Susan's Place Transgender Resources

Aaaaaaaand here it is! 

This chart looks at all of the federal employee health benefit plans except for a few we were not able to get in time to put them in.  It reports on whether they provide trans* inclusive coverage.  You should still look at your individual plan brochures to make sure we didn't make a mistake and to see the specific limits on what is/is not coverage.  The chart covers all plans available in all 50 states.  If anyone has any questions, please don't hesitate to let me know and I'll try to either answer myself or find you an answer.

https://drive.google.com/file/d/0B8jns1Hgd2ITZDFzTjA1eXJMZkk/preview?pli=1

Maybe I'm a wee bit knackered tonight but I can't make sense of this chart. As a VA employee in Alaska is there a plan that's trans-inclusive?

Green = no trans* exclusion.  Look to see if a plan has a green line under Alaska. 

Hi, Phoenix,

In my neck of the woods I can pick aetna, foreign service, both of which are PPO's, or Kaiser Permanent which is a HMO. I am inclined to sign with Kaiser, however, they have been unable or unwilling to tell me which providers who can do a SRS they have

How can I find the SRS providers for any of this companies?

THX!

I went back to this again after some sleep and was delighted to see AETNA removed the exclusion. I was even more delighted today when I learned the VA is offering AETNA for the first time this year. Time to change providers!

Quote from: peky on November 05, 2014, 06:39:14 PM
Hi, Phoenix,

In my neck of the woods I can pick aetna, foreign service, both of which are PPO's, or Kaiser Permanent which is a HMO. I am inclined to sign with Kaiser, however, they have been unable or unwilling to tell me which providers who can do a SRS they have

How can I find the SRS providers for any of this companies?

THX!

That's a good question.  Aside from looking at their website, I don't really have answer.  This is mtf spectrum, correct?  I know they have some surgeons for ftm spectrum.  But I can see about reaching out via some contacts and seeing whether I can get some other info. 

If memory serves, you are also in Maryland, right? 

In all honesty, this is one of the tricky parts.  We see transition benefits being included in an increasing number of policies.  But we don't see them actually having SRS surgeons who can do the surgery in network.  As a result, reimbursement is unsettled as to both amount and procedure.  We also see people still having to make payment up front.  So now that insurance coverage is beginning to exist again (it used to be covered back in the 70s), one of our next battles is about convincing physicians to participate in insurance networks so this will go as smoothly for people.

Quote from: Wynternight on November 05, 2014, 09:07:27 PM
I went back to this again after some sleep and was delighted to see AETNA removed the exclusion. I was even more delighted today when I learned the VA is offering AETNA for the first time this year. Time to change providers!

Aetna seems quite proud of themselves for doing it too.  They aren't being shy about it. :)

Quote from: ThePhoenix on November 05, 2014, 10:31:12 PM
Aetna seems quite proud of themselves for doing it too.  They aren't being shy about it. :)

I commend them for this. Now I just need to figure out who they'll cover. I'd like Brassard for GRS but would an American insurance company pay a Canadian surgeon?

So far I've managed to reach a physician inside of Kaiser who says there is such a person who provides SRS services, but not who the person's name is.  Stay tuned . . . .

Quote from: ThePhoenix on November 06, 2014, 03:46:50 PM
So far I've managed to reach a physician inside of Kaiser who says there is such a person who provides SRS services, but not who the person's name is.  Stay tuned . . . .

Thanks Phoenix! BTW I am in Virginia...

Quote from: peky on November 06, 2014, 08:49:09 PM
Thanks Phoenix! BTW I am in Virginia...

Okay, well, still mid-Atlantic, anyway.  I got the question pushed up to the President's office and I'm supposed to get an answer next week.  So stay tuned . . . .

I wonder if we know each other.

Quote from: ThePhoenix on November 06, 2014, 10:02:02 PM
Okay, well, still mid-Atlantic, anyway.  I got the question pushed up to the President's office and I'm supposed to get an answer next week.  So stay tuned . . . .

I wonder if we know each other.

Perhaps... sometimes I walk along those who every now and then go down range... do you ?

Quote from: peky on November 07, 2014, 07:59:09 PM
Perhaps... sometimes I walk along those who every now and then go down range... do you ?

Not sure I understand the question.  But I do show up at places like MAGIC and the Second Friday group.  I was a guest speaker once at TGEA, but I have not otherwise attended it.

I spoke with the Kaiser SoCal referral nurse back in July and she said they had Dr. Toby Meltzer under contract for MTF GRS.  I expect that situation will change before I am ready to pursue surgery anyway.

Freya

I think I may sign with aetna or the foreign HS. I need to call them to find out exactly what they would cover, money wise, and who are their preferred providers for SRS

It seems, according to the article below, that they all may not be providing what we need

http://insurancenewsnet.com/oarticle/2014/11/11/limited-number-of-federal-employee-health-benefit-providers-to-cover-transition--a-572386.html#.VGIlroc-DVo

Quote from: peky on November 11, 2014, 09:06:05 AM
I think I may sign with aetna or the foreign HS. I need to call them to find out exactly what they would cover, money wise, and who are their preferred providers for SRS

It seems, according to the article below, that they all may not be providing what we need

http://insurancenewsnet.com/oarticle/2014/11/11/limited-number-of-federal-employee-health-benefit-providers-to-cover-transition--a-572386.html#.VGIlroc-DVo

I'm going with AETNA. BCBS, my current provider, did not abide by the OPM and still has the exclusion in place.

I have a chat with Kaiser set for Thursday morning.  So hopefully by then I will have info for folks about the coverage they offer.

Okay, I just got off the phone with Kaiser.   I spoke with the head of the appeals and correspondence unit. For the mid-atlantic region, they tell me that SRS is performed in San Francisco and in Scottsdale, Arizona.  I don't follow the surgeons closely, but that sounds like Toby Meltser and Marci Bowers.  But I'm waiting for confirmation of that.

The other big news is that they do not provide the full range of services called for under the WPATH standards.  They don't provide facial hair removal, voice modification, facial surgery, etc.  It is limited to hormones, mental health, and genital surgery.  In FTM cases, top surgery is provided, but they are supposed to get back to me about hysterectomy and phaloplasty. 

Anyhoo, them'so the basics.  If any other questions pop up, please do let me know and I'll see what I can do.

Quote from: ThePhoenix on November 13, 2014, 09:23:34 AM
Okay, I just got off the phone with Kaiser.   I spoke with the head of the appeals and correspondence unit. For the mid-atlantic region, they tell me that SRS is performed in San Francisco and in Scottsdale, Arizona.  I don't follow the surgeons closely, but that sounds like Toby Meltser and Marci Bowers.  But I'm waiting for confirmation of that.

The other big news is that they do not provide the full range of services called for under the WPATH standards.  They don't provide facial hair removal, voice modification, facial surgery, etc.  It is limited to hormones, mental health, and genital surgery.  In FTM cases, top surgery is provided, but they are supposed to get back to me about hysterectomy and phaloplasty. 

Anyhoo, them'so the basics.  If any other questions pop up, please do let me know and I'll see what I can do.

Well, that is not too bad...full SRS... I hardly have any facial hair... and less I speak without thinking, I do pass 100%...

So, now I am not so sure I want to sign with Aetna as Marci Bowers and Toby Metzer are pretty well established and reputed SRS surgeons...

o course one will need to pay for the ticket to SF or Scottsdale... but that it is not a gbiggie...

Thank you a lot Phoenix... G-d bless your heart for such an altruistic work

OO

P

Quote from: peky on November 13, 2014, 08:41:22 PM

Well, that is not too bad...full SRS... I hardly have any facial hair... and less I speak without thinking, I do pass 100%...

So, now I am not so sure I want to sign with Aetna as Marci Bowers and Toby Metzer are pretty well established and reputed SRS surgeons...

o course one will need to pay for the ticket to SF or Scottsdale... but that it is not a gbiggie...

Thank you a lot Phoenix... G-d bless your heart for such an altruistic work

OO

P

The plane ticket is provided, as is a stipend for meals, hotel, etc.  I'm not saying for sure it is Meltser and Bowers who do the work.  It just sounds like it might be. 

As far as altruism . . . You're welcome, but it's not the least bit altruistic.  I'm losing everything.  I just had a government job offer revoked for reasons related to being trans*.  Except instead of saying it was for that, they cited what has happened to me because of who I am and then accused me of committing some sort of unspecified crime by being dirt poor.  I've been unemployed two and a half years.  I just need a reason to get out of bed.  Most of the people who say very flattering things about me don't auite grasp that.

I'm getting closer to choosing Kaiser.  Aetna and Kaiser are the only T related choices available in the SoCal area.  Kaiser specifically covers GRS, HRT, and Counseling.  It seems that Aetna is limited to GRS.  I haven't seen anything in the Aetna plan document regarding counseling, but in Section 5(f). Prescription drug benefits, they state that compounded bioidentical hormone replacement (BHR) therapy that includes progesterone, testosterone and/or estrogen are not covered.

I asked the Socal Kaiser Trans referral nurse about HRT and she confirmed that depending on doctor's recommendations, progesterone and injectable estrogen may be prescribed.  I asked about the cost of injectable estrogen and she said if I am self administered, I would pay the usual plan copay fees for pharmaceuticals and supplies, but if I came in to the appropriate in plan nursing station, that the injections would be provided for free.  Earlier this year, my endocrinologist prescribed injectable estrogen once a week for me.  When I went to pick up the prescription the cost was $315.00 for a 10 week supply without insurance.  It seems Kaiser's coverage for HRT is a potentially significant savings.  Personally I decided to just wait a few months and stay on oral estrogen until I change plans.

Freya

Thanks ThePhoenix for your work.

I will probably stick with BC/BS because they reached an agreement with our local hospital. I know that I should reject BC/BS out of principle because of their trans exclusions, but I have a family to think about which broadens my healthcare considerations. Overall, I have been pleased with their plan. 

For those selecting Aetna, I would be interested in how you rate their plan throughout the year as well as anything that stands out, good or bad, about their plan.

ThePhoenix,
Nice job on putting together the entire chart for all 50 states!

It looks like in summary, the options are the Aetna plans, the Foreign Service Benefit plan, or Kaiser (regional).

I have also been slowly gathering info on my local Kaiser clinic and it looks like I will be going with them as well because it is the most budget friendly plan and they already have an established transgender care clinic here in Honolulu, HI.  Pretty much all of the info I have echos what you and Freya have already stated, but I will add any additional info I find.

I went ahead and made my selection for Kaiser today.  Aetna was the only other choice in my area without a Trans exclusion, but it seems Kaiser has much more to offer in total trans care coverage.

Freya

Wait, so what does this mean for PA? I have the Geisinger Health Plan.

Quote from: Daydreamer on November 23, 2014, 10:41:19 PM
Wait, so what does this mean for PA? I have the Geisinger Health Plan.

Off the top of my head, I don't know about Geisinger.  But check it out on the chart. :)

Quote from: ThePhoenix on November 23, 2014, 11:07:28 PM
Off the top of my head, I don't know about Geisinger.  But check it out on the chart. :)

I guess I read the chart wrong because it's placed all weird, but I'm going to assume it's in the red unless I saw it wrong.

The Pennsylvania Geisinger Federal health Plan has not removed the "Sex transformations" exclusion.

Here's the link to the plan, exclusions are always in section 6:
http://www.opm.gov/healthcare-insurance/healthcare/plan-information/plan-codes/2015/brochures/73-849.pdf (http://www.opm.gov/healthcare-insurance/healthcare/plan-information/plan-codes/2015/brochures/73-849.pdf)

Aetna may be your best, if not only bet in Pennnsylvania.

Here's the link to the Pennsylvania plans:

http://www.opm.gov/healthcare-insurance/healthcare/plan-information/plan-codes/2015/states/pa.asp (http://www.opm.gov/healthcare-insurance/healthcare/plan-information/plan-codes/2015/states/pa.asp)

Just look at each plan brochure and verify in Section 6 exclusions, whether or not "Sex transformations" is there.  Just check the HMOs, since all of the nationwide plans still maintain the exclusion.

Hope this helps,
Freya

Ugh, was so hoping they would have changed things for next year. So much for getting my hopes up.

Quote from: Daydreamer on November 24, 2014, 09:40:00 PM
Ugh, was so hoping they would have changed things for next year. So much for getting my hopes up.

Daydreamer, it's open season for Federal employees until 08DEC, so you could consider changing to a comparable Aetna plan that has removed the trans* exclusion, rather than stay with Geisinger.

Freya

Quote from: Freya on November 25, 2014, 05:00:11 PM
Daydreamer, it's open season for Federal employees until 08DEC, so you could consider changing to a comparable Aetna plan that has removed the trans* exclusion, rather than stay with Geisinger.

Freya

I'll think things over.

Quote from: ThePhoenix on November 13, 2014, 10:51:32 PM
The plane ticket is provided, as is a stipend for meals, hotel, etc.  I'm not saying for sure it is Meltser and Bowers who do the work.  It just sounds like it might be. 

As far as altruism . . . You're welcome, but it's not the least bit altruistic.  I'm losing everything.  I just had a government job offer revoked for reasons related to being trans*.  Except instead of saying it was for that, they cited what has happened to me because of who I am and then accused me of committing some sort of unspecified crime by being dirt poor.  I've been unemployed two and a half years.  I just need a reason to get out of bed.  Most of the people who say very flattering things about me don't auite grasp that.

I hope your situation improves soon...

Quote from: Daydreamer on November 25, 2014, 07:09:38 PM
I'll think things over.

If you already selected Geisinger in the 2015 Federal Employees Health Benefits Open Season, then as far as I know, you cannot make a second selection until the 2016 Open Season.  If you haven't made a selection already this open season, you have until December 8th to select a new plan.

Freya

I'm 95% sure I'm stuck with their "Health Plus" garbage. Cool. -sighs to eternity-

More problems with our hospital ::). BC/BS out and made the switch to Aetna.

Quote from: Stochastic on December 07, 2014, 09:09:29 PM
More problems with our hospital ::). BC/BS out and made the switch to Aetna.

Aetna removed the trans exclusion for the new year. I changed my insurance this open enrollment from BCBS to Aetna. This was also the first year the VA offered Aetna as a provider.