Community Conversation => Transitioning => Hormone replacement therapy => Topic started by: AuroraSTL on August 07, 2013, 06:19:09 PM Return to Full Version
Title: HRT and Insurance confusion
Post by: AuroraSTL on August 07, 2013, 06:19:09 PM
Post by: AuroraSTL on August 07, 2013, 06:19:09 PM
Hey all,
I've been doing a lot of research and I just can't seem to find a clear answer. Ok here goes I have Federal BCBS, I can't find a section where it clearly states if they'll help cover the cost of HRT or not. Does anyone have a clear answer or knowledge if they will or won't cover HRT? If they do how difficult is it to get approved? Thanks have a wonderful evening.
Aurora
I've been doing a lot of research and I just can't seem to find a clear answer. Ok here goes I have Federal BCBS, I can't find a section where it clearly states if they'll help cover the cost of HRT or not. Does anyone have a clear answer or knowledge if they will or won't cover HRT? If they do how difficult is it to get approved? Thanks have a wonderful evening.
Aurora
Title: Re: HRT and Insurance confusion
Post by: Sarah Louise on August 07, 2013, 06:24:44 PM
Post by: Sarah Louise on August 07, 2013, 06:24:44 PM
It depends on your policy.
Mine with BCBS specifically excludes anything to do with being transgendered.
Mine with BCBS specifically excludes anything to do with being transgendered.
Title: Re: HRT and Insurance confusion
Post by: Kim 526 on August 12, 2013, 06:20:15 AM
Post by: Kim 526 on August 12, 2013, 06:20:15 AM
Sarah, so does mine, Anthem BCBS, in the exclusions section. Therefore I must pay for my patches myself. No huge deal.
Title: Re: HRT and Insurance confusion
Post by: LordKAT on August 13, 2013, 06:15:01 AM
Post by: LordKAT on August 13, 2013, 06:15:01 AM
My BCBS says thesame, but my HRT is covered somehow anyway.
Title: The Insurance Question
Post by: Sanceria on August 13, 2013, 01:50:06 PM
Post by: Sanceria on August 13, 2013, 01:50:06 PM
Now you've got me wondering if my Anthem BlueCross insurance will cover it. But it doesn't matter anyways, considering that my father doesn't wish for me to use his insurance anyways. Guess when I find my own policy next month that I'll have to look for something else.
Anyways... I've got good news for all of you in America. Starting in October, there is going to be a HUGE insurance reform. (FINALLY, right? :-P) They are going to create an "insurance marketplace" where you can shop for coverage. Well my therapist mentioned that there was a list of things that isn't going to be covered. Fortunately, she said that "transcare" (my buzzword, and I'm coining it, lol) isn't included on that list of denials, rather it supposedly is going to end up being covered. In fact, she said that there was talk that they are even going to start covering "the surgery" as well. Except she cautioned me to be careful with HMOs like Kaiser, considering that even if they MAY cover the surgery (or at least partially, but every little bit helps), they MAY also not give the choice of a surgeon. She said she was worried about that, since she is usually very picky with her surgeons, because it is "your labia" that we are talking about after all. (Gawd it is still a bit weird to have that term used in reference to me, but I must admit kinda normal, too. Much more normal than that other thing, heh.) So if you want a choice, I'd suggest sticking to a PPO. They always tend to be more "pro-choice."
Not only that, there wasn't just an insurance reform. Nah, there was a tax reform, too. Some of us may be dreading the surgery, because for one thing, it IS a HUGE expense for most if they don't have insurance. Fortunately... Just like insurance is now deductible, Sexual Confirmation Surgery is now seen as a "Medically Necessary" procedure and can be deducted 100% from your taxes! (Well, I'd still have a tax professional confirm it. At least this is what I found out from my research.) But yeah... You've got to love how they finally are seeing us trans as actual human beings. Quite shocking, really. I mean, who ever knew that we were deserving of human rights, too?
But if you have to pay out-of-pocket... There is a good resource for that. Online pharmacies. Don't worry, I'm not promoting self-prescribing, because fortunately you can't get prescription drugs from these pharmacies without a prescription. Places like these save a LOT of money in the long run, because sometimes you can get them cheaper than what even insurance would cover. For example, there is a prescription medication that I have to take for Fibromyalgia (yeah, I'm cursed with that, heh), and my doctor said that "there was no generic version of your medication." Well I checked out one of the sites, and lo and behold there WAS one! We have been paying $60 a month for a three month supply when apparently we can get it for like only $14 to $28, depending on the dosage. So yeah... Good news, good news. Anyways... The said websites are AllDayChemist.com and InHousePharmacy.biz just to name a few. Hope it works out!
I'm finding that where there is a will, there is way. And not only that, things that seem dire now almost always end up brightening up. So don't worry. Things will work out somehow. Have a good day! ^o^
Anyways... I've got good news for all of you in America. Starting in October, there is going to be a HUGE insurance reform. (FINALLY, right? :-P) They are going to create an "insurance marketplace" where you can shop for coverage. Well my therapist mentioned that there was a list of things that isn't going to be covered. Fortunately, she said that "transcare" (my buzzword, and I'm coining it, lol) isn't included on that list of denials, rather it supposedly is going to end up being covered. In fact, she said that there was talk that they are even going to start covering "the surgery" as well. Except she cautioned me to be careful with HMOs like Kaiser, considering that even if they MAY cover the surgery (or at least partially, but every little bit helps), they MAY also not give the choice of a surgeon. She said she was worried about that, since she is usually very picky with her surgeons, because it is "your labia" that we are talking about after all. (Gawd it is still a bit weird to have that term used in reference to me, but I must admit kinda normal, too. Much more normal than that other thing, heh.) So if you want a choice, I'd suggest sticking to a PPO. They always tend to be more "pro-choice."
Not only that, there wasn't just an insurance reform. Nah, there was a tax reform, too. Some of us may be dreading the surgery, because for one thing, it IS a HUGE expense for most if they don't have insurance. Fortunately... Just like insurance is now deductible, Sexual Confirmation Surgery is now seen as a "Medically Necessary" procedure and can be deducted 100% from your taxes! (Well, I'd still have a tax professional confirm it. At least this is what I found out from my research.) But yeah... You've got to love how they finally are seeing us trans as actual human beings. Quite shocking, really. I mean, who ever knew that we were deserving of human rights, too?
But if you have to pay out-of-pocket... There is a good resource for that. Online pharmacies. Don't worry, I'm not promoting self-prescribing, because fortunately you can't get prescription drugs from these pharmacies without a prescription. Places like these save a LOT of money in the long run, because sometimes you can get them cheaper than what even insurance would cover. For example, there is a prescription medication that I have to take for Fibromyalgia (yeah, I'm cursed with that, heh), and my doctor said that "there was no generic version of your medication." Well I checked out one of the sites, and lo and behold there WAS one! We have been paying $60 a month for a three month supply when apparently we can get it for like only $14 to $28, depending on the dosage. So yeah... Good news, good news. Anyways... The said websites are AllDayChemist.com and InHousePharmacy.biz just to name a few. Hope it works out!
I'm finding that where there is a will, there is way. And not only that, things that seem dire now almost always end up brightening up. So don't worry. Things will work out somehow. Have a good day! ^o^
Title: Re: HRT and Insurance confusion
Post by: LordKAT on August 13, 2013, 10:39:48 PM
Post by: LordKAT on August 13, 2013, 10:39:48 PM
Medical bills, in order to be deduct-able, have to be a certain (7.5?) percentage of your income. Only what is paid after reaching that percentage is deduct-able.
Title: Re: The Insurance Question
Post by: Khalysta on August 16, 2013, 03:19:20 PM
Post by: Khalysta on August 16, 2013, 03:19:20 PM
Quote from: Sanceria on August 13, 2013, 01:50:06 PM
Now you've got me wondering if my Anthem BlueCross insurance will cover it. But it doesn't matter anyways, considering that my father doesn't wish for me to use his insurance anyways. Guess when I find my own policy next month that I'll have to look for something else.
I have anthem blue cross and they cover everything as long as the doctors use the codes for gender identity disorder. If they use the one for transexual Anthem denies it. So I have my endocrinologist using the 302.85 code for gid. To me and my doctor's its like the same thing but for anthem they just do not like that transexual code but GID is fine.