Surgery and insurance?

[roseyfox]

Maybe this has been answered or not. But I was wondering if any insurance has been know to cover my face top surgery. Some people tell me they have heard of cases. While others tell me it a myth. But only reason why I am curious is because I am in a bind just lost Medicaid because I got a job that pays to much. But can't get my jobs insurance for another month so currently without insurance. But my job offer 3 different healthcare plans according to my manager who said they offer blue Cross blue shield of, signature and United healthcare. So was wondering if any one has had any luck with getting top surgery approved by any of those 3. :3 thanks if you can help. I am completely confused by health insurance.

[Denise]

Rosey,

I'm MTF and BCBS is covering everything.  They covered my breast augmentation last fall, FFS in 13 days [emoji3], SRS in December, and another FFS (maybe) in the fall of 2019.

Ask your HR benefits department if it's covered.  They will require a diagnosis of gender dysphoria (or gender identity disorder maybe)

It's no myth. 

Denise

Sent from my LG-H910 using Tapatalk

[Kendra]

Hi roseyfox, congratulations on your new job!

I'm certainly not an expert on this but I'll tell ya what I know. 

In the US, employer-provided health insurance must meet the minimums currently required by federal and state law.  Some employers provide more than the minimum as an employee benefit, and in a few cases the additional coverage can go quite far. 

Insurance company decisions are not always obvious and may fall into a grey area.  If the answer is no that might not be a final answer - people have successfully challenged decisions and changed the answer from no to yes, or from a small percentage to a major amount of the cost covered.  This can require time and and a lot of persistence.  You might have to become familiar with the written policy and documenting "medical necessity" if the initial answer isn't yes. 

Your compensation at work is a package of benefits, more than hourly pay or a salary.  Some employers improve their benefits package so they can attract or retain better talent in a competitive field.  People have been known to switch jobs to gain better insurance, or do everything possible to stay where they are if they have excellent coverage. 

Kendra

[amydane]

You will need to research each insurance company and their policy regarding transgender services.

If you work for a large employer they may have a self funded plan, which means they have a big say about what things are covered above the standard ACA required minimum coverage.

If they are fully insured plans, then it's more about the insurance company policy, the group may have less or no say about what is covered.

Regardless, you will want to look at the plan contract or master policy of covered benefits. If you get that document you will be able to do a quick ctrl + f to find the transgender covered services. Or call each insurance company and ask them specifically about your employer sponsored plan.


Sent from my SM-G920V using Tapatalk

[Denise]

Hi roseyfox, congratulations on your new job!

I'm certainly not an expert on this but I'll tell ya what I know. 
...

Insurance company decisions are not always obvious and may fall into a grey area.  If the answer is no that might not be a final answer - people have successfully challenged decisions and changed the answer from no to yes, or from a small percentage to a major amount of the cost covered.  This can require time and and a lot of persistence.  You might have to become familiar with the written policy and documenting "medical necessity" if the initial answer isn't yes. 
... 

Kendra

Kendra is very right here.

My policy covers everything listed in the WPATH recommendations at the same rate as everything else, from a broken arm to heart transplants.  But I was denied 5 times, yes, 5 times for everything.  I finally called my employer assistance person in HR and used words like "lawyer" and, surprise, surprise, three days later everything (!) was magically covered.  From electrolysis (which took some doing because of licensing in Illinois) to SRS (BA, FFS, on-going therapy).

They don't cover "letters" but if I pushed it they probably would.

Don't give up.  If your policy includes transgender care, you should get at least some things covered.

If you're comfortable talking to HR about this (eventually you'll have to) I suggest you start there. 

Another resource is the HRC CEI.  If your company is rated they will list the benefits available and missing.  A score of 100% indicates at least one plan has transgender coverage.

Sent from my LG-H910 using Tapatalk

[roseyfox]

JUST GOT MY INSURANCE. :3 I got blue Cross blue shield silver plan through Walgreens. So now to find doctors here in nv and Cali to get my surgery set up. An get back with a therapist and physc to try and fight for some surgery they don't on the surface covered.

[Denise]

JUST GOT MY INSURANCE. :3 I got blue Cross blue shield silver plan through Walgreens. So now to find doctors here in nv and Cali to get my surgery set up. An get back with a therapist and physc to try and fight for some surgery they don't on the surface covered.

Congratulations.  Call BCBS's customer support and ask for a gender transition specialist.  There may be a better term but request to speak with someone who understands what gender dysphoria is and the treatment for it. You will save yourself a bunch effort.

Sent from my LG-H910 using Tapatalk