Yet another insurance question

[michelle666]

I started a new job(yay!!!!!!) at an awesome company this week. They use TriNet for their benefits and my choices are Aetna and Tufts Health. I called today to make sure that there were no exclusions because supposedly in Massachusetts, its now illegal for carriers to exclude trans treatments and according to the person I spoke to, the policies cover no trandgender services at all. Can they do this even though Massachusetts made it illegal to exclude us? Does anyone else here have benefits through Trinet in Mass and use Aetna?

[mrs izzy]

Contact the company HR and make sure they are up to date.

You can also contact the States health administrator and ask them why these two companies are allow to sell or give policies in your state that still hold exclusions.

[michelle666]

Contact the company HR and make sure they are up to date.

You can also contact the States health administrator and ask them why these two companies are allow to sell or give policies in your state that still hold exclusions.

Thats the problem, TriNet is my HR, the company outsources the benefits to them because we're a startup.

[jeni]

I googled and found this (http://thinkprogress.org/lgbt/2014/06/20/3451591/massachusetts-transgender-health/). If that is the latest, it does certainly seem to indicate that the Division of Insurance says that medically necessary treatments, including surgeries, need to be covered.

It is described as "guidance," however, so I suspect that this is not a binding decision the way a court finding would be. This is, I believe, the executive branch defining how it is going to interpret and enforce the law. It could conceivably be the insurer's plan to press its luck and hope nobody notices this. However, that's just my non-lawyer guess at what might be going on.

It might be more plausible that the person you talked to was clueless. Can you obtain the official list of exclusions? (I don't know what it's called.)

[michelle666]

So the person I takled to was clueless. I called back and got through to someone who knew exactly what was going on. He walked me through everything and we were in the phone for well over an hour. We figured out which plan I need to get so I can be covered for surgery with Marci Bowers. It seems that she accepts Aetna, but not all plans in Aetna. It's mainly the PPO plans. He emailed me a document of what guidelines need to be met, which is basically the wpath guidelines. But he ended up being extremely helpful with it all. I'm glad I called back.

[jeni]

Yay! I'm really glad that your perseverance worked out (and that the company employs at least some caring and competent people).