Insurance Advice

[translora]

Does anyone else have experience with a high deductible medical plan when it comes to gender therapy?

I used to have a $25 co-pay per session, but then our insurance changed. Now I have to pay the whole amount -- $150 for each session -- until I've spent $3500 for the year, after which the insurance picks up 100%.

But we don't have that kind of money laying around, which makes it darn near impossible for me to even consider resuming therapy.

I know that every plan is different, but I'm really feeling stuck, and looking for ideas on reducing this cost.

Thanks!

Lora

[LShipley]

Have you checked with your employer for insurance options? I think you have to jump if you want anything changed before the next year.

My employer offers a premium insurance that caps out lower for deductibles but costs an extra $60 a month for the insurance. So it kind of depends how often your sessions are.

I'm not sure what your costs are annually but unless something goes wrong I have no chance of hitting my deductible on either plan unless I have a procedure.

The other option is speak to your doctor for self pay options.

[translora]

We have only this specific option available to our family. And it actually should work well enough for most other medical expenses we might have.

But it definitely discourages any medical treatment which isn't absolutely necessary. Sadly, I can probably survive without therapy -- and any other transgender-related expenses, which I've just discovered are specifically excluded by the policy.

I think I'm screwed on this one.

Lora

[FTMax]

Yes, my deductible was much more than I could afford if I would've had to pay for therapy.

What is the goal of therapy for you? Are you actively needing it for mental health or are you just looking for a referral for HRT?

If you're just looking for HRT, you could do some research into informed consent options that would help you bypass the therapy requirement. Some Planned Parenthood locations offer this. Most LGBTQ clinics offer this. Sometimes you'll find individual general practitioners or endocrinologists that do as well, but they're a bit rarer. The benefit of finding a Planned Parenthood or LGBTQ clinic that you could go to is that they usually operate on a sliding scale. So you could potentially not worry about insurance at all.

If you think therapy would actually be helpful, you could consider doing online therapy. An online therapist can still write a referral for medical transition stuff, but is usually cheaper. My copay for a traditional therapist was $75. I bought a package with an online therapist for 6 sessions and a referral letter for $320.

[translora]

What is the goal of therapy for you?

That's a question that I need to think more about. I've realized for a few months that my mental health is in a somewhat precarious state. I'd say that about 70% of that is related to gender identity, and the rest is about issues of middle age. That number shifts around. It's a thick soup.

I had something of a crisis moment last summer, related to my futile and discouraging search for meaningful employment. My self-worth plummeted, and I fell into a spiral of negative thinking. When I put it all into some despondent, self-critical words one day, my spouse couldn't believe what she was hearing, and said that I needed to get help. She suggested that I could probably benefit from a low dose of anti-depressant like she takes.

But my first thought was just to get back to therapy and try talking through it. A while back I decided to take a hiatus from therapy because I had begun to spin my wheels a bit. At the time I didn't feel ready to take the obvious next step that my therapist was suggesting -- starting on a low dose of hormones. It felt like too much since I have no real prospect of social transition.

If I went back, it wouldn't be with HRT specifically in mind, though I'm more open to it now than I was then. I'd be looking more to deal with this situational depression, while also getting a gender check-up. At the time of my meltdown, it seemed like a pretty good idea.

But that's when I became fully aware of the limitations of our insurance. Since then, I've been treading water.

So my actual goals for therapy would be... I'm not sure. Maybe just work through the situational depression in the interest of taking a more positive approach to my employment search. Maybe explore HRT without transition.

Asking for help is hard. Mostly I just want to talk to someone about all of this. Neutral ears. Independent observer. Analyst. Asker of the right questions to spur my thinking. I want to be able to speak in an unfiltered manner, and listen to myself talk a bit -- which seems to help me get out of my head. Did I mention that asking for help is hard?

That could go on a long time, and the dollar signs associated with it are just too much to contemplate.

Lora

[JoanneB]

Does anyone else have experience with a high deductible medical plan when it comes to gender therapy?

I used to have a $25 co-pay per session, but then our insurance changed. Now I have to pay the whole amount -- $150 for each session -- until I've spent $3500 for the year, after which the insurance picks up 100%.

But we don't have that kind of money laying around, which makes it darn near impossible for me to even consider resuming therapy.

I know that every plan is different, but I'm really feeling stuck, and looking for ideas on reducing this cost.

Thanks!

Lora

I'm not sure which flavor of stuck you are compared to me. In my case for therapy, I have an "Out of Network" provider. Seems like many to about all are these days. For out of network I have a $2500 threshold to break.

A few years back, same insurance company, different plan, different state, and a therapist In Network, I think it was $25 per session. I think my current plan would be $40 if in-network. Maybe less

If I believed even 5% of the Psyc Today Doc-Find (which I learned not to) and hunted around for a therapist in network whose experience with TG exceeded a bit more then; I once had a class where I think we talked about it; The expense of time and energy is not worth it compared to the known entity whom I am seeing today. She was with a group that focused on LGBT and especially trans and now on her own.

Back when I first started seeing her it was $150 per session. Which for these parts, NYC metro area, about the going rate. Though my income is fairly high I have a ton of expenses so $150 was an expense I could easily pass up since "I almost got this trans stuff beat". After telling her I'd like to see her more frequently but.... She said call the office and they will likely cut you a deal, and they did. Down to $100, something a bit more palatable.

Have you tried broaching the possibility of a lower fee so you can see your therapist more often?