Feeling Devastated - Insurance and SRS

[Stella Sophia]

Hi ladies,

I have a really nice insurance plan through work and previously for 2015 we were covered for SRS. I found out we had some changes done this year and I just found out SRS is no longer covered. I am feeling pretty devastated and have no idea what to do. I was going to be full time for a year later this summer so was hoping to have my surgery this year. What can I do? I don't know how I am going to save up for something so massive nor do I really want to go to Thailand which is still very expensive. What do you ladies recommend?

Thanks in advance.

A very depressed Stella

[Dena]

I have two not so hot thoughts. The first is like me, you may need more than one year of RLE. All totaled I was 2.5 years because I lost my job and needed to rebuild my funds. The second is for many years I carried two insurance policies. One policy was pretty cheap and I got it young. The reason for two policies was because I was out of work often enough that I needed health insurance to span the time when I was out of work.

Of corse, if you are out at work, you can talk to the management and see if they are willing to stand good for what they messed up. They might be willing to provide the part of the money the insurance policy would have covered.

[Stella Sophia]

Work changed insurance providers so they wouldn't be willing to negotiate anything as my company is a really large fortune 100 company and wouldn't make a work around like that. I have a lot of debt I may just file bankruptcy and save up for the next few months for Thailand..

[Emjay]

Wow, I'm so sorry about that. 

I'm not exactly sure if mine will cover it or not.  I'm on my wife's policy and haven't really looked into it yet.  I *think* it does but just haven't confirmed.  Her premiums are much more affordable than what my employer offers so that's what we went with.  I know the insurance offered through my employer does cover it so at least that's an option (when open enrollment opens up again at the end of the year).  I don't know your relationship status but could that be an option?

Insurance plans do change from year to year.  Could you advocate with someone that it be changed for the next years' coverage?  I know that sucks as an option but it would still be better than trying to come up with that much money all at once.  I know I couldn't do it in just one year, even without any other bills to pay.

Me personally, I would be very cautious about bankruptcy as an option.  I have debt too but I also have spent a lifetime building credit and would hate to lose all of that if there were any other option.

[Stella Sophia]

Thanks for the reply Emjay. I might just have to hold my breath and hope for the best next year. I am currently going through a divorce so I am on my own in that regard. Well my credit sucks already so its not like I am going to lose much of anything.

[Dena]

Work changed insurance providers so they wouldn't be willing to negotiate anything as my company is a really large fortune 100 company and wouldn't make a work around like that. I have a lot of debt I may just file bankruptcy and save up for the next few months for Thailand..

You simply tell personal that the change made them LGBT unfriendly and let them worry about it.

[Stella Sophia]

You simply tell personal that the change made them LGBT unfriendly and let them worry about it.

I suppose its worth a shot I'll schedule a meeting with my HR rep and run this by them. Thanks

[Jalynn]

Just do the right thing. Bankruptcy probably should be avoided just on principal.

[Mariah]

Definitely contact them because in some states they can't intentionally avoid covering it if they do it for anyone else in any form. I.E. corrective procedures after birth. Hugs
Mariah

[XKimX]

Medical insurance is regulated by states.  In some of the more liberal states, like California, the regulators have decreed that gender surgery may NOT be excluded in any policy sold in that state.

Also, any insurance policy issued under a state health insurance exchange under Obamacare may NOT exclude gender surgery.

It may be a disrupting nuisance to move to another state for its in insurance coverage, but it is a way to save a lot of money and reach your goals earlier.

[JLT1]

Most of the fortune 100 companies carry an HRC raiting.  To get a 100, the have to cover transgender surgeries.  Check on your companies raiting.  If it is 100, there will be someone  in charge of keeping that.  Find them or talk with HR.

Second, most fortune 100 companies are self insured and tey use an insurance company to run the paperwork.  It is probable that someone dropped the ball in your company.  Again, talk to HR once you find out the HRC score and if you are self insured.

I can help with this.  You may PM me.  I, too, work for fortune 100 company. 

Hugs,

Jen

[KarynMcD]

Also, any insurance policy issued under a state health insurance exchange under Obamacare may NOT exclude gender surgery.

That is incorrect. There are only 10 states where that is true.
http://www.hrc.org/state_maps
(Choose Transgender Healthcare from the issues menu.)

[WendyA]

Also, any insurance policy issued under a state health insurance exchange under Obamacare may NOT exclude gender surgery.

That is incorrect. There are only 10 states where that is true.
http://www.hrc.org/state_maps
(Choose Transgender Healthcare from the issues menu.)

If it is true or not has nothing to do with state laws.  @XKimX is referring to federal law that applies to all state run health exchanges under the Affordable Care Act.  Mind you, I have no idea if what she states is or isn't true.  I just know it has nothing to do with state laws.

[KarynMcD]

There is NO federal law regarding transgender care being covered.

[Stella Sophia]

Thanks ladies, I have started speaking with my HR rep about this today, i'll keep you posted.

[WendyAnn.1969]

Thanks ladies, I have started speaking with my HR rep about this today, i'll keep you posted.

I was able to work with my HR benefits director at my Fortune 500 company where GRS was flat out excluded.  Let's just say we 'came to an understanding' and they are doing an override for my procedure and will also consider future cases - based on mine. [emoji4][emoji56]

Do NOT give up.  This is medically necessary. How many of your physicians will write letters for this? I had 3....in addition to the 3 normal referrals.

Good luck!

[archlord]

Or do like some transwoman did.. move to Canada/Quebec,  get your nationality and enjoy the covered SRS after 1 year full time.

Maybe not the best but if you dont have any other solution

[KarlMars]

Or do like some transwoman did.. move to Canada/Quebec,  get your nationality and enjoy the covered SRS after 1 year full time.

Maybe not the best but if you dont have any other solution

So are you saying if someone gets citizenship in Canada than they can SRS for free after they lived there a year?

[archlord]

Well... i am aware that it has been done for transwoman that moved from brazil to canada/Quebec because she was living discrimination/violence there and after she got her citizenship... well she is citizen of canada so same laws protect her and she benefit from the RAMQ( Régime Assurance Maladie Québec ) system like anyone that live here or any immigrant that earned citizenship.. She had her SRS after some time. They allowed 25 000 immigrant from Syrie and they all will benefit of same thing i do..

Be warned that you cant just get your citizenship, you need to live here in canada/quebec for the time required ( at least)  You cannot have an appartment there and fake the system.  I dont think many person would do this.. it is hard decision to take .. Leaving everything behind but if you can do it  and it is the only viable solution for you then why not.

[KarlMars]

Well... i am aware that it has been done for transwoman that moved from brazil to canada/Quebec because she was living discrimination/violence there and after she got her citizenship... well she is citizen of canada so same laws protect her and she benefit from the RAMQ( Régime Assurance Maladie Québec ) system like anyone that live here or any immigrant that earned citizenship.. She had her SRS after some time. They allowed 25 000 immigrant from Syrie and they all will benefit of same thing i do..

Be warned that you cant just get your citizenship, you need to live here in canada/quebec for the time required ( at least)  You cannot have an appartment there and fake the system.  I dont think many person would do this.. it is hard decision to take .. Leaving everything behind but if you can do it  and it is the only viable solution for you then why not.

I love my home in my state in USA. Where I live is not a good area for trans people though. From the resources I've heard that are available in my state I would have to travel 4 or 5 hours away and stay in cheap motels every time I get something done. It feels great to stay where you're used to.