Blue Cross / Blue Shield Insurance

[Denise]

Does anyone have any experience with BCBS insurance and their requirements for coverage?

Specifically something I just read has the order of transition being:
1) diagnosis of Gender Identity Dysphoria [sic]
2) living as the other gender
3) hormones
4) surgery

I want to start hormones and live as Male until I can't any longer.  Anyone have any insight?

[JoanneB]

In NJ with Horizon BCBS there was some initial BS I went through getting them to approve my estradiol because "I was a male" the pharmacist told me. Under Aetna there wasn't even a blip. It took a "Doctor to Doctor" call in order to get it approved. Living in role certainly is not a pre-requisite for HRT.

The big question to ask/research is does your policy not exclude any TG coverage? Yes, they may write polices that do. It does not mean yours does. Finding that out used to be easy back in the day when you got the policy booklet detailing all that fun stuff. The past few years getting a hold of that level of detail in writing is difficult

[FTMax]

It will probably vary by state, and sometimes within states depending on what kind of plan it is. My coverage was very different under the BCBS Federal Employee Plan than it is now under a BCBS marketplace plan for DC. If you don't know and can't tell based on the information you have, it's best to call or write to them and ask.

[Denise]

My policy does include Transgender Services.  But I'm getting mixed messages from the service line.

Here's the 411 on the coverage:
The summary:
Transgender benefits: (as written)
   If diagnosed with Gender identity Dysphoria, members can be considered for benefits which will follow the guidelines designated by the World Professional Association for Transgender Health, Inc.  This benefit will require a predetermination and is subject to review.

The details are:
http://www.medicalpolicy.hcsc.net/medicalpolicy/activePolicyPage?lid=iggh37jn&corpEntCd=IL1

[kelseygal]

Well, as far as Transgender coverage goes, I'm pretty sure it can vary by state. Being in California, I simply went to a therapist who was able to 'diagnose' the GID and write a letter stating such, then I brought said letter to a recommended doctor, the doctor provided a prescription for testosterone blockers, and I picked them up from the pharmacy, no problem. I will be prescribed estradiol patches in a few weeks, but I presume it will be pretty smooth. Again, this is going to vary by state - I'm sure CA  is one of the more open states, but I really dont have any info to back that up. But check this site out has more relevant info by state IIRC:
http://transgenderlawcenter.org/

J

[Rebecca Perez]

Not sure if this is in line with the topic but does anyone have a list of in-network provider for Blue Shield/Blue Cross? I think Bowers does but she is so backed up right now. The out of network coverage is horrid. I was gonna go to Sinclair but found out he was out of network. The good thing is that he has openings the bad things is that the surgery would still cost about $18K

[kristincardigan]

Depends on state and which BC/BS subsidiary you have. For example two different subsidiaries: I now have Independence which covers HRT, top and bottom surgery. Yay! When I had Anthem I had to fight just to see a therapist and they had a by-line that was anti trans. Boo! I would check with them, tbh.


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[Britney79]

I live in the Midwest and have BCBS and have had no problems. It may differ from state to state my company is located in Oklahoma and so far its been relatively easy for me.

[Debra]

I've had several different insurances over the years but when I was 'diagnosed' with GID, my ins didn't cover that particular diagnosis so my therapist had to add on other things like 'adjustment disorder' which was of course still appropriate as well.

As for meds, whatever diagnosis codes my doc used, the ins always paid no questions asked. I may have gotten lucky and/or the doctors knew which ones to use.

[StephanieMI]

PJ  I live in Jacksonville Fl and have been transitioning for the last two years.  My Blue Cross and Blue Shield coverage has paid for my pschological evaluations, my hormones and all blood work in preparation for my GRS coming up this June.  Even paid for speech therapy.  Of course I had to pay the co-pays for everthing, but I have been pleasantly surprised for the coverage.  I must say my primary doctor and other professionals I have interacted with have all worked with me as far as finding an appropirate medical code in order to obtain coverage.  If they only covered the GRS and breast augmentation.  Then again, I am very grateful for what has been covered.
My best wishes for you,
Stephanie