Community Conversation => Female to male transsexual talk (FTM) => Transsexual talk => FTM Top Surgery => Topic started by: Rengar on March 11, 2017, 05:38:05 PM Return to Full Version
Title: Medical Necessity
Post by: Rengar on March 11, 2017, 05:38:05 PM
Post by: Rengar on March 11, 2017, 05:38:05 PM
Hello! I've finally gotten a job with insurance that might cover this surgery but I have a few questions about your experiences.
My insurance states it will cover cosmetic surgeries as long as they are medically necessary. I know that transition related surgeries are often labelled "cosmetic". I have United Healthcare and I live in Colorado so I know that Colorado and United Healthcare have policies to ban exclusions for trans related healthcare.
What I wanted to know is if anybody had United Healthcare and was able to get their surgery paid for under medical necessity and what that entailed. I've been on Testosterone for nearly 3 years and have been living as a male for even longer. I know I'll have to call my insurance provider but I just wanted to know if anyone has any advice they could give me.
My insurance states it will cover cosmetic surgeries as long as they are medically necessary. I know that transition related surgeries are often labelled "cosmetic". I have United Healthcare and I live in Colorado so I know that Colorado and United Healthcare have policies to ban exclusions for trans related healthcare.
What I wanted to know is if anybody had United Healthcare and was able to get their surgery paid for under medical necessity and what that entailed. I've been on Testosterone for nearly 3 years and have been living as a male for even longer. I know I'll have to call my insurance provider but I just wanted to know if anyone has any advice they could give me.
Title: Re: Medical Necessity
Post by: Dena on March 11, 2017, 06:31:28 PM
Post by: Dena on March 11, 2017, 06:31:28 PM
I haven't done it but this is were your therapist comes into play. They will have to document the medical need for the surgery and write letters to the insurance company. If you are not in therapy, you may need to have at least a few visits for them to write the letters.
Title: Re: Medical Necessity
Post by: Rengar on March 11, 2017, 06:47:38 PM
Post by: Rengar on March 11, 2017, 06:47:38 PM
Thanks! I have a therapist that I've been communicating with for about 2 years now so I'll let her know.
Title: Re: Medical Necessity
Post by: FTMax on March 11, 2017, 07:52:43 PM
Post by: FTMax on March 11, 2017, 07:52:43 PM
When I had top surgery my plan excluded trans care. The plan I have currently is inclusive and covered my hysto and was open to covering my bottom surgery as well (albeit with a very high out of pocket amount, which is why I'm going overseas). I needed a letter from the doctor that does my hormones detailing my transition history, and two mental health referrals to get bottom surgery covered. For top surgery, I believe it is a doctor letter and one mental health referral.
Title: Re: Medical Necessity
Post by: Contravene on March 15, 2017, 02:51:23 AM
Post by: Contravene on March 15, 2017, 02:51:23 AM
I have United Healthcare too and I'm planning to see if they'll do a one time contract with the surgeon to cover part of my top surgery. I found this guide online that talks about what you need to get your surgery covered as a medical necessity. https://www.unitedhealthcareonline.com/ccmcontent/ProviderII/UHC/en-US/Assets/ProviderStaticFiles/ProviderStaticFilesPdf/Tools%20and%20Resources/Policies%20and%20Protocols/Medical%20Policies/Medical%20Policies/Gender_Dysphoria_Treatment.pdf
I'm not sure if it depends on which plan you have or not but I would think that in states that ban exclusions for trans related healthcare it wouldn't matter and they would have to honor it regardless or what individual plan you have.
I'm not sure if it depends on which plan you have or not but I would think that in states that ban exclusions for trans related healthcare it wouldn't matter and they would have to honor it regardless or what individual plan you have.