Actually, I just got an email back from HCA...
Hello Heather-
My name is Tonja and I am part of the transhealth care team. I would like to offer you this overview of the transhealth benefit. This is general information that may answer your questions. Please read it over and email me back if you have additional questions or concerns. I will be happy to discuss specific questions with you at any time.
Hormone therapy and mental health services have been covered for quite some time. If you are covered by one of our managed health care organizations such as Molina, United Health Care, Amerigroup, Coordinated Care, Columbia United Providers or Community Health Plan of Washington, these services are paid for by them. Contact them to inquire about providers. The telephone number is on the back of your insurance card.
Other procedures, mostly surgical will be covered by Fee For Service which you may know as Provider One (your teal colored card). Here is a list of some of those services. Again these services may have specific criteria and will need to be authorized by the agency prior to receiving any service.
ü Breast reconstruction (male to female);
ü Bilateral mastectomy with or without chest reconstruction;
ü Genital surgery (male to female);
ü Genital surgery (female to male);
ü Genital electrolysis as required as part of the genital surgery;
ü Hysterectomy; and
ü Orchiectomy.
The provider of these services does need to be a Medicaid agency approved and enrolled provider.
There are different requirements depending on what service you want to have performed. For top surgery the agency requires one letter from a licensed mental health care provider, a letter from the provider managing your hormone therapy and a letter from the surgeon who will perform the surgery. For bottom surgery the letters you need are the same with the addition of a second letter from a different mental health care provider. These letters should be given to the surgeon who will then submit them along with the prior authorization request to the agency. A hysterectomy and orchiectomy only require one mental health letter for authorization.
Currently we have several surgeons contracted with the agency. The names given here are not recommendations based on care provided or provider preference. They are some providers that we are aware are transfriendly. For top surgery you can contact Dr. Thakar in Oregon at 503-413-4992, Dr. Helen James at 360-676-0972 or Dr. Stiller in Pullman at 509-338-0632. Dr. Thakar is limited on how many clients she is able to take currently. For partial bottom surgery such as a hysterectomy you can contact Dr. Katherine Lessman at 509-838-2531, Dr. Healther Weldon at 360-514-1060, Dr. Javad Sajan at 206-209-0988, Dr. Megan Bird at 503-415-4160 or Dr. Tracy Irwin at 206-744-3367. For surgeries such as an orchiectomy you can contact Dr. Josephine Hildalgo-Tamola at 206-987-1623 or Dr. Thomas Walsh at 206-543-3640 or a general surgeon or urologist contracted with the agency.
For full bottom surgery you can contact Dr. Marci Bowers in California at 650-570-2270. She is currently the only provider that does full bottom surgery.
This is not an exhaustive list of providers and it is important to know that you can see any surgeon that performs the surgery you are seeking as long as they are enrolled with our agency and the provider gets prior authorization. We will have them sign a paper that makes them a COE. We are actively working to contract with additional providers. If needed, your transportation to and from appointments for covered services is paid for. You just need to call an agency contracted transportation broker and schedule a ride. You only need to tell the broker that you are going for a transhealth appointment and no other details. If you have additional questions that your regional brokers can't answer, call our Customer Service Center at 1-800-562-3022. For comments or other questions regarding Transportation Services, email Transportation Services at
HCANEMTTRANS@hca.wa.gov. Report Medicaid Fraud 1-800-562-6906 To get started, just call the contracted provider you are interested in seeing and schedule a consultation.
We also have a website with some additional information. You can access that at:
http://www.hca.wa.gov/medicaid/transhealth/Pages/provider.aspx. It is a work in progress and is updated frequently.
Thank you for your inquiry and I hope this information helps. Please contact me by email. If needed, include your telephone number and the time it is best to call you if you still have questions and would prefer a telephone response rather than an email one. With my meeting schedule, it is usually quicker to respond via email.
Have a great day!
Tonja - RN,BSN, MN, CPC-A
Clinical Quality and Care Transformation (CQCT)
Health Services and Management
Physician Services Program Manager, Transgender Program Manager
Work hours are 7:00am to 5:30pm Monday through Thursday
Life is so much brighter when we focus on what truly matters.......
