Susan's Place Transgender Resources

I am hoping to find out if anyone here is or has done it.  It doesn't look like  there is much in the way of insurance coverage is available, but I am hoping someone may have some insight on that.

Fortunately there is a policy protecting individuals in transition:
http://www.opm.gov/diversity/Transgender/Guidance.asp (http://www.opm.gov/diversity/Transgender/Guidance.asp)

Freya

Either this is a touchy subject or otherwise I hope I am not the lone pioneer on this board about to head out on this adventure.

Freya

I'm Australian so I can't really comment, which of course has never stopped me.

There are a number of police woman on the site who have transitioned. I'm not sure if that means they are Fed or not, and there are several ex service woman who are on site. Not sure how they fit in to your question.

There are also a number of problems at the moment with access to the site so be patient in waiting for answers. I think the USA Vets were saying they did get some support.

One I do remember was the Head of Dade County Police who transitioned 'on the job' you can probably find her details easier than I can.

One thing that is worth mentioning is to talk to your human resource people quite early in the act. They know the laws and have to enforce them. It is easier to get them on side early rather than late.
Again from an Aussie perspective (upside down :laugh:) they organise my toilet arrangements and my care arrangements and counsel people who may have problems with what I'm going through.  With a bit of seniority, tact, tears and knowing the law, you can make your problems theirs. Which I'm very happy to do. It doesn't mean you will not be discriminated against, it means you can sue the ass off the employer, and HR have to support you because they had prior knowledge and therefore had to understand the legal implications. Even if they didn't.

In practice I have had no problems. It may be different in the USA military machine, but from what I understand you are now mainly an office based person rather than a field combatant. My intelligence and ability are not affected by my gender or how I'm dressed. I do follow the proper clothes code for my profession. I seriously doubt that your gender affects your job, it hasn't so far and your gender has never changed. Your sexual identity is also of little importance in most jobs, and your sexual presentation only really becomes an issue if you want to work in a profession were overt sexual presentation is important.
I believe you have a chain of bars? called Hooters? where the waitresses were skimpy clothes and look overtly bimbo female. You may not qualify for such a position. But i sort of doubt that you want that sort of career.

In an office based career I think you may well find females and males contributing equally.

What is between your legs has little impact on your ability to do a good job. IMO.

I even know some guys who can think :laugh: :laugh: :laugh: You just have to prompt them. But getting them to have an attention span to put down the toilet seat is impossible. ;D

Cindy

QuoteOne thing that is worth mentioning is to talk to your human resource people quite early in the act. They know the laws and have to enforce them. It is easier to get them on side early rather than late.
Again from an Aussie perspective (upside down ) they organise my toilet arrangements and my care arrangements and counsel people who may have problems with what I'm going through.  With a bit of seniority, tact, tears and knowing the law, you can make your problems theirs. Which I'm very happy to do. It doesn't mean you will not be discriminated against, it means you can sue the ass off the employer, and HR have to support you because they had prior knowledge and therefore had to understand the legal implications. Even if they didn't.

You're absolutely right, Cindy!

I have talked to my therapist about this and we intend to go to them probably about the same time I start HRT.  I don't see the point in bringing up the issue now since I don't plan on making changes other than work on my beard that will matter at this time.

One of the big fears for me is that I work for a small, but very significant Command with 3 Admirals on my floor.  We get visits from some of the highest ranked military personnel and even foreign dignitaries.  It's just going to be an interesting place to transition.

From what I have read, Vets do get their hormones paid for through the VA hospitals, but I don't think any surgeries are covered.  I am not a vet, nor have I ever served in the military.  In fact I have no idea how I got my job without having a degree, not that I am complaining ;)

Freya

Unfortunately I'm not much help.  I'm under the federal BCBS insurance, and to my understanding it doesn't cover anything specifically trans related.  I guess you can get therapy and hormones by asking the therapist/doctor to be non-specific with how they phrase things, but I'm not sure how well that works.  If you find anything out, please let me know. 

QuoteUnfortunately I'm not much help.  I'm under the federal BCBS insurance, and to my understanding it doesn't cover anything specifically trans related.  I guess you can get therapy and hormones by asking the therapist/doctor to be non-specific with how they phrase things, but I'm not sure how well that works.  If you find anything out, please let me know. 

Lee,

My understanding is that's true.  I looked at all the available policies and everyone of them has "Sex Transformations" in their exclusions, almost as if it was a "cookie-cutter" policy statement.  Unfortunately for me to have a chance at having the therapist of my choice covered I will need to switch to an FFS/PPO plan.  I'll have to wait for open enrollment season in November.  Until then I am paying out of pocket for it.  When I get close to HRT I will work with my GP to get a referral to the best TG HRT Endo in town and see if I can get that covered by the FFS/PPO.

Freya

Hello,

I don't know if anyone mentioned, but in the US the American Medical Association (AMA) recently passed a resolution (or something) that stated that insurance companies should cover surgeries related to transitioning as they are medically necessary, and that to not do so would be discrimination. I found this out from a friend of mine and he made a youtube video on it. The link to the pdf of the resolution is:

http://www.tgender.net/taw/ama_resolutions.pdf (http://www.tgender.net/taw/ama_resolutions.pdf)

Maybe you can talk to your health care provider (higher ups maybe?) and mention this and see if they will cover it?

-Alex (just realized there is a  :police: and that made me real happy)

Youtube username: adt2010
Check it out, and feel free to ask me any questions on here or YouTube.

Alex,

Thanks for the info on the AMA and the DSM-IV-TR regarding Gender Dysphoria.  I hadn't seen that yet.

My next Open Enrollment should be in November.  I intend to switch to a PPO, which will cut some costs.  I am hoping at least one of the plans won't have a "ex Transformation"Exclusion.

I saw your videos regarding work troubles.  I would hope by now that has been all cleared up.

Freya.

Hi Freya, I asked the same question about transitioning as a fed recently. Did you ever find more info, like whether fed bcbs will cover hrt?

It looks like the FY2014 Plans all have the "Sex Transformations" exception again, so nothing directly pertaining to transition is covered.

I was able to get a referal to an endocrinologist for low T and when I told him I'd rather do HRT he prescribed Spironolactone and Estradiol for me.  He identified  the Spiro is for another condition , so I get that covered, but I pay out of pocket, about $28, for 90 days of Estradiol.

Freya

Freya, after rattling my brains, I think I shook loose that Brooke777 transitioned on the job as a federal employee.  You might drop her a PM, and tell her I am the knucklehead who mentioned her.

There is very clear guidance on how to transition in the Federal workforce that protects individuals transitioning, which can be reviewed in this link:
http://www.opm.gov/diversity/Transgender/Guidance.asp (http://www.opm.gov/diversity/Transgender/Guidance.asp)

That being said, there are no Federal insurance plans that cover transition, so unless you can get some expenses covered for other medical reasons, HRT and surgery are 100% out of pocket.

Freya

The FEHB Kaiser plan now covers transgender services, including hormones and surgery as of January 2014.  Also the OPM is now reviewing the legality of even including "sex transformations" in its insurance benefit exclusions.  So there is a possibility that transgender specific care may be covered be multiple FEHB policies by January 2015.

I wish I knew about Kaiser during the last open enrollment or I would have switched right then.  Unfortunately I ended up in the hospital 3 times during the open enrollment and was afraid to change plans right then and missed it.  Fortunately the issue I had was ultimately trivial and went away on its own.  So now I can't wait to switch to Kaiser or maybe something else in the next open enrollment around November.

Freya

Quote from: Freya on March 09, 2014, 04:25:53 PM
The FEHB Kaiser plan now covers transgender services, including hormones and surgery as of January 2014.  Also the OPM is now reviewing the legality of even including "sex transformations" in its insurance benefit exclusions.  So there is a possibility that transgender specific care may be covered be multiple FEHB policies by January 2015.

I wish I knew about Kaiser during the last open enrollment or I would have switched right then.  Unfortunately I ended up in the hospital 3 times during the open enrollment and was afraid to change plans right then and missed it.  Fortunately the issue I had was ultimately trivial and went away on its own.  So now I can't wait to switch to Kaiser or maybe something else in the next open enrollment around November.

Freya

Please correct me if I'm mistaken, but I believe only Kaiser plans issued in California are trans* inclusive. 

Quote from: ThePhoenix on March 09, 2014, 09:14:41 PM
Please correct me if I'm mistaken, but I believe only Kaiser plans issued in California are trans* inclusive.

You are mistaken. My previous (awesome) plan hooked me up with a vast network of therapists and endos. Idk about ffs and surgeries, although I always ecpected to pay out of pocket for that. I paid for lhr and anything else I wanted done though so I'm accustomed to it.

I have Kaiser now, against all my wishes. But I must admit, they're exceptional with trans stuff. They covered my therapy and hrt and all sorts of stuff. I believe they cover srs as well. My endo at Kaiser has been working with trans people for 20+ years. One thing that is convenient is every new doctor I have to see has my records and basically knows what's going on before I have to explain. It makes life much easier.

Info on the California ban on the exclusion of transgender issues in health coverage.

http://transgenderlawcenter.org/archives/4273 (http://transgenderlawcenter.org/archives/4273)

Quote from: Freya on March 09, 2014, 04:25:53 PM
The FEHB Kaiser plan now covers transgender services, including hormones and surgery as of January 2014.  Also the OPM is now reviewing the legality of even including "sex transformations" in its insurance benefit exclusions.  So there is a possibility that transgender specific care may be covered be multiple FEHB policies by January 2015.

I wish I knew about Kaiser during the last open enrollment or I would have switched right then.  Unfortunately I ended up in the hospital 3 times during the open enrollment and was afraid to change plans right then and missed it.  Fortunately the issue I had was ultimately trivial and went away on its own.  So now I can't wait to switch to Kaiser or maybe something else in the next open enrollment around November.

Freya

I understand in California Anthem Blue Cross has some trans* benefits, but I don't know if it is affiliated with the federal government.

I am fairly certain California health insurance policies do not apply to US federal employees.  That being said, Kaiser has the only policy that does not exclude transition coverage for federal employees, but apparently only in California.  Federal employees may be benefitting from the fact that as a California based company, Kaiser must provide transition coverage.  I did not check all the locations, but that seems to be the case.  If anyone else finds another federal plan that does cover transition, please let us know.

You can look up the Kaiser plans for federal employees by location from the following link to check a specific location.  You'll need to select the Kaiser plan location link, then click the PDF link, and go to section 6, "Exclusions."  If the exclusion says "sex transformations", then the policy does not include specific transgender transition, such as hormones and surgery.  Employees in transition are still protected by federal law for all other insurance benefits.  If the plan does not exclude "sex transformations", then do a search on "transgender" and you will find what the policy covers.

http://www.opm.gov/healthcare-insurance/healthcare/plan-information/compare-plans/PlanSearch.aspx?planname=kaiser&empType=a&payPeriod=c (http://www.opm.gov/healthcare-insurance/healthcare/plan-information/compare-plans/PlanSearch.aspx?planname=kaiser&empType=a&payPeriod=c)

There is a possibility of the "sex transformation" exclusion being removed from all federal employee health benefit plans by the next open enrollment for 2015, based on the following article from the Federal Times.

http://blogs.federaltimes.com/federal-times-blog/2014/01/15/opm-considering-transgender-care-in-future-employee-health-plans/ (http://blogs.federaltimes.com/federal-times-blog/2014/01/15/opm-considering-transgender-care-in-future-employee-health-plans/)

I apologize if I get any information incorrect.  I really just stumbled into this and now I wish I known about it for the open enrollment, last November.

Freya

Quote from: TiffanyT on March 10, 2014, 02:43:19 AM
You are mistaken. My previous (awesome) plan hooked me up with a vast network of therapists and endos. Idk about ffs and surgeries, although I always ecpected to pay out of pocket for that. I paid for lhr and anything else I wanted done though so I'm accustomed to it.

I have Kaiser now, against all my wishes. But I must admit, they're exceptional with trans stuff. They covered my therapy and hrt and all sorts of stuff. I believe they cover srs as well. My endo at Kaiser has been working with trans people for 20+ years. One thing that is convenient is every new doctor I have to see has my records and basically knows what's going on before I have to explain. It makes life much easier.

TiffanyT,

Looking at the Kaiser specific care, it seems to be all in the East Bay, San Francisco area.  I am hoping you may have had some experience with services in the SoCal area, since it would be great to identify a primary care and an endocrinologist with transgender care experience.  Please let me know if you have any recommendations.  I have a very supportive endo that I hate to give up and a clueless primary care physician, I'd be happy to replace next year.

Freya

Quote from: Freya on March 10, 2014, 09:29:47 PM
TiffanyT,

Looking at the Kaiser specific care, it seems to be all in the East Bay, San Francisco area.  I am hoping you may have had some experience with services in the SoCal area, since it would be great to identify a primary care and an endocrinologist with transgender care experience.  Please let me know if you have any recommendations.  I have a very supportive endo that I hate to give up and a clueless primary care physician, I'd be happy to replace next year.

Freya

I'm sorry but I don't have any experience beyond the Bay Area. My therapist does do phone sessions though. Send me a pm if you'd like her info as she could be really helpful n getting you moved through their system. Especially if your endo is on board.

Kaiser permanente will cover it where in California, but yes the bay area is the center of transgender health care for them, mostly because well, the bay area is kinda the center of the LGBT community in California. 

It is still Kaiser so, even though it's a different area, you should still have access to that area as long as you are in the area.

Quote from: TiffanyT on March 11, 2014, 02:22:30 AM
I'm sorry but I don't have any experience beyond the Bay Area. My therapist does do phone sessions though. Send me a pm if you'd like her info as she could be really helpful n getting you moved through their system. Especially if your endo is on board.

Thanks to info from Tiff, I was able to get some more detail from Kaiser.  First, the nurse I spoke with said she didn't know that Kaiser transgender coverage now applies to California Federal employees and she would like me to follow up with one of their insurance specialists to confirm.  I'll do that next week and post what I find out.

When I asked her about doctors, she told me they have several that are WPATH trained and trans friendly.  As part of the service, she would work with me to select the right doctor, once I am in the Kaiser plan.  One surprise, she told me Dr. Toby Meltzer is doing the transition surgeries for Kaiser.

The OPM should be reviewing the legality of denying transition coverage to Federal Employees this month (March 2014).  So hopefully All Federal employee health benefit plans will cover transition care in the next open enrollment.

Freya

Hi all,

Another Fed here. Thanks everyone for the updates. So far, I have had no questions about therapy from my healthcare provider and am charged regular copay. Will be discussing HRT in a couple weeks, but I am not too concerned with cost of meds because it is budgeted. What is concerning is the unknown costs for tests/labwork and whether it is covered. I wanted to hear from others on this. I am sure each provider has their own policies, so there probably is not one simple answer (that is until there is universal coverage).

Julia

Quote from: Stochastic on March 15, 2014, 07:11:54 AM
Hi all,

Another Fed here. Thanks everyone for the updates. So far, I have had no questions about therapy from my healthcare provider and am charged regular copay. Will be discussing HRT in a couple weeks, but I am not too concerned with cost of meds because it is budgeted. What is concerning is the unknown costs for tests/labwork and whether it is covered. I wanted to hear from others on this. I am sure each provider has their own policies, so there probably is not one simple answer (that is until there is universal coverage).

Julia

I got a referral to see an endo, when my T level tested as slightly low.  When I saw the endo, I told him I'd rather transistion, so he switched my water pill I was taking for another issue, to Spironolactone from Lasix.  Later he prescribed Estradiol, when I asked for it.  I have had an ongoing referral to the endo for about a year and a half and insurance has covered all costs except for the Estradiol. When I was prescribed the Estradiol, I just paid for it out of pocket to avoid raising any concerns with the insurance company.  It hasn't been very expensive, I think about $20 every 60 days.

My endo hasn't had my hormone levels tested since I started seeing him, but I do get blood work done about once every 3 months to make certain I am not getting sick in other ways.  I haven't had any issues so far.  My endo said the insurance company wasn't likely to be concerned about the lab work or Spiro, since they are used for other medical issues, and even felt I would probably get the Estradiol covered too, if I went that way.

I hope that helps some,
Freya

Quote from: Stochastic on March 15, 2014, 07:11:54 AM
Hi all,

Another Fed here. Thanks everyone for the updates. So far, I have had no questions about therapy from my healthcare provider and am charged regular copay. Will be discussing HRT in a couple weeks, but I am not too concerned with cost of meds because it is budgeted. What is concerning is the unknown costs for tests/labwork and whether it is covered. I wanted to hear from others on this. I am sure each provider has their own policies, so there probably is not one simple answer (that is until there is universal coverage).

Julia

Good point ^^^ I wonder what would be the extent of the coverage: SRS, breast implants, FFS, voice surgery, electrolysis, laser, ?

the devil is in the detail... but at the end of the day if all I get is my new purse, if I was a Fed... I will be totally delighted.. LOLO

Quote from: peky on March 15, 2014, 03:53:45 PM
Good point ^^^ I wonder what would be the extent of the coverage: SRS, breast implants, FFS, voice surgery, electrolysis, laser, ?

the devil is in the detail... but at the end of the day if all I get is my new purse, if I was a Fed... I will be totally delighted.. LOLO

From the Kaiser website:
"Kaiser Permanente members needing hormone consultations, gynecologic care, psychological services and surgical evaluations for transition and sexual reassignment surgeries."

From the Kaiser Plan:
"Not covered
• Services for the promotion, prevention, or other treatment of hair loss or hair growth
• Cosmetic services that are intended primarily to change or maintain your appearance, such as breast augmentation, reduction of Adam's apple or facial feminization surgery
• Transgender surgical services, other than genital surgery and mastectomy"

So it seems it covers the non-cosmetic costs.  I sure wish it covered electrolysis/laser.

Freya

For the hair loss aspect.  Most of the policies will cover the basic for Male pattern baldness.  Such as propecia and such.  The services they cover for the general male population.  Things like hair implants won't be covered.

Quote from: Freya on March 15, 2014, 04:10:12 PM
From the Kaiser website:
"Kaiser Permanente members needing hormone consultations, gynecologic care, psychological services and surgical evaluations for transition and sexual reassignment surgeries."

From the Kaiser Plan:
"Not covered
• Services for the promotion, prevention, or other treatment of hair loss or hair growth
• Cosmetic services that are intended primarily to change or maintain your appearance, such as breast augmentation, reduction of Adam's apple or facial feminization surgery
• Transgender surgical services, other than genital surgery and mastectomy"

So it seems it covers the non-cosmetic costs.  I sure wish it covered electrolysis/laser.

Freya

Awesome information! Thanks Freya!

I've posted a bunch of information in this thread (https://www.susans.org/forums/index.php/topic,162283.0.html) about the FEHBP trans exclusion that will be of interest to trans Federal employees. Indeed, right now, only Kaiser in Northern California actually covers trans procedures, and they're a lone anomaly as OPM explicitly instructs all other insurers not to cover them. :-\ There's no sign yet as to whether this will change in 2015, but we can continue to work to get this changed.

Why they didn't remove the exclusion back in 2011, when they released that excellent guidance on trans employees, really boggles my mind; not only would it have been the right thing to do, they could've limited the inevitable right-wing tantrum over trans Feds to a single news cycle.

Quote from: บ้านสิริรอดชีวิต on March 31, 2014, 12:23:39 AM
I've posted a bunch of information in this thread (https://www.susans.org/forums/index.php/topic,162283.0.html) about the FEHBP trans exclusion that will be of interest to trans Federal employees. Indeed, right now, only Kaiser in Northern California actually covers trans procedures, and they're a lone anomaly as OPM explicitly instructs all other insurers not to cover them. :-\ There's no sign yet as to whether this will change in 2015, but we can continue to work to get this changed.

Why they didn't remove the exclusion back in 2011, when they released that excellent guidance on trans employees, really boggles my mind; not only would it have been the right thing to do, they could've limited the inevitable right-wing tantrum over trans Feds to a single news cycle.

Thanks for the additional info!

Both High and Standard plans for NorCal and SoCal have the Exclusion removed, but nowhere else that I have seen by looking at some others.  The only reason I can think of that the exclusion was removed for Kaiser in CA, is that they may be following the 2014 DHMC ruling for all CA health plans because they are headquartered there.  But that's just conjecture.

Hopefully the OPM review that should have happened this month will go in our favor, but I haven't seen any news on this yet.

Freya

Hi again,

I wanted to get back to everyone about my recent Federal health care coverage experience. I have the basic option for Blue Cross/Blue Shield. When I went to my pharmacist to fill my first HRT prescription (Spiro and patches), I requested that I pay out of pocket because my insurance did not cover it. I came back later to pick up the meds. They had run the meds through my insurance, and I only had to pay the copay. This applied for both meds.

I later called BC/BS customer service to be honest in that I was improperly discounted for my meds. They could not be of assistance because they subcontract the pharmacy portion of their service. I was transferred to the phone line for the pharmacy subcontractor. While on the automated phone line, I was not given an option to talk to a customer service representative. Recently, my second round of meds were also discounted.

I do not feel as if I won the HRT lottery because I am sure there will be an audit. A bill for $1,000 will surely end up on my mailbox sometime by the end of the year. I do feel as if I made an honest effort to contact the program's customer service reps.

Quote from: Stochastic on April 25, 2014, 02:54:17 PM
I do not feel as if I won the HRT lottery because I am sure there will be an audit. A bill for $1,000 will surely end up on my mailbox sometime by the end of the year. I do feel as if I made an honest effort to contact the program's customer service reps.

I don't think you'll have any problems. I've belonged to two different FEHB plans now, and both fully covered my HRT as long as my doctor coded it properly. They're unlikely to challenge and audit you because OPM and its contracted carriers are seriously walking on eggshells and know that an audit would open themselves up to another EEO complaint.

In fact, when I was looking for a new plan last open season, I called CareFirst BC/BS and asked about HRT coverage, and they were very candid in admitting they will cover it as long as the doctor codes it as something like "endocrine disorder NOS" or "hypogonadism" instead of for transsexualism/GID/GD. And indeed, they have, with no co-pay. ;)