Susan's Place Transgender Resources

I dont have any insurance right now, i have been looking into getting my own personal coverage. but i want to know if anyone knows of a good company to go through, or what kind i need to get to cover my transition, hrt, therapy,surgey.etc.
  thank you.

where do you live?

I live in west Ga about 30min from atlanta, and i have no clue who to call or what kind of insurance to seek for my transition or etc.. thank you for relpyng back to me.

Pretty much no matter where you live unless it's CA and maybe OR or WA having a doctor prescribe or treat for anything that says "GID" will have the insurance company deny paymeny altogether.

OTH, with diagnoses like "hypogonadism" or "hypergonadism" most endos can write scripts for your hrt that will pass muster with insurance companies.

Same is true for gender therapists: if GID makes an appearance the claim will be rejected, that quick. Instead the treatment will be for depression, anxiety, etc that will pretty much get the gist without naming it.

Except for CA I am not certain that SRS is covered anywhere at all without specific inclusionary riders that the employer pays extra o have included in the group policy.

Although I am fairly certain that someone will give you a reference from somewhere other than their memory. :)

Nichole

Insurance is a bet.  You are giving them money hoping you will get sick or need care, they are betting you are going to give them more than they have to pay out.  The only policies I know of that cover such stuff are from pretty good corporate health care policies - health insurance from your work.  I'm not sure of any private ones that would, though I'm sure you could get one to write you one the cost would be huge.

insurance is a tricky thing to navigate.  MOST policies have specific exclusions for GID-- SRS and FFS are "cosmetic" and therefore unnecessary.  You would have to check on the specific policy you're looking at purchasing.  Gender-related treatment can be covered by a huge variety of insurance carriers, but it's usually at the request of the group purchasing insurance.  So not all carriers will cover GID on all policies, only in instances where it is requested. 
I have Aetna, for example, and they pay for a lot of stuff, including a lot of my HRT.  My blood tests are REALLY expensive, but the hormones themselves are covered pretty well.  My therapy visits, too.  I don't think Aetna covers SRS or FFS. 
My SO works for Wachovia bank right now, and with the merger with Wells Fargo, I might get to switch to an insurance carrier that DOES cover SRS. 
The point to my incoherent rambling?  Check before you buy.  If you're not sure, make a few calls.  Just probe around.  You don't have to admit to having anything, just ask for a list of all exclusions.  Or something like that. 
Also, the HRC has a very nice workplace equality book that they publish every year.  It contains information about benefits and includes some information on transgender coverage and which companies offer health insurance that includes some form of TG coverage.  It's definitely worth checking out. 

Quote from: Nichole on January 19, 2009, 04:18:26 PM
Pretty much no matter where you live unless it's CA and maybe OR or WA having a doctor prescribe or treat for anything that says "GID" will have the insurance company deny paymeny altogether.

Not in WA, but all depends on your health insurance plan, especially if it's a HMO, local/state plan, national plan, corporate/company plan or an umbrella plan (a plan overlying a Blue Cross/Blue Shield plan). Almost all have their coverage plans on-line, or ask, so you can research their coverage, and look for anything related to sex transistion, transformation, etc., and more than likely it's specifically excluded. It's best not to mention anything GID/trans-related but read the coverage plans. You can simply progress without any mention of it. if they ever catch on, it's doubtful they'll audit and/or seek compensation.

Quote from: SusanK on January 19, 2009, 06:13:05 PM
It's best not to mention anything GID/trans-related but read the coverage plans. You can simply progress without any mention of it. if they ever catch on, it's doubtful they'll audit and/or seek compensation.

And that IS the truth. A good and experienced endo will not be sending through their request for reimbursment using the sort of code that will blare out that this is T-related anyhow.

Pretend you're in the military: don't ask, don't tell. But do investigate all riders and exclusions. Even some of the companies that are "trans-friendly" don't have "trans-friendly" health insurance.

Nichole

QuotePretend you're in the military: don't ask, don't tell

Which brings us back to morals. Because the insurance discriminates against us is it OK to misrepresent our condition? This post modern world has lost all sense of responsibility and honesty which leaves people into believing it is OK to be screwed and like wise to screw others. Sounds like the reason for the financial crises. Who ever screws the best wins. In the government it is called a work around. Bush was very good at it.

Quote from: Nichole on January 19, 2009, 06:50:35 PM
And that IS the truth. A good and experienced endo will not be sending through their request for reimbursment using the sort of code that will blare out that this is T-related anyhow.

Or should your physician if they're the prescribing doctor (often preferred because they're about your whole health and fitness and endo's often defer to them). The only piece of paper noting anything similar is the one you sign with your physician accepting you understand what hrt is and does and hold the physician harmless for your own decisions and actions with respect to hrt. And that's buried in your paper file never to see the light of day again.

so far my insurance has covered everything.  From therapist visits, all my doctors appointments, including my endocrinologist, and HRT.  The insurance policy specifically states that they dont cover anything trans related, but so far so good.  I assume they will NOT cover srs or anything else (ffs etc).  I will also note that I did pick doctors quite carefully to have the best shot at being covered and also have no idea how they wrote up the reasons for hrt and whatnot or if it would make a difference.

My therapist codes my visits as depression and anxiety as primary and gid as secondary in case they ever audit and so far my insurance covers everything but my co-pay.

Paula.

Quote from: lizard on January 20, 2009, 07:18:52 PM
so far my insurance has covered everything.  From therapist visits, all my doctors appointments, including my endocrinologist, and HRT.  The insurance policy specifically states that they dont cover anything trans related, but so far so good.  I assume they will NOT cover srs or anything else (ffs etc).  I will also note that I did pick doctors quite carefully to have the best shot at being covered and also have no idea how they wrote up the reasons for hrt and whatnot or if it would make a difference.

So far mine has done the same and like yours  has an exclusion clause for anything trans related. What concerns me is that I should be f/t in 3 weeks and with that a name change which to the insurance carrier will very obvious. I havent discussed it with my Endo as I have turned a blind eye to it so far and my Threapist codes it as depression.

Still, I am a bit worried as to what the name change will do, even though the gender marker will remain the same. I'm afraid they will want me to repay them or something along those lines. Suggestions anyone? Its a bit like a dance. Hugs

Wendy

Quote from: Wendy C on January 28, 2009, 10:34:56 AM
Still, I am a bit worried as to what the name change will do, even though the gender marker will remain the same. I'm afraid they will want me to repay them or something along those lines. Suggestions anyone? Its a bit like a dance. Hugs

Good luck. Somehow, though, I think the name change will trigger some flags to review the file, but you never know, it could easily sail through and you get a new card and keep rolling on. If they do catch it, it's likely to take a few (4-6+) months, and you'll get a nasty letter about an audit and upcoming repayment statement. Prepare to file an appeal just in case stating the name change is personal. But again, your file will become visible and flagged. It will depend on the reviewers. Best wishes.

I have Kaiser Permanente in OR, and the only thing they cover is HRT.  They list Orchidectomy, but only for valid medical reasons.  And they don't list transsexualism as valid.  Go Figure.  They will change it if Oregon ratifies or adopts the AMA Resolution 122.  Maybe they will someday.

Janet

ooh hey, i didnt think about the name change triggering stuff.  Lets hope it just slides on thru.

Quote from: Janet Lynn on January 29, 2009, 12:49:25 AM
I have Kaiser Permanente in OR, and the only thing they cover is HRT.  They list Orchidectomy, but only for valid medical reasons.  And they don't list transsexualism as valid.  Go Figure.  They will change it if Oregon ratifies or adopts the AMA Resolution 122.  Maybe they will someday.

Janet

Janet brings up an important point. I keep hearing people here in town who say to go with Kaiser because it covers everything. Well, it depends on your employer--that is, it depends on which company negotiated the contract. Some Kaiser policies cover HRT, some cover certain surgery, and some--like the one that my partner is eligible for--completely exclude ALL trans-related stuff and aren't worth a damn. So even Kaiser, which so many people claim is the best, varies.

As Jessica says, you have to see the specific policy. If you go online to look at policies, you will likely encounter a drop-down menu of policies for different regions/companies. You have to choose the right one to find out what is covered by the particular policy you will be buying.

And now I'm worried because when I went in for blood tests, my GP insisted on writing something down about my being trans. I don't know whether my blood tests will be covered. He says that they will because he attributed the need for tests to "fatigue," but I'm not convinced. I'm guessing that the insurance company only sees specific paperwork that my doctor submits--they don't see the whole file, right? I've got my fingers crossed. Because I'm guessing that once "trans" makes it into your paperwork, everything you do is red-flagged from then on...

So far I have been lucky.  My therapist has me down for depression due to a life changing event.  Which is true.  I know my insurance lists trans as not covered, and that is with bc/bs.  Fortunately there is an agency here that pays for the doctor visits, and blood work. I have to pay for the prescriptions though.  I was told that the cost isn't too bad however depending on the administrtion. I will know more on friday when I go in for my first examination.

Let me clarify about insurance in California.  It all depends on what the policy, usually provided by an employer, covers.  The only employers I know for sure cover GRS are the University of California (120,000 employees) and the City and County of San Francisco.  Medi-Cal (California's Medicaid program) will reimburse the cost of GRS surgery, supposedly, but if you've got the cash for surgery you probably don't qualify for Medi-Cal.

There may be other companies that provide surgical benefits, I just don't know who they are.  I wasn't aware that drugs require a diagnosis to go with them.  Mine never come with one and the drugs used in HRT are common and relativly inexpensive.  The only time my carrier has questioned a prescription was for one that's expensive, $900 per month, that's not related to HRT at all.

Which brings us back to morals. Because the insurance discriminates against us is it OK to misrepresent our condition? This post modern world has lost all sense of responsibility and honesty which leaves people into believing it is OK to be screwed and like wise to screw others

I often don't agree with Lisa, but she is right on here.  And, with money getting tight and all, I'm sure the companies are going to be looking a lot more closely at what they can get out of covering.

And, as I said in another post.  If you EVER get dropped from one policy for anything pertaining to fraud, or misstatements, you will NEVER, EVER, get covered again.  Insurance companies share information like Deadheads share pot.

Different story in Indiana--I can't think of one health insurance company that will cover any transgender-related medical costs.

Unless any transgendered Hoosier (a person from Indiana) can stump me, then feel free to post a reply. ???

Insurance companies will pay whatever they are contracted for.  The more you want, the more you pay.  Every few years when we have our benefits meeting it gets pretty heated - are we going to cover braces, do we cover health club memberships and the like.  Currently we cover HRT, but not SRS or FFS.  Its all in what you contract for.

Quote from: tekla on February 11, 2009, 11:09:30 AM
Insurance companies will pay whatever they are contracted for.  The more you want, the more you pay.  Every few years when we have our benefits meeting it gets pretty heated - are we going to cover braces, do we cover health club memberships and the like.  Currently we cover HRT, but not SRS or FFS.  Its all in what you contract for.

I think the coverage issue may change.  C&C San Francisco paid a big premium increase when they began to cover SRS.  The cost went down after several years as only a very small number of people took advantage of it.  There was a piece in the Chomical about it a couple years ago.  UCSF started providing transition benefits a little over a year ago.  I'm fairly well connected there but I've heard nothing about anyone taking advantage of the coverage.

What really strikes me as strange is that a major medical center, always in the top 10 nationwide, offers nothing in treatment for GID.  It's located in what may be the TG capital of the world yet provides no services, other than those one may obtain from a PCP in its faculty practice.

While I'm bitching about the place, I should say that it's a great institution and I'm proud to be a part of it.

Its a cost benefit deal, for the people I know, like a person who was a BoA VP at the time, paying out $80K over a few years was not much compared with what he/she was making in pay.  But I'd be real reluctant to shell that out for someone working for minimum wage.  The cost of the coverage for them, is more than they are worth as an employee.