Sad Day :'(

[darius82501]

Found out today insurance denied my claim for chest surgery. I came off the last few days feeling amazing because I have received nothing but kindness and support from my extended family after I sent a letter explaining that I am transgender and am transitioning. I started a chip in account to see if I could raise money for the surgery, but now that insurance has decided to not cover I need to come up with $4,700.00 by August. I was hoping to have the surgery done before beginning graduate school in the Fall.

All the positive and then SLAP in the face takes me back down. I know I should be happy still about the positive, but it is difficult when you see how discriminatory the world really is. I have meritian health insurance in case any of you were considering submitting a claim. They said the surgery is in an exclusionary clause of my insurance. Looks like I probably will not be getting the surgery for sometime now. Anyway, I felt I needed to vent to those who really understand the importance of what this surgery could do for me mentally and my everyday life.

[James-Alen]

Aww, I'm sorry! I was told that insurance wont cover most of our surgeries because they consider it cosmetic. Hopefully that will change. In the mean time I accepted/ planned on having to pay for all of my transition in cash (hence I haven't gotten far in 6 years). Anyways, I wish you luck. I would offer to help you out, but I'm in the poor bracket o.o'

[darius82501]

I figured it was a long shot, but a few guys I know have had it covered. They cover my T. I probably just built it up in my mind too much. Thanks for the reply man!

[Da Monkey]

That sucks dude.

But as a last resort could you finance the remaining amount?

[darius82501]

It is possible, I need to talk to the back that works with my surgeon. I have a large amount of student loans, but a good credit score so I will have to see. I can save $2,000.00 by myself, but I am hoping my ship in account will help. I have been told to do a benefit at a local gay club here, but not sure I could get enough people there to make a dent. Idk...just really pessimistic right now.

[Amy1177]

Sorry to hear.  It really sucks that between insurance and doctors, health is nothing more than another big business.  If the insurance company can figure out a way to not pay it and increase profits they will, and if you don't have insurance or the cash the doctor's don't even want to give you a business card.

[sascraps]

Sorry man, that really sucks. I hope you'll be able to find a way to fund it soon and won't have to put it off for too long. 

[Robert Scott]

Challenge the decision ... insurance companies often times deny knowing people will challenge it

[darius82501]

Challenge the decision ... insurance companies often times deny knowing people will challenge it

Any direction on how to do that?

[Arch]

If trans-related surgeries are specifically excluded, then that probably makes a successful challenge very unlikely, but you never know. You might try doing a bit of research about challenges in general, especially on trans sites if you can turn anything up. If you make enough noise, you could force your insurance company to change its policies. But that takes time.

ChipIn is a good idea. If you can save $2000, then you would need another $2700 or so, right? Have you investigated surgery loans and credit card options (be careful)? What about sponsorships?

[darius82501]

If trans-related surgeries are specifically excluded, then that probably makes a successful challenge very unlikely, but you never know. You might try doing a bit of research about challenges in general, especially on trans sites if you can turn anything up. If you make enough noise, you could force your insurance company to change its policies. But that takes time.

ChipIn is a good idea. If you can save $2000, then you would need another $2700 or so, right? Have you investigated surgery loans and credit card options (be careful)? What about sponsorships?

They said there were exclusions, so my guess is it would be a waste of time.

The total for the surgery is $6,700.00. I can save $2,000.00 so I'll need $4,700.00. This is unlikely in 3 months. I know a lot of great and kind people, no rich ones.  My surgeon doesn't accept surgery loans or places such as care credit. IDK...frustrated.

[Arch]

The total for the surgery is $6,700.00. I can save $2,000.00 so I'll need $4,700.00.

Ouch. I thought you meant that you already had $2000 or something.

My surgeon doesn't accept surgery loans or places such as care credit. IDK...frustrated.

One of my friends got his loan through his regular bank/credit union a number of years ago. His surgeon didn't have any say in the matter. I guess I don't know much about surgery loans. Is this not the usual way people do things?

[Cindy]

Can you get your insurance policy read by someone with legal knowledge?  Insurance companies often use their interpretation of law until it is questioned.

Cindy

[Robert Scott]

Saying some exclusions apply is very vague and the perfect way for them to get someone from challenging them.  Unless it specifically says no trans stuff will be covered - and since they cover your T I would imagine it doesn't --  often times when pushed the insurance needs something like "it's a medical necessity" in the letter from the doctor/counselor.  Something most counselors don't think to include.  That's what the glitch was on my paperwork.   Also, is your doctor willing to work with you.  My doctor said if it didn't get approved that she will do it as that I needed a breast reduction due to excessively large breast tissues - and said my insurance company didn't need to know how far she reduced them. 

I suggest calling your insurance and find out how do you go about challenging the decision.  One of my group facilitators had to challenge his as well and when he pushed back they agreed to both top and bottom surgery for him.  Insurance companies bank on the fact that people won't challenge their decisions and then they don't have to pay.  Advocate for yourself!