Quote from: lilangel on December 07, 2015, 10:39:39 PM
SNIP
I'm on my insurance plan with Aetna through the company my dad works for, and I saw someone on here say that Aetna told them to talk to the company because their general guideline doesn't get too specific and that the employment company might cover what insurance can't or something like that?? My dad wants to see if his company can cover it, but who can he talk to or how to even word it? He's afraid he'll get on the phone with someone who doesn't understand what he's talking about. Is this a possibility anyone has made happen?
He should contact HR and ask for the person who deals with health insurance questions. Depending on the size of his employer it may be someone who works for his employer, if it a large company they could have onsite representative from the insurance company. There should also be a detailed explanation of benefits available to him. They should have a process to pre-approve what procedures you need. This requires your chosen surgeon to fill out the pre-approval form for you and send it to the insurance company.
Another note, insurance coverage is not universal across all employers. It is the employer who decides what is covered in the insurance they provide to their employees. Anything not specifically required under ACA ( AKA ObamaCare ) or state law is left to employer discretion. Another note, if the company is large enough they may self insure, which means they use a health insurance company as the administrator, this allows them to have even more control over what is covered. My employer self-insures, BCBS and United Health administrate the plan, but the coverage is the same between the two.
Hopefully your father's health insurance covers your medical procedures. Remember if they don't specifically exclude specific trans related procedures, they could still try to deny it as cosmetic surgery. This is when you have to be ready to appeal.
