Susan's Place Transgender Resources

I hope this is the right place to ask this question. I have group health insurance through my employer that doesn't have benefits for transitioning. Does anyone know of any health insurance I can purchase here in the states, I live in TX btw, that would give me that kind of coverage?

Has anyone had any luck personally in this regrard?

Thanks,

Kaylee

Anything helpful here? http://www.hrc.org/resources/entry/finding-insurance-for-transgender-related-healthcare

I believe the ACA (Obamacare) insurance marketplace plans cover trans care.

There are also some clinics that do sliding scale billing if you don't have insurance.

Quote from: Devlyn Marie on October 23, 2014, 02:09:08 PM
Anything helpful here? http://www.hrc.org/resources/entry/finding-insurance-for-transgender-related-healthcare

Thanks Devlyn Marie. :)

Quote from: ImagineKate on October 23, 2014, 02:14:15 PM
I believe the ACA (Obamacare) insurance marketplace plans cover trans care.

There are also some clinics that do sliding scale billing if you don't have insurance.

ACA plans do not require trans related care coverage.

I was looking into that as well. My employer does not cover it either. I live in NY. Most surgeons do not take ins. I am seeking top surgery. I was told by all consultations to pay for it and they will give a receipt to submit to insurance.

Although now I hear Medicare/Medicaid covers it.

Best of luck.

Quote from: LordKAT on October 24, 2014, 01:44:40 AM
ACA plans do not require trans related care coverage.

Oh?  I was under the impression that they did.

In any case don't the changes to the law make it better? I think I remember a member here was featured in a CNN article?

The article was a bit misleading. The law says they cannot withhold treatment for a trans person that they would not give to anyone else. They cannot refuse to set a broken arm since they would do that for anyone else under their insurance. It does not say anything about trans related care. They also cannot use the excuse of a pre existing condition. That makes it better for that point only, worse in others.

If you live in a state that requires trans related coverage, then the ACA plans must include it as well. This is the case in the article you refer to.

I hope this will make a forum topic for sure not just a post. This topic has been brought up about insurance on HRT, and other topics. ;D
As far as insurance goes it all depends on the doctor that will take it. Some will ask that you pay up in front then it is on you to follow up with your insurance for reimbursement. I guess the question might be what doctor are you going to then find out what insurance they work with. Then go from there as far getting some. The medicare thing is so new that nobody takes it for now unless anyone has new info please post.

Hi,

I just wanted to share my experience with this and what I did.  I live in Minnesota and my insurance through my employer didn't have coverage for SRS either.  However, I spoke with HR and she told me that a lot of insurance have a prior authorization process where if you can prove that it is medically necessary, it will be covered.  That what I did.  Using the WPATH standards, I had my surgeon submit prior authorization to my insurance.  I had to get two letters of recommendation from two different therapist to supplement the case as well.  It was approved but does take a while.  I'm wondering if you can do the same with yours?  If SRS is what you're looking for.

Quote from: ForeverGiselle on October 28, 2014, 11:19:42 AM
Hi,

I just wanted to share my experience with this and what I did.  I live in Minnesota and my insurance through my employer didn't have coverage for SRS either.  However, I spoke with HR and she told me that a lot of insurance have a prior authorization process where if you can prove that it is medically necessary, it will be covered.  That what I did.  Using the WPATH standards, I had my surgeon submit prior authorization to my insurance.  I had to get two letters of recommendation from two different therapist to supplement the case as well.  It was approved but does take a while.  I'm wondering if you can do the same with yours?  If SRS is what you're looking for.

Hi,

I live in Minnesota as well (Twin Cities).  I proved medically necessity for Facial Feminization Surgery (FFS, way beyond SRS coverage here) using the WPATH standards, two psych letters, a letter from the surgeon, a letter from my primary doctor and a letter from my endo.  My surgeon submitted prior authorization and was rejected.  We filed a bunch of additional documentation and information and then I appealed the rejection to some committee in my insurance company and lost.  I started the paperwork for an appeal to the state, including additional information from the insurance company and suddenly, the insurance company rolled over and they paid.  It took me eight months.  It was a lot of work.

Copy the WPATH standard and get as much documentation you can that it is medically necessary and a medically recognized treatment.  Then, be prepared to loose, but keep fighting. 

Hugs,

Jen

None of the pubic and individual Texas plans cover SRS. The only way to get such coverage in the state of Texas would be to have a judge order the coverage.

In thought,

Jamie Nichols