PCOS Causing Medical Conditions—Grounds For Insurance To Help Cover Hysto?

[Brayden]

I have been on T for 3 years now.
My doctor figured out that I have become resistant to insulin as a result of PCOS and has put me on medication to help with maintaining a healthy blood sugar level when without the meds my blood sugar runs abnormally low, and am considered to be pre-diabetes. The insulin resistance was caused by the PCOS, not by diet, though diabetes does run on one side of my family.

Has anyone been in a similar situation where PCOS has caused not only pain but has caused another condition or other troubles?

I would like to get a hysto at some point and I am wondering if have PCOS that is causing other medical conditions is grounds to have insurance help pay for the cost without it being considered a sex change operation.
I have medical mutual and the plan I am on does not cover anything related to being transgender, at least not yet.

My fear is leading to type two diabetes and am wondering if a hysto would help with not only the insulin resistance to decrease chances of leading to diabetes but to also help with discomfort and cramps.
Have you had similar experiences?

[Sigyn]

Read your policy carefully. Most policies have a "catch all" statement that will cover surgeries that are 'medically necessary'

I would talk to your endo and your surgeon to obtain letters from them to state that it is their professional opinion that a hysto would be medically necessary in order to protect your health regarding the diabetes. Submit COPIES (keep the originals) to the insurance company with the claim.

Should they not pay, you may want to consult with an 'insurance bad faith' attorney in your local area. Most of them take whatever case they do 'on contingency', meaning that they take a portion of the settlement, or mandatory attorney fees.

[Dex]

I had PCOS and endometriosis since (my first) puberty. I didn't have the insulin issue, but did have pain, adhesions throughout my abdomen, and large cysts. I struggled with that for 15 years prior to ever starting T. I had multiple work ups (ultrasounds, CTs, 2 laparoscopies to remove adhesions and cysts that didn't resolve on their own). Once I started T, I had hoped it would take care of a lot of those issues but unfortunately, I still had pain daily. My doctor referred me to Ob and I met with a really great doctor who said that since I am on hormone replacement already and had had so many interventions over the years already that she thought hysterectomy/oophorectomy would be a good solution (provided I had no plans to go off of T in the future). She submitted it to insurance as being medically necessary because of my history and my continued pain despite a variety of treatments. I didn't have any issues with my insurance covering the surgery but I did have that solid paper trail supporting that it was a long standing issue for me (which it sounds like you do as well). I would say it is definitely worth asking about and looking in to.

[HeyTrace19]

Yes, a good ob/gyn surgeon should be able to get the surgery covered for you.  You can begin by getting a referral from your doctor to a surgeon who may be 'in the know' about this issue.  Make an appointment for a consultation to discuss your concerns and learn how they may go about coding the procedure for you.  Try more than one surgeon if you need to...but somebody will find a way!