Anyone had FFS covered by Kaiser NorCal Senior Advantage?

[Michelle_P]

I'm getting conflicting information.  Member Services is telling me that FFS is NOT covered, while a social worker with the Kaiser NorCal Multi-Specialty Transitions (MST) department says they have had members receive FFS while on Senior Advantage.  Thus, the question:

Anyone had FFS covered by Kaiser NorCal Senior Advantage?

Next November my current ACA coverage is terminated and I have to go onto a Medicare/Medicare Advantage plan.  IF I am on Kaiser NorCal Senior Advantage, yet can still receive the FFS I was evaluated for, a complex two stage set of surgeries to be done by their most experienced people, I may grit my teeth and wait out the delays.   I will likely have a date in early 2019, just two years after I was evaluated for surgery.

Just one more year to go, statistically, maybe two assaults and one crazy following me around and screaming. 

On the other hand, it would be nice to know in advance that I'm basically out of luck, so I could plan a nice overseas vacation ASAP.

Anyone?

[Michelle_P]

Not surprisingly, I've gotten two different, conflicting answers from 'authoritative sources' in Kaiser NorCal.  So, I filed a grievance to produce a definitive answer that we older members can actually rely on.

The Grievance Agent just called.  They are having the Benefits Department run the proposed procedures for FFS that were put in my record last May against Kaiser NorCal's Senior Advantage plan, their Medicare Advantage coverage. 

The procedures are fairly typical for FFS.  They'll be a good guess as to what I'll wind up having covered in 2019.  Yes, over two years between being evaluated for medically necessary care and receiving treatment.  I suspect they may be understaffed for the demand they are experiencing.

I'll make a new post when I get the results.

[Laurie]

I read their Senior advantage book of benefits my sister received and found nothing in it regarding services for transgender members. I also tried the online Evidence of Coverage for 2018  and only found one reference of "Transgender" in it under needing approval for "medically necessary surgery" which can mean anything. I didn't bother to call a Kaiser enrollment expert because they are sales people and I have no confidence in getting the truth from a sales person.

[DawnOday]

I am so jealous. I have too many issues for FFS. I hope everything comes out the way you dreamed it to be. Hugs

[Michelle_P]

I got the grievance results. Current policy is that all medically necessary treatment for transition will be covered under Senior Advantage, just as under the current individual ACA Kaiser HMO plans.

Since my FFS is medically necessary it would be covered.


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[Donica]

That's great new Michelle_P! As I have Kaiser SoCal Advantage Plus, I started HRT over 10 months ago and I am looking forward to GRS hopefully late next year. I most definitely have several medically necessary appendages that need reconstruction.

Love!
Donica