I posted this in the "what made you happy" thread but it applies to people transitioning in either direction.
Some of you have been aware of my battles with my insurance BCBS. After the original submission for FFS was denied, the first appeal denied, the second appeal denied, my personal appeal denied I requested a review by an outside physician. I got some OMG great news today... They finally APPROVED EVERYTHING! (Exactly 1 year from when I first started this process with my surgeon)
Note my employer specifically has a rider in the insurance that is very hard to dig up, but basically it says if you are diagnosed with Gender Identity Disorder [sic] that everything recommended by WPATH will be covered if deemed medically necessary.
What I learned - make sure the original submission has it clearly spelled out that the procedures are Medically Necessary due to Gender Dysphoria (fka Gender Identity Disorder). I submitted TWO different letters from TWO different doctors (one medical, one therapist) that clearly stated Gender Dysphoria made these procedures medically necessary. I strongly suspect that once the outside medical review looked at it and figured out what was going on it was all approved. NOT ONLY THAT but the approval letter goes on to list all the procedures for transgender services that are covered. Some are for Transmasculine transformations so they don't apply but two jumped right off the page: ELECTROLYSIS and VOICE THERAPY. ALL COVERED. See below for the list they sent me.
Guess who is a happy girl?
This is, in part, what I received: (Please understand this is for MY policy. Your's will vary)
Procedures or services to create and maintain gender specific characteristics (masculinization or feminization) as part of the overall desired gender reassignment services treatment plan may be considered medically necessary for the treatment of gender dysphoria ONLY. These procedures may include the following:
• Abdominoplasty;
• Blepharoplasty;
• Brow lift;
* Calf implants;
• Cheek implants;
• Chin or nose implants;
• External penile prosthesis (vacuum erection devices);
• Face lift (rhytidectomy);
• Facial bone reconstruction/sculpturing/reduction, includes jaw shortening;
• Forehead lift or conturing;
• Hair removal (may include donor skin sites) or hair transplantation (electrolysis or hairplasty);
• Laryngoplasty;
• Lip reduction or lip enhancement;
• Liposuction/lipofilling or body contouring or modeling of waist, buttocks, hips, and thighs reduction;
• Neck tightening;
• Pectoral implants;
• Reduction thyroid chondroplasty or trachea shaving (reduction of Adam's apple);
• Redundant/excessive skin removal;
• Rhinoplasty (nose correction);
• Skin resurfacing;
• Testicular expanders;
• Voice modification surgery; and/or
• Voice (speech) therapy or voice lessons.
