Insurance questions for coverage requirements

[josie76]

To start out I do know every company and every policy is different.

But for those who got coverage for SRS what things helped sway the insurance?

Why I am asking, in Illinois, no policy can outright exclude transgender health coverage by state law. They dance around the issue by not mentioning it at all in their certificates of coverage. They can only leave in the bit about not covering experimental procedures which I have read some companies in the past tried to define SRS as. In my situation, my primary doctor wonders if I may have a mild ais AR mutation or something similar. The AR gene tests I have found are a bit above $1k. He said there is no medical nessecity for the test since there is no treatment for the genetic mutation and I am already under an endo's care for HRT. But would having a proven AR mutation and a MAIS diagnosis help the case for SRS? Under Illinois law, either malformation of sexual organs or genetic mutation legally define being intersex. Would that help my case with an insurance company for SRS though. Basically is it worth paying the $1000 out of pocket for the test?

[Colleen_definitely]

While I haven't had surgery yet, I am knee deep in dealing with insurance to lay the groundwork for it right now.

The best thing I ever did was to stop trying to make sense of the policies and forms and call them.  They gave me all of the information I needed over the phone.

About the gene test, you might want to see if your doc (or a geneticist he can refer you to) has any agreements with some of the labs for reduced costs to his patients.  Mine did when my doc referred me for a karyotype test.  It dropped the bill from $2500 to $250.

[Harley Quinn]

I'm also knee deep in the insurance debockle... I wonder if they can just mark it as an intersex condition and move forward.

[JillianC]

I'm interested in this topic.  I am about to start soon.  I'm currently in the process of getting all my letters in order.  I heard that some insurance companies will assign you a claims helper/specialist if you request one at least I know BCBS does.  I am going to that soon.

[Colleen_definitely]

BCBS is who I am working with and the phone support has been so much better than expected.  Just wade through 5 minutes of automated system, and once you get to a human just explain that you're looking for some answers regarding transgender care.  They'll transfer you to somebody with a clue and so far they have been super helpful for me.

[josie76]

While I haven't had surgery yet, I am knee deep in dealing with insurance to lay the groundwork for it right now.

The best thing I ever did was to stop trying to make sense of the policies and forms and call them.  They gave me all of the information I needed over the phone.

About the gene test, you might want to see if your doc (or a geneticist he can refer you to) has any agreements with some of the labs for reduced costs to his patients.  Mine did when my doc referred me for a karyotype test.  It dropped the bill from $2500 to $250.s

I had the karyotype done. The lab system part of the hospital system my regular doctor works for charged $750 for that. He sent it with a gender dysphoria ICD code so my current insurance denied payment for it. BCBS Mississippi. I need to change insurance in any event as I'm paying COBRA for it now and I've had a couple of plain blood tests denied for my hormone monitoring as well. My karyotype was 46xy but that doesn't explain other lesser obvious traits I have.

[Colleen_definitely]

Same here, 46xy as expected but that doesn't explain my lack of adam's apple, very slight brow ridge, and near complete lack of body hair when these are all very prominent features in every other male in my family on both sides.

That's not good to hear about them denying blood work. 

[Cassi]

Ladies, I sometimes suffer from information overload; med for male pattern baldness, surgical name for ball removal, and surgical name for penis removal.

Anyway, it will be a couple of years before the latter of the two mentioned above are done but I was curious as to what my insurance would cover. I am retired and had switched from Blue Cross to Healthcare of Nevada.  And after doing such I heard that Aetna was good for transgender issues. 

Anyway, I attempted to see if my insurance covered HRT but couldn't get an answer until it was submitted to by the pharmacy and they covered it with me having an out of pocket expense of $14.

Then the morning before my shrink eval, the policy book for my insurance came in the mail and I checked and according to the book cost to me is only $25.00 per surgery.  Wow.

Now, as far as other things like hair removal, not as lucky as far as I know.