will no longer be covered by my insurance?

I was just about to pose this question and am currently trying to get info about it myself! Gender marker change for me insures my T, but no clue about hystos. They have informed consent here too so it just serves to confuse me even more about it.  Can you call your provider and ask them? While they cannot change what is inside of you, some companies are very weird about gendered care and insuring it without some sort of fight and appeals.

Good luck to you, find out your insurer's general policies and ask them about it.

[LordKAT]

I think the ruling of care can't be denied to you if it is offered to anyone else with the same policy would make it covered. You may have to battle for it though.

[tgchar21]

The reason for the hassle/denial of coverage of hysterectomies in those with a male marker (or any other gender-specific treatments for those with the opposite marker) is to help cut down on insurance fraud (trying to claim treatments that are usually not possible). Unfortunately that means for transfolk you may have to jump through hoops, but I think you should prevail as long as there's documentation that you legitimately have/had a uterus (or whatever organ may apply in your case).

[Arch]

You haven't said whether you had the cysts pre-T. I asked because I have heard of insurance companies that acknowledge that you did have those parts, but the company refuses to pay out on the grounds that HRT caused the adverse symptoms. In other words, you brought it on yourself. If you have a documented history of the symptoms pre-T, you should have an easier time. However, insurance laws keep changing. It could be easier to get this covered than it was even five years ago when I heard about the guys who had appealed and won (and I'm not sure when these surgeries and appeals happened, but the situations must have been resolved by 2009).

[androidnick]

The cysts were pre-t so yes that should be fine. And I haven't changed anything so far with my insurance company so yeah. Hopefully things work out. I don't care if I have to jump through hoops

[Hex]

I think it boils down to what insurance provider you have and how diligent you are. I've also heard that it's easier to get the hysto before the gender marker change and becomes more of a nagging hassle afterwards just because you have to speak with both your dr and insurance and convince them both to send and get the needed information to prove you have those organs and they need to be removed even if your gender says otherwise.
Best to call your insurance and try to explain your situation and see what they have to say on the matter. You might need to also push to speak to a higher up seeing as normal representatives usually don't have all the answers for situations such as these and or are just taught to read from their screen prompts.

[sneakersjay]

I know a lot of guys who got it covered after their documents were M.  I also don't know the specifics; I was very early in transition when I had mine done so still had the F marker.  I also waited and left the F marker on my insurance (even after my documents were M) so I could get that last mammogram before top surgery (required by my top surgeon).  Fortunately at that time they didn't want to see my ID along with the insurance card like they do now.

[aleon515]

It's illegal to do that. According to the ACA (doesn't matter how you got your insurance) says that basically whatever is a human procedure is covered for anyone regardless of their gender. That doesn't mean they won't attempt to give you trouble for it. There is somewhat of a law that the default position of insurance companies is refusal. I am guessing you will have additional hurtles to jump thru.

--Jay

[BGking]

It's illegal to do that. According to the ACA (doesn't matter how you got your insurance) says that basically whatever is a human procedure is covered for anyone regardless of their gender. That doesn't mean they won't attempt to give you trouble for it. There is somewhat of a law that the default position of insurance companies is refusal. I am guessing you will have additional hurtles to jump thru.

--Jay

Hey I thought the same thing but upon some research from my understanding; the ACA just protects people against dropping a member from insurance or not giving you insurance due to gender identity or anything of the sort discrimination-wise. I thought the very same thing but apparently insurance companies still have the right to deny coverage to gender transition related things. I am going through the very same thing at the moment. I got my insurance through the ACA and they denied all forms of T to me until my gender marker was changed. Which, very thankfully, it is and the process was made simpler. So if that were the case what they were doing would be illegal. I have a feeling I'll be running into the same problem now that my marker is changed when I try to get my hysto covered in a year or so. Please let me know where you found this information because if it is true I will have to use it against my insurance's crappy discrimination regarding coverage for T.

[CR]

Nearly impossible.

[mac1]

I think  if you have a uterus, tubes and ovaries and have a problem with any or all of them it should be covered as having a F or M in the computer or paper doesn't change what organs you physically have.

I would hope that is the case. They should have to cover the medical conditions and parts which you have.

[aleon515]

I would hope that is the case. They should have to cover the medical conditions and parts which you have.

They do *have to*, according to the ACA (as well as morality) but might be a fairly good fight. I've seen people win them but it takes awhile. But hysto is still in it's own little category.

BGing, a lawyer friend of mine who has worked on this says that this *is* the case with the ACA (that do have to cover this-- but here are the provisos). What they are NOT required to cover is SRS/GCS.  So in that case you are correct. They don't need to cover transition related expenses, and haven't been required to. But a medical necessary procedure (i.e if they can think of a non-transition reason to cover it), yes they have to cover it, regardless of your gender marker. But they won't necessarily cover a hysto if the only reason is for your transition in some way, regardless of your gender marker. A lot of doctors can cleverly code this one, as there are so many reasons that this is done.

I think this would apply to things like screening mammograms (the kind FAAB people get), pap smears and so forth.

--Jay

[Sebryn]

They don't need to cover transition related expenses, and haven't been required to. But a medical necessary procedure (i.e if they can think of a non-transition reason to cover it), yes they have to cover it, regardless of your gender marker. But they won't necessarily cover a hysto if the only reason is for your transition in some way, regardless of your gender marker. .


--Jay

Exactly this according to a lawyer friend I have locally who only deals with medical insurance companies and the more recent changes. If you have official medical documentation that proves you had conditions before starting HRT and before marker changes it can be easier to convince the insurance you're the same person you were prior to the legal changes and that you need the procedure.

[CR]

You guys make it sound like a walk in the park.  It is not.  I've been dealing with mine for over a year.  I had no prior documentation though.  Everything is denied because the genders don't match.  There really is no way around it if you have no previous documentation and they even coded it as a problem.  I even had it pre-authorized.

[campenella]

You guys make it sound like a walk in the park.  It is not.  I've been dealing with mine for over a year.  I had no prior documentation though.  Everything is denied because the genders don't match.  There really is no way around it if you have no previous documentation and they even coded it as a problem.  I even had it pre-authorized.

I think everyone has been very pragmatic about the outlook and telling the O.P. his options. All insurance companies handle it different and different states offer different things/deal with it differently. I'm sorry that you've been having so much trouble with it though. I wish you the best of luck with your appeals.