Gender change and insurance implications

[HappyMoni]

I couldn't find a post addressing this, so here goes. I have a legal name change. I plan to change name and gender with Soc. Sec. and MVA and eventually birth certificate. My question, if anyone has any thoughts, is that when I inform my health insurance company, do I stay away from the gender change issue. I will still have a prostate. Does any claim for that issue then get rejected based on now being a female? Is it better for them to see me as male with a gender confusion situation? Not a fan of keeping any male identity, but wonder about how confusing versus the benefit of changing it.
Moni

[Brooke]

I believe that once there has been a legal gender change that is when it's necessary/time to change gender with insurance (in my case both medical and auto).

In many states they will consider you a specific gender if you have proof of appropriate chromosomes or have had gender reassignment surgery.

They are not concerned with a remaining prostate as removing it can lead yo further complications (urinary incontinence comes to mind) and can decrease sexual pleasure ..

Think of legal gender as confirmation that your have A. Fully transitioned and B Need access to some or all services and treatment typically given to cis females.


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[Brooke]

And of course the rates for auto insurance are different for male and female. Actually just got asked about that yesterday by my auto insurer- for calculating rates.


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[JoanneB]

There is no overall universal answer. Much is in hazy legal territory. Most issues come up in the FTM world where a lot of required health care gets denied because of gender markers. Most males don't have a need to see a gyno.

If you have anything other then government supplied insurance then each provider has their own rules or guidelines and each plan perhaps exemptions. I ran into this 2 years ago with my work insurance. Aetna had no prob with my HRT. Blue Cross denied me on Gender. Eventually I got it approved, but for only a year. Went through the same hassle this year. Even bigger since it took 3 months and not 3 days. Nothing says panic and depression like being jerked around for your meds and eventually running out having to pay the full price

[Deborah]

I was a licensed medical insurance agent in Georgia for a short time a couple of years ago until I was able to get a job that actually included making some money.  At the time, I was taught that the rule was that a sex change would not change gender for insurance purposes.  This may have changed by now and the rules may vary by state.   

[Lady Sarah]

My health insurance rejected a claim for my orchiectomy after it was done. The doctor had to include notes upon resubmission. It can be tricky to be female, with male parts. Your doctors just have to know how to submit claims correctly when there is an anomaly as it pertains to your gender.

[Brooke]

My health insurance rejected a claim for my orchiectomy after it was done. The doctor had to include notes upon resubmission. It can be tricky to be female, with male parts. Your doctors just have to know how to submit claims correctly when there is an anomaly as it pertains to your gender.

I believe now with the new ICD10 billing codes its much easier to get granular in billing. I've heard some weird ones like "second in-office follow up for shark attack laceration"

In any case there are also several billing codes that can bypass the initial rejection that would normally be associated with misgendered care.


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