Getting FFS Covered by Insurance

[maybeventually]

Has anyone else gotten FFS covered by your insurance company, my insurance is trans friendly but excludes FFS. If anyone has advice on the correct channels to pursue to get someone to listen and approve that would be great!

I am currently covered by an insurance company that a few years ago created a non discrimination policy for trans related healthcare. They basically banned exclusions for trans related care. Their policy is in line with WPATH, stating "The following criteria are based on the Standards of Care for the Health of Transsexual, Transgender, and Gender Nonconforming People, Version 7, published by the World Professional Association for Transgender Health (WPATH)."

The plan covers GRS, but specifically does not cover cosmetic procedures that includes a list of things typically performed during FFS. However, as the WPATH and APA are considering trans related reconstructive surgeries such as FFS medically necessary, I see this exclusion to be in direct conflict with APA and WPATH opinions.
APA, 2015   
https://www.apa.org/practice/guidelines/transgender.pdf
WPATH, 2106                                                                   
http://www.wpath.org/site_page.cfm?pk_association_webpage_menu=1352&pk_association_webpage=3947

Based on BCBS nationwide settlements which include my provider,
http://www.hmosettlements.com/settlements/bluecross/Thomas%20-%20Amended%20Settlement%20Agreement%20_Joinder%20of%20IBC_.pdf
it is stated
"Medical Necessity Definition . . .
For these purposes, "generally accepted standards of medical practice" means standards that are based on credible scientific evidence published in peer-reviewed medical literature generally recognized by the relevant medical community, Physician Specialty Society recommendations and the views of Physicians practicing in relevant clinical areas and any other relevant factors. . ."

Thoughts? Opinions?

[Maybebaby56]

I certainly agree with your thoughts, but insurance companies are experts at denial, diversion, and delays.  I had a six-month fight with Aetna just to get genital electrolysis covered.

You might want to check out this thread if you haven't already: https://www.susans.org/forums/index.php/topic,161778.0.html

With kindness,

Terri

[maybeventually]

Hi Terri,

Did you get your FFS covered? I heard Zukowski can be pretty proactive in helping with the insurance company, which is who I'm having it with.

[Maybebaby56]

Hi Sweetie,

No, I didn't even try. I did try to get my rhinoplasty/septoplasty reimbursed because I had a deviated septum, but since I didn't get pre-approval for out-of-network, the claim was denied.

Dr. Z's office is very good about helping with insurance.  Whatever letters or documentation you need, they will supply.  Dr. Zukowski has been doing FFS for 20 years, and they really know the drill when it comes to patient care. Their office is a well-oiled machine.

Oh, and congratulations!  I think you will be very happy with your results. Recovery is rough, but I would do it again. I'm pretty happy with how I turned out (see my avatar).

Best wishes,

Terri