Susan's Place Transgender Resources

I got a letter yesterday from Blue Cross Blue Shield saying that all forms of T (as well as some other drugs) would need pre-approval before being covered. Their "reasoning" is to make sure the drugs aren't being used incorrectly. ::) So my endo would need to fill out their form saying why I'm taking it and then they'll decide if it's a good enough reason.

My insurance point blank says it won't cover anything dealing with a "sex change". I was lucky in that they covered my therapy and psychological tests. The only endo in my area who will do HRT for transpeople (as well as know anything about it) doesn't take insurance so that's out of pocket.

My current insurance did cover T but it only covered about $18 of it. The rest of the amount I had to pay for, so it's not a huge loss. I'm thinking about not having my endo contact them because then it may raise a red flag. Right now they do cover my bloodwork even though part of it checks T levels. The bloodwork cost over $400 each time- something I can't afford on my own.

I'm curious if anyone else with BCBS has gotten this letter. I'm not sure if it's strictly in my state or not. I'm also curious about reputable online pharmacies that ship T with a prescription. My total T cost right now uninsured is around $85/vial.

I would avoid making waves for fear of having to pay that blood work fees.
Just pay for the T out of pocket and don't bother the insurance.

i agree with the above statement rocking the boat or fighting them over such a small amount may end up costing you everything in the end especially if they deam you uninsurable or unneccessary risk.
jessi

Quote from: cynthialee on June 15, 2011, 03:37:46 PMI would avoid making waves for fear of having to pay that blood work fees.
Just pay for the T out of pocket and don't bother the insurance.

I totally agree with you. The extra amount I'd have to pay isn't worth it. I'm still listed as F with my health insurance in hopes that maybe I can get a hysterectomy and oophorectomy partially covered. Once I get on insurance as male then the T could be prescribed for hypogonadism (which is what it's labeled as now) and probably pass.

I'm just curious about online pharmacies other guys use with success and their prices since I don't have to worry about the insurance anymore. I'm also curious if any other BCBS subscribers got this letter too- especially in a different state.

hmm not sure on all that.  I know I get my T from Coordinated care network (http://www.coordinatedcarenetwork.org/) which is a mail out pharmacy but only services 4 states.

But for myself I'm actually the opposit, get most my fee covered for T through them and only pay 18 dollars most time for a 10ml vial but that to might be partially my insurence which covers most my stuff (been lucky i guess)

Gonna have to agree with cynthialee--if it were me and I challenged it, I would fear them taking a closer look at the other claims and deciding not to cover the bloodwork.  My insurance (not BCBS) has anything regarding a 'sex change' explicitly excluded from the policy, but it has been partially covering bloodwork (covered under "preventative care").  I haven't even tried to get my T covered.  I can handle the <$60 for a 10mL vial of T, needles, and shipping.  I get mine from Stroheckers: http://www.stroheckersrx.com/ (http://www.stroheckersrx.com/) and I have nothing but good to say about their service.

I also go through Strohecker's; yep just under 60$ for 10ML vial  all necessary gear. Insurance isn't involved. The fewer hands in your process the better sometimes... 8)

You could also research other insurance companies if that is a possibility for you (don't know if you're covering yourself, getting it through work or parents ...) I pay for my own insurance and although I'm not taking T I've switched insurance companies about 4 times in the last 5 years because one started pulling crap I didn't like or changed their coverage or up'd their fees.

Wow, that's really stupid that insurance companies are allowed to explicitly exclude sex-change related things from their policies. That should be against the law, since trans people should be able to receive adequate health coverage through their insurance.

Here, in Croatia, you can get everything covered through public health, the problem until recently was that there are hardly any specialists here willing to work with trans folks. Now, there are a couple of endos who will work with us, so T can be covered - however, from what I've heard, they won't GIVE you your T so you can take it yourself, but you have to come to the clinic/hospital each time to get your shot (supposedly it's due to a fear of you re-selling the T you receive). However, if you can't/don't want to come in for each shot, you can get your prescription in a neighbouring country (Serbia), and it costs about $100 for 3 years worth of T. EDIT: Maybe it might even be easier for you guys to travel to Serbia (or elsewhere where T is cheap) and get enough for a few years - it would probably be cheaper even with travel costs than getting it for over $60/month in the US. Just not sure how much you are allowed to carry across borders. Here, if you have a prescription, they supposedly don't cause you any problems when crossing the Croatia-Serbia border, even for a three-year supply.

Supposedly, there's also one surgeon in Croatia who does top surgery (which is also covered), however, I'm not sure how good he is. Unfortunately though, there's no one who does bottom-surgery here, so the closest option (and a good one, from what I hear) is again in Serbia. There are even some folks who are working on getting surgeries that can't be done in Croatia covered by Croatian public health. And they even managed to get hormone-blockers and a prosthetic covered for this kid who is now maybe 15 or so - so, he is using a prosthetic until he is old enough to get surgery (and they're covering the prosthetic on the basis of him having as normal and healthy of a growing up experience as possible). And he'll probably be allowed to get his ID as male when he turns 16, even though he still won't be on hormones or have had any surgery or anything. I was surprised to learn about all this, but it was all thanks to the kid's mom and this legal team of an LGBT organisation here being persistent and working things out with the government officials (they've been working on things since the kid was about 7 or 8 years old).

So yeah, I think the US could learn a thing or two from more "conservative" countries like Croatia. Or you guys should move here :D It's not perfect, there aren't many people who will work with us, there is discrimination (but again, that's the case more-or-less everywhere), but things are definitely getting better and at least the government is willing to work with us.

Sadly Strohecker's can't legally ship to my state. Something about a state law that prohibits them from doing it. It also looks like they just have testosterone cypionate. My prescription is for testosterone ethanate.
FYI I'm insured through work.

Just not sure how much you are allowed to carry across borders.
You've never tried to enter the US have you?  I doubt you could carry very much at all, and even then you'll get the 'why don't you wait over there' treatment from Customs. Particularly for something that is on the 'banned' list for sports.

that's really stupid that insurance companies are allowed to explicitly exclude sex-change related things from their policies
Insurance companies can write any policy they want, the customer can have any policy they want, its just a matter of whose paying for it.  For years my policy excluded coverage for 'specifically listed items', which included: mountain climbing, spelunking, hang gliding and other high-risk behaviors.  I had to take out a separate rider (cost about 100 a year, 20 years ago), to cover that stuff because at the time I was doing a lot of high country camping and climbing.

After searching online it seems there's no non-shady pharmacies who ship testosterone ethanate in my dosage that's any cheaper than what I get at Wal-Mart. There were some that shipped testosterone cypionate at a better price. I think on my next visit I'll ask my endo about switching to cypionate.

I currently have Blue Cross/ Blue Shield through my partner's job.  They have been covering everything and I haven't received a letter like that.  Now I'll keep my eye out for it.

What state are you in Radar?  If you don't mind me asking. 

Quote from: Squirrel698 on June 16, 2011, 11:03:53 AMWhat state are you in Radar? If you don't mind me asking.

North Carolina. The letter seemed to apply to all BCNSNC plans (except for plans that allowed GID and SRS coverage). To tell you the truth, I don't even know if BCNSNC would even allow employers to have that coverage put into their plans. The more I read the more it sounds like they don't.

I also noticed on the pre-certification list for the hormones they were just androgens- no female hormones including E. Hmmm.

GoodRX had printable coupons to get your T vial for about 40 bucks or so depending on the pharmacy you go to.

I have BCBS and they cover my T with no issues after the second script.

Quote from: LordKAT on November 08, 2013, 06:26:00 PM
I have BCBS and they cover my T with no issues after the second script.

How did you get your T covered?

Sounds like they are working on getting a law suit. I don't know that this is actually legal under the ACA (regardless on whether this is thru the exchange or no). I guess it will take a law suit to get them to cover it.

--Jay

Quote from: mooncab on December 03, 2013, 06:17:25 PM

How did you get your T covered?

I simply filled it at the pharmacy who billed the insurance. end of problem.

The first script they wouldn't cover, so I went to Stroheckers. Next time it was no issue.

3 Questions:
1. Did you get your doctor to fill out the prior authorization forms?

Nope, it was simply put down to hormonal imbalance. That is not totally uncommon. She may have done it without me asking though.

2. Does your BCBS insurance plan have a transgender exclusion policy?
Yes it does.

3. How did you get Stroheckers to bill the insurance? When I filled my script at Stroheckers, I was told that they wouldn't take insurance...

Stroheckers didn't bill my insurance, they are just way cheaper than any pharmacy, especially if you have no insurance. $60 for 10 ml vial, needles, syringes, alcohol wipes, is a very good deal.