Susan's Place Transgender Resources

Hello guys, I hope someone can help me with my problem...
To cut my long story short, I am currently in an unfair situation with my health insurance denying the hysterectomy I had when my insurance stated female in their system and it was approved beforehand.  So after I had the surgery, I changed it to male like I was told I could to make it match with my state ID. Now that it already says male, they will of course naturally deny it and I definitely won't be changing it to F because I would then need to change my ID back to F(since they need proof to update the insurance)  So even though the insurance indeed prior authorized the coverage, they're now denying it. 
I don't know what I should do here because I would understand it if I had the insurance saying male but it was not...

Quote from: trumi on December 05, 2015, 11:24:37 AM
Hello guys, I hope someone can help me with my problem...
To cut my long story short, I am currently in an unfair situation with my health insurance denying the hysterectomy I had when my insurance stated female in their system and it was approved beforehand.  So after I had the surgery, I changed it to male like I was told I could to make it match with my state ID. Now that it already says male, they will of course naturally deny it and I definitely won't be changing it to F because I would then need to change my ID back to F(since they need proof to update the insurance)  So even though the insurance indeed prior authorized the coverage, they're now denying it. 
I don't know what I should do here because I would understand it if I had the insurance saying male but it was not...

If your insurance actually authorized the service, there should be an authorization number.  I don't see how they can deny the claim after the authorization was created.

Stand your ground. They authorized it, you have evidence. Now they're just jerking you around.

Thanks for the replies guys, it's really stressing me out.
From what I understand so far, even though the insurance did approve the surgery while it stated F, when the hospital billed the insurance some time later (it apparently didn't happen right away- like how was I supposed to know this when no one informed me about it ?!) I had already changed it to M. I would have waited to change it to M if at least someone told me about it.
So, does this sound like it's the hospital's fault for sending the bill at that time or the insurance's for denying it for saying M?

Quote from: trumi on December 05, 2015, 11:24:37 AM
Hello guys, I hope someone can help me with my problem...
To cut my long story short, I am currently in an unfair situation with my health insurance denying the hysterectomy I had when my insurance stated female in their system and it was approved beforehand.  So after I had the surgery, I changed it to male like I was told I could to make it match with my state ID. Now that it already says male, they will of course naturally deny it and I definitely won't be changing it to F because I would then need to change my ID back to F(since they need proof to update the insurance)  So even though the insurance indeed prior authorized the coverage, they're now denying it. 
I don't know what I should do here because I would understand it if I had the insurance saying male but it was not...

Oh My

Your Insurance agent should be on this like NOW. They will do anything to not pay and I think that your agent should be on it.
Big Hugs
Lyndsey

Quote from: trumi on December 06, 2015, 11:32:42 AM
So, does this sound like it's the hospital's fault for sending the bill at that time or the insurance's for denying it for saying M?

It sounds like a pathetic excuse from the insurance company.

Quote from: WorkingOnThomas on December 06, 2015, 01:38:13 PM
It sounds like a pathetic excuse from the insurance company.

you are right

They authorized it, you had the surgery. Not your problem. This is now squarely between your insurance and the hospital - not between the hospital, your insurance, and yourself. If either actually attempt to hold you liable, you just furnish your authorization notice (I wouldn't let whomever have the actual original however; a copy for those purposes should suffice). Nothing they can do. Not your fault, and certainly not your problem. Retain that authorization, though. It would be your only proof and protection, should they stupidly try and hold you accountable for THEIR backpedaling. And for that matter, the hospital, for not filing their claim in a timely manner in the first place (they ought to know better. I mean, I certainly wouldn't leave MONTH'S grace between services rendered and payment! That's begging to get stiffed, that is. Tsk. Tsk).

Local hospital tried for years to make us pay up for an ER visit (collections hounding and all). They had no legal standing, it was THEIR error, that they didn't attain authorization from insurance, and thereby received no payment (which they would have, if having done their job correctly). Not any fault of mine. (And just how they thought they'd actually be able to hold a 13 YEAR OLD financially liable, besides... well, LMFAO).

Don't worry about it. You are NOT liable for their mutual screw-up.

Thank you everyone.
I am going to STOP CALLING the insurance about it to get more information as if I am the one responsible for this in the first place.  It's bad enough to have my gender questioned but I just called them back to check if they had that prior authorization in their system but they said they don't see any approval's nothing regarding to the hysterectomy was showing up.  So that's why I am going to check it with the doctor's office.

I just know that I will NOT change it to F...
I will keep this updated and hope for a solution :-\

Quote from: trumi on December 06, 2015, 02:49:00 PM
Thank you everyone.
I am going to STOP CALLING the insurance about it to get more information as if I am the one responsible for this in the first place.  It's bad enough to have my gender questioned but I just called them back to check if they had that prior authorization in their system but they said they don't see any approval's nothing regarding to the hysterectomy was showing up.  So that's why I am going to check it with the doctor's office.

I just know that I will NOT change it to F...
I will keep this updated and hope for a solution :-\

The Affordable Care Act put into place that one's legal gender should not keep them from being able to have care for the body that they have.  Meaning, a "female" or a "male" can get authorized for a hysto if they have the parts.

This is my understanding, anyway.  I would look into it.

Hi again, I wanted to update my situation.  Unfortunately, it's gotten worse because just recently when I checked with the hospital's billing department after receiving another bill, they're making it like it was a "co-pay" when it was NOT. I know because I had already checked it with insurance (which is unfortunately Medicaid so I am not even sure if ACA's policy's apply here)  that no portion was covered and it was due to my gender marker now stating M.

http://www.transequality.org/know-your-rights/healthcare (http://www.transequality.org/know-your-rights/healthcare)
http://www.transequality.org/additional-help#legal (http://www.transequality.org/additional-help#legal)

Get in touch with someone on the legal help list and let them know what's going on. They may be able to advise you further.

Quote from: trumi on January 03, 2016, 03:14:34 PM
Hi again, I wanted to update my situation.  Unfortunately, it's gotten worse because just recently when I checked with the hospital's billing department after receiving another bill, they're making it like it was a "co-pay" when it was NOT. I know because I had already checked it with insurance (which is unfortunately Medicaid so I am not even sure if ACA's policy's apply here)  that no portion was covered and it was due to my gender marker now stating M.

Medicaid isn't paying?  I thought that when someone had Medicaid there was never any copay for anything?  Have you sent that authorization letter to anyone?  Sent it to the insurance company and the hospital.

Quote from: Bimmer Guy on December 06, 2015, 04:57:06 PM
The Affordable Care Act put into place that one's legal gender should not keep them from being able to have care for the body that they have.  Meaning, a "female" or a "male" can get authorized for a hysto if they have the parts.

This is my understanding, anyway.  I would look into it.

Here is a quote from the top link Max posted:

Can my insurance plan exclude routine tests or other services usually associated with one gender?
No. According to the U.S. Department of Health and Human Services, plans cannot deny coverage for medically appropriate service simply because you are transgender or because of the gender listed in your insurance record. Denials like this can often be resolved through an appeal with the plan.

Find out how to do a written appeal to Medicaid in your state.

We're you F or M when you had the surgery? If you wre F and then changed it after surgery.  Contact the hospital...they can chage it and not that you changed post surgery.

Jen

I don't understand why they would do that. when I had my top surgery the authorization department called me because my insurance says M. They asked if I knew that a double mascetomy was for a woman, I simply answered I was born a woman and now I live as a man. they said ok and approved it.

I haven't personally tried this but sounds like it would work.
https://scontent.xx.fbcdn.net/hphotos-xft1/v/t1.0-9/12348093_10208087052004876_7037730891487334188_n.jpg?oh=14e5bcd51db9209e337d65a33905fbc6&oe=573FE5EB

Quote from: Alexthecat on January 17, 2016, 05:14:08 AM
I haven't personally tried this but sounds like it would work.
https://scontent.xx.fbcdn.net/hphotos-xft1/v/t1.0-9/12348093_10208087052004876_7037730891487334188_n.jpg?oh=14e5bcd51db9209e337d65a33905fbc6&oe=573FE5EB

That can work.  Once.  If it gets used for a denial, the next time they deny a claim it will be rerouted to a review committee that has the credentials.  (That is generally the appeals committee.)  Then, if you want to appeal, they have to form a new board. But, it can work once.

Jen

JLT, I was F when I had the surgery on the insurance and then changed it later. But apparently what happened was during the time I changed it , the hospital hadn't billed my insurance yet so when the insurance received the bill they denied it which is "understandable" BUT they still DID approve the surgery for a FEMALE which I will NEVER change it  back to (and the insurance kept telling me to change it back , so I quit calling them) 

Alex, I checked out the link and it does look useful but I am not sure if I would be able to do it. Does it HAVE TO be ME who calls?

Teddybear, how long after  you had top surgery did the authorization department call you?

Since my last post, I received two more letters from the hospital holding me responsible.

Lawyer up ASAP! Alexthecat's plan seems like a really good idea. Threaten them back and don't pay anything. And do not change your ID. They're wrong for discriminating you, it's not your problem at all.

I feel ABSOLUTELY DISGUSTED to update my case by saying that it unfortunately involves me having the gender changed back to that FILTHY FEMALE..... on the insurance.. AT LEAST, it's ONLY on that but still, I have my stomach sickened....
The LGBT legal services didn't even help me get through this that didn't involve me doing such action.
It obviously means that I will not see a single doctor when this takes effect just so they can cover the damn thing.  I never want to go to that doctors office ever again nor ask any health related questions there even though I was and am  really thankful for the hysto just because of me having to go through this turmoil.

I don't even want to talk about this BS.

I am so sorry to hear how this has hurt you. I have no good advice or help.  I just want you to know that people do care.
I hope your journey smooths out from here.

With warmth,

Joanna