Hmm ... Aetna and Therapy?

[Epigania]

Hi.

So I just got this lovely letter in the mail with a new insurance card with a note saying that my company has changed the administration of our behavioral health coverage from Unicare (crappy company) to Aetna (who does my health/dental/vision insurance).

I looked on their DocFinder and discovered that two Psychologists that I explicitly know specialize in GID are located as preferred providers!    My only concern is that in my handy dandy employee benefit manual, under Healthcare Plan exclusions  (this is prior to this change for Mental Health) it says:

Sex therapy and all related services and supplies including those associated with sex changes; gender identity disorders; sexual dysfunction; deviations; disorders; or inadequacies or complications arising from, including therapy, supplies or counseling to address an illness or injury that does not have a psysiological or organic basis

That's basically saying that Aetna doesn't cover sex changes, viagra, or HRT.

If I go to a psychologist, do you think Aetna would cover me?   I suppose they could leave out the whole GID diagnosis and file it as anxiety and depression.   Has anyone else had any experience with Aetna and therapy?

[Silver]

I have Aetna. I went to one of their suggested therapists and it didn't work out. They paid for it. Now I'm going to a gender specialist (out of network, of course) and they are paying 50% (pretty good, it says they'll pay 50% of any out of network health service.) But maybe we don't have the same plan.

[lilacwoman]

i]
Sex therapy and all related services and supplies including those associated with sex changes; gender identity disorders; sexual dysfunction; deviations; disorders; or inadequacies or complications arising from, including therapy, supplies or counseling to address an illness or injury that does not have a psysiological or organic basis[/i]

Does the US rate TSism as a mental illness or not as per the HBIGDA? 
Over here in UK/Europe there have been court cases that determine that TSism is an illness and so must be fixed by the National health.  I shall be using this argument in my lawsuit.
Physiological should surely cover problems of brain/body mismatch?   but maybe the people who wrote Aetna's plans had been influenced by the Jerry Springer show?

[Samantha_Marie]

Depends on your company's agreement with them. I know Costco they claim they won't cover anything under gender identity except counseling, but then they have this entire section dedicated to it. I think it's one of those things that you first have to prove you have it to them before they will go further.

And of course, once you have a psychologist/therapist and a doctor that will give you a "diagnosis" of having gids, the insurance company will have to cover it.

They word it so they won't cover any of the electives, so ffs are out of your pocket. I imagine the same for BA. Although I do think that they will help cover some of the hospital time and other necessary medical procedures, they just won't cover the actual doctors bill for the surgery itself.

I would look up where your company stands on this and where they are rated. If they are high on the charts then everything should be fine.

Oh, and as always, talk to your doctor, if they prescribe you something that has other uses as well then your insurance company will cover it. So always talk to your insurance company and find out which dosages they will cover and ask your doctor the pros and cons of one vs the other.

Either way, it can be a bit of an annoyance and I know how discouraging it can be if your insurance company is saying no they won't cover it.

[Epigania]

Depends on your company's agreement with them. I know Costco they claim they won't cover anything under gender identity except counseling, but then they have this entire section dedicated to it. I think it's one of those things that you first have to prove you have it to them before they will go further.

I have insurance through Costco as well so ... I guess I'll give the insurance thing a go ...