Obamacare coverage

[carrie359]

I am hoping when open enrollment starts November 15th I can find a carrier who does not exclude SRS since I plan on doing it in 2015.  My current coverage with BCBS does not cover it and specifically excludes it.
I am in Oklahoma.. not sure any of the plans I pick from will.
If anyone has tips on this let me know..
I do know someone who is covered but they are a federal employee..
Carrie

[LordKAT]

You could move to a state that requires it to be covered. You have 5 states and DC to choose from.

[Jessica Merriman]

Carrie I am in Oklahoma as well. The problem really isn't trans care is excluded, it is no surgeon will take it. I have applied to every single provider of SRS in the U.S. Even though Medicare and insurance will cover it, they do not accept it. I have been turned down by every single one of them. Private pay is still the only way so even if you get coverage for it they will not take it. 

[LordKAT]

Carrie I am in Oklahoma as well. The problem really isn't trans care is excluded, it is no surgeon will take it. I have applied to every single provider of SRS in the U.S. Even though Medicare and insurance will cover it, they do not accept it. I have been turned down by every single one of them. Private pay is still the only way so even if you get coverage for it they will not take it. 

Also not accurate. While that is true for medicare, it is not true for ACA plans.

[Jill F]

Also not accurate. While that is true for medicare, it is not true for ACA plans.

If you happen to know, can you please tell us if there are any surgeons that actually take insurance?  That would be awesome.  I've personally been met with a lot of "NO!", and am starting to think it's a lie.

[Mariah]

Jill, Group Health (in Washington State) works with Toby Meltzer, MD, who performs all genital surgical services at the Greenbaum Surgery Center in Scottsdale, Ariz. 
I don't know if he is aligned with other insurance companies, but you can ask and find out.

Mariah

[Jessica Merriman]

I will keep my worthless information to myself from now on. I have to go delete all my turn down E-mails. Sorry I bothered you all. 

[LordKAT]

I agree that too many of them won't take insurance at all. A number of the insurance policies will reimburse you to a point.


I think I need to clarify. Medicare has taken down the ban on trans health coverage. ACA has not made trans health care have to be covered. If a plan includes trans health care and the doctor has agreed to take that insurance plan, they cannot refuse to cover it.  That is a big if. ACA plans may cover SRS, but don't have to except in the states where laws were made to force them to cover it. Medicare, on the other hand, is no longer allowed to simply say no to coverage. Doctors won't deal with Medicare due to the small payment they receive. ACA plans already have a network of doctors who take the insurance.


I know it may be hard to understand the difference, but it is huge.

Obviously, not all doctors have an agreement with all insurance policies. You have to first find an insurance that will cover it, then go through the list of providers to find a doctor that you can use. In at least some cases, if a doctor isn't within the network that covers the procedure needed, the insurance will have to pay in network costs to an out of network provider.

It is still a lot of work on your own to find the right insurance and then a doctor that you can work with.

[Eva Marie]

Doesn't Marci Bowers take insurance?

Maybe what i've been told is wrong?

[LordKAT]

I've heard conflicting stories on M Bowers taking insurance. That would take at least a phone call or email to find out.

[carrie359]

Jessica pm me anytime .. open enrollment starts in November.. I am already on obamacare but was going to start looking at other providers... but don't want to pay higher premiums for nothing.. lets keep in touch on this in Oklahoma...

Ok well not as simple as I thought it might be.. I was hoping that if through obamacare I find an insurance provider that does not exclude srs that I was good to go.. even if premiums were higher.. I suppose I should still pick a provider with low premiums and just go out of pocket..
I really want to pick my doc anyway so if it is also complicated by provider networks then it even gets more tricky.. its a big surgery and I want to pick.
Damn.. suppose I will have to start really counting my pennies..
If I am lucky and don't need FFS that will be helpful... I really want SRS next year.. for sure..
Carrie

[carrie359]

Ok so lets say I could move anywhere in the country if I want to.. just for one year so I can get SRS paid for..where would you move?
I do have a way to set up residence in Colorado really easily... In fact I could be in Colorado before end of this year...and I know they require all insurers to cover srs..!
Does the doc have to live in the state I get Obama care coverage in..

What strategy would you use to do that.
I could rent my house here and just move.... just like that!!
I am thinking I would have to move and have a residence set up renting in that state before the new open enrollment ends..
Carrie

[Jill F]

I've heard conflicting stories on M Bowers taking insurance. That would take at least a phone call or email to find out.

From Marci Bowers' website:

Dr. Bowers accepts all major insurance plans, and are in network with most insurance companies.

If you are being seen in the clinic for a consultation, annual exam, or other office visit, please bring your insurance ID card. You will be responsible for any coinsurance.

If you are having a surgery or procedure, we will likely need to obtain pre-authorization from your insurance company. You will be given specific paperwork and instructions to allow us to complete the pre-auth. Please call the office with any questions at 650-570-2270.

From Curtis Crane's website:

Payment: Brownstein & Crane Surgical Services does accept major credit cards, however there is a 3% fee for their use.  Care Credit is a financing company that the office also accepts.  Information about Care Credit can be found at www.carecredit.com.

Insurance: Dr. Crane and Dr. Satterwhite are two of the few trans surgeons that are currently accepting insurance. Due to the high volume of requests, we find it necessary that you provide our office with a copy of the front and back of your insurance card along with the letters of recommendation required by your specific insurance company prior to scheduling surgery. Our office will verify if your insurance plan includes trans benefits and we will submit your letters of recommendation along with a letter from your surgeon to your health plan.

Our office does not currently accept Medicare and if the surgeons are out of network with your insurance plan you may be responsible for the surgeon's fee prior to surgery. Our office will always submit for prior authorization in order to try and obtain reimbursement for patients postoperatively.

The scheduling fee for facial feminizing surgery and breast augmentation is $500.  The scheduling fee for vaginoplasty is $1000.

From an outdated article on another trans* website re: Dr. Gary Alter:
From a reader in 2005:

Dr. Alter's office confirms they will accept AETNA insurance for SRS and have done more than once in the past.  AETNA only offers plans to groups.  Pre-ops who own their own corporations of two or more may be able to switch their health insurance to AETNA.  Travis will add a "rider" to the plan that explains what specific surgeries, therapies, check-ups and medicines the insured will expect to have.

I had my orchi with Dr. Alter.  They said that they spent so much time trying to get paid a fair price for what they do from insurance companies that they had to essentially give it up.  They try once, usually get told to get lost, and that's it.  Getting reimbursed fully or partially is up to you (good luck!).  For me, my out-of-network deductible was $1000 more than my surgery.

Anyway, it seems this can theoretically be done, but they've put up a pretty serious obstacle course for you and plenty of "gotchas" that must be successfully navigated.  Because my insurance stipulates that it has to be done within the State of California, these doctors are my 3 options.  If I want to have it at least partally covered, I apparently need to start the ball rolling by fighting with the insurance company pretty far in advance, not taking their first several offers and possibly even lawyering up.  When paying the surgeon is less money to them than paying their lawyers to fight you after you have all of your ducks in a row, you will finally win. 

[carrie359]

Well,
I plan to move to Colorado.. I know they require all insurance companies to cover SRS.. so I just need to pick a doctor first then pick the provider they like the most right??  then I should be good to go... seems to simple.. but I already have a place rented starting December.....so plan to get a DL and apply for insurance through a Colorado exchange... Already talked to a doc in California and they said they take BCBS and United..
Something seems to easy .. hmmmm..
Carrie