Insurance Covering Surgery

[bumble]

Hello,

I just got a response from my insurance company in question about my FFS and SRS. Anyone know what exactly it means? I'm a little confused... Also, do you think I should try and see if they would cover my top surgery as well. Or is that a waste since it is cosmetic? Does my doctor submit a claim to my insurance company? Sorry this is all new to me. I rarely use my benefits. Below is the message I received from them:

Thank you for taking the time to contact me. I hope your day is going well. I received your message about coverage for gender reassignment surgery and will be happy to look into this for you.

Gender Identity Disorder and surgery is covered under this plan. Your plan pays 50% of eligible expenses after satisfying the $1,800 deductible. Benefits are payable up to $75,000 for the lifetime of your plan. For surgical procedures, the facility charges such as room & board are also included in the maximum. Gender Identity Disorder Surgery does not apply to the out of pocket maximum. Surgical Procedures are covered at In-network providers only. Your normal plan benefits apply. You can have your doctor submit a notification for whatever procedure you are interested in for United Healthcare to review. Your current Health Reimbursement Account balance is $1,881.69.

[Cynobyte]

Hello,

I just got a response from my insurance company in question about my FFS and SRS. Anyone know what exactly it means? I'm a little confused... Also, do you think I should try and see if they would cover my top surgery as well. Or is that a waste since it is cosmetic? Does my doctor submit a claim to my insurance company? Sorry this is all new to me. I rarely use my benefits. Below is the message I received from them:

Thank you for taking the time to contact me. I hope your day is going well. I received your message about coverage for gender reassignment surgery and will be happy to look into this for you.

Gender Identity Disorder and surgery is covered under this plan. Your plan pays 50% of eligible expenses after satisfying the $1,800 deductible. Benefits are payable up to $75,000 for the lifetime of your plan. For surgical procedures, the facility charges such as room & board are also included in the maximum. Gender Identity Disorder Surgery does not apply to the out of pocket maximum. Surgical Procedures are covered at In-network providers only. Your normal plan benefits apply. You can have your doctor submit a notification for whatever procedure you are interested in for United Healthcare to review. Your current Health Reimbursement Account balance is $1,881.69.

They will payfor 50% of the procedure, after you pay the first 1800.  Now, id ask if that is, you have to pay 1800 the beginning of ech surgery.  So, lets say you want  boob job, im just quoting since I was looking.  The cost is 4500, so you pay the first 1800, now that leaves 2700, now they would pay 50 percent of that which they only pay 1350, and you pay 3150.  Now you have to first find a dr that is on their list..  usually you have to call them, and they will give you a list of drs..  usually not the one you want..

Hope this helped;)

[KristinaM]

I have United Healthcare insurance as well, so I'm intrigued to know about your findings.  This sounds similar to my understanding of my policy as well, but I'm not really sure of the details.  My HR department will be looking into our coverage to make sure I'm covered (yay! go them!) like I need to be, but I'm not really sure what that means either...

[teddybear_zach]

They will payfor 50% of the procedure, after you pay the first 1800.  Now, id ask if that is, you have to pay 1800 the beginning of ech surgery.  So, lets say you want  boob job, im just quoting since I was looking.  The cost is 4500, so you pay the first 1800, now that leaves 2700, now they would pay 50 percent of that which they only pay 1350, and you pay 3150.  Now you have to first find a dr that is on their list..  usually you have to call them, and they will give you a list of drs..  usually not the one you want..

Hope this helped;)

you actually gave a pretty accurate example. one correction: the deductible is paid only once per year. so after paying 1800 of her own medical costs in the policy year, the insurance will start kicking in to pay 50% of everything else for the rest of the year.