Good news for some of us........Those of us that are employed FT or become employed FT at Sears are entitled to their Blue Cross Select PPO which now PAYS FOR SRS, GRS, GCS.......in the manual they refer to it as sex reassignment surgery.
YEA!!!
(https://www.susans.org/proxy.php?request=http%3A%2F%2Ftickers.tickerfactory.com%2Fezt%2Fd%2F4%3B10704%3B96%2Fst%2F20120220%2Fe%2FGCS%2Bwith%2BDr%2BMcGinn%2Fk%2Fe753%2Fevent.png&hash=a4447cb9c0696fe7b9b9f52fb753f79b2778450e)
(http://www.tickerfactory.com/)
you do not need to work for sears to get this insurance it is available as private purchase threw anthems site here are the policies related to gender reassignment coverage as pulled from their policies page but you also need to remember that most grs surgeons do not currently take insurance so you will still have to pay up front then file for reimbursement.
Jessi
Medically Necessary:
Gender reassignment surgery* is considered medically necessary when all of the following criteria are met:
The individual is at least 18 years of age; and
The individual has been diagnosed with the Gender Identity Disorder (GID) of transsexualism, including all of the following:
The desire to live and be accepted as a member of the opposite sex, usually accompanied by the wish to make his or her body as congruent as possible with the preferred sex through surgery and hormone treatment; and
The transsexual identity has been present persistently for at least two years; and
The disorder is not a symptom of another mental disorder or a chromosomal abnormality; and
The disorder causes clinically significant distress or impairment in social, occupational, or other important areas of functioning; and
For those individuals without a medical contraindication, the individual has undergone a minimum of 12 months of continuous hormonal therapy when recommended by a mental health professional and provided under the supervision of a physician; and
The individual has completed a minimum of 12 months of successful continuous full time real-life experience in their new gender, with no returning to their original gender, including one or more of the following:
Maintain part- or full-time employment; or
Function as a student in an academic setting; or
Function in a community-based volunteer activity; and
The individual has acquired a legal gender-identity-appropriate name change; and
The individual has provided documentation to the treating therapist that persons other than the treating therapist know that the individual functions in the desired gender role; and
Regular participation in psychotherapy throughout the real-life experience when recommended by a treating medical or behavioral health practitioner; and
Demonstrable knowledge of the required length of hospitalizations, likely complications, and post surgical rehabilitation requirements of various surgical approaches; and
Demonstrable progress in consolidating one's gender identity, including demonstrable progress in dealing with work, family, and interpersonal issues resulting in a significantly better state of mental health (this implies satisfactory control of problems such as sociopathy, substance abuse, psychosis, suicidality, for instance); and
A letter** from the individual's physician or mental health provider, who has treated the individual for a minimum of 18 months, documenting the following:
The individual's general identifying characteristics; and
The initial and evolving gender, sexual, and other psychiatric diagnoses; and
The duration of their professional relationship including the type of psychotherapy or evaluation that the individual underwent; and
The eligibility criteria that have been met and the physician or mental health professional's rationale for surgery; and
The degree to which the individual has followed the eligibility criteria to date and the likelihood of future compliance; and
Whether the author of the report is part of a gender identity disorder treatment team; and
A letter** from a second physician or mental health provider familiar with the individual's treatment and the psychological aspects of Gender Identity Disorders, corroborating the information provided in the first letter (see #10 above); and
When one of the signatories on the letters indicated above is not the treating surgeon, a letter from the surgeon confirming that that they have personally communicated with the treating mental health provider or physician, as well as the individual, and confirming that the individual meets the above criteria, understands the ramifications and possible complications of surgery, and that the surgeon feels that the individual is likely to benefit from surgery.
* Gender reassignment surgery may include any of the following procedures:
Male-to-Female Procedures
Orchiectomy
Penectomy
Vaginoplasty
Clitoroplasty
Labiaplasty
Female-to-Male Procedures
Hysterectomy
Salpingo-oophorectomy
Vaginectomy
Metoidioplasty
Scrotoplasty
Urethroplasty
Placement of testicular prostheses
Phalloplasty
** At least one of the professionals submitting a letter must have a doctoral degree (Ph.D., M.D., Ed.D., D.Sc., D.S.W., or Psy.D) and be capable of adequately evaluating co-morbid psychiatric conditions. One letter is sufficient if signed by two providers, one of whom has met the doctoral degree specifications, in addition to the specifications set forth above.
Not Medically Necessary:
Gender reassignment surgery is considered not medically necessary when one or more of the criteria above have not been met.
Sears has been covering SRS for three years now.
Also, it's a tad bit cheaper to have Anthem through Sears than it is to pay it through a personal plan you created for yourself.
agree as it would be for any employer sponsored plan but it is still a viable option if you are not employed by them
Jessi
for those that wish it anyways
Quote from: jesse on October 31, 2011, 11:54:36 PM
agree as it would be for any employer sponsored plan but it is still a viable option if you are not employed by them
Jessi
for those that wish it anyways
Oh absolutely
Here is a list I compiled last July. I know there's about 15 more companies added in the next quarter so I haven't been able to add them in yet:
Coca Cola
Campbells Soup
Walt Disney
State of Conn. Teacher Association
The Government of Louisana
HRC
Johnson and Johnson
Aetna Insurance (private plan)
AmeriHealth
Anthem Blue Cross Blue Shield
Blue Cross Blue Shield for:
Massachusetts
Minnesota
Michigan
Ameriprise Financial Inc
Avaya Inc.
Barclays Capital
Bingham McCutchen LLP
Booz Allen Hamilton Inc.
Cardinal Health Inc.
Chrysler LLC
Cisco Systems Inc.
Clifford Chance US LLP
Covington & Burling LLP
Cummins Inc.Deloitte LLP
Deutsche Bank
Diageo North America
DLA Piper
E. I. du Pont de Nemours and Co. (DuPont)
Eastman Kodak Co.
Ernst & Young LLP
Exelon Corp.
Faegre & Benson LLP
Food Lion LLC
Ford Motor Co.
Fried, Frank, Haris, Shriver & Jacobson LLP
Genentech Inc.
General Motors Corp.
Google Inc.
Herman Miller Inc.
Intel Cigna
International Business Machines Corp. (IBM)
Katten Muchin Rosenman LLP
Kimpton Hotel & Restaurant Group Inc.
Kirkland & Ellis LLP
KPMG LLP
Kraft Foods Inc.
Latham & Watkins LLP
Littler Mendelson PC
Marsh & McLennan Companies Inc.
McGraw-Hill Companies Inc., The
Microsoft Corp.
Morrison & Foerster LLP
Nike Inc.
Northern Trust Corp.
PG&E Corp.
Pillsbury Winthrop Shaw Pittman LLP
Replacements Ltd.
Robins, Kaplan, Miller & Ciresi LLP
Shearman & Sterling LLP
Sonnenschein, Nath & Rosenthal LLP
Sun Microsystems Inc.
Sutherland Asbill & Brennan LLP
White & Case LLP
Yahoo! Inc.
Cigna Private plan
Emblem Health
HealthNet
Health Partners (Minnesota)
Medica
University of Pennsylvania
Penn State
Goldman Sachs
Bank of America
City and County of San Francisco
IBM
AmEx
AT&T
Wells Fargo
Eastman Kodak
Sears
Morgan Stanley
Price Waterhouse
State Farm
New York Life Insurance
Angell Palmer and Dodge Law Firm
City of Berkley
All of these have GRS/GCS/SRS included in their policies.
However, getting disability insurance (i.e., paychecks while you are out recuperating) is at the discretion of your specific company's individual Disability Carrier Contract Guidelines.
Could we sticky this thread, please?
Thanks ladies for your research.
Does anyone know about the Interpublic Group and the UnitedHealthcare PPO that they offer? I've found mixed answers online about it.
Quote from: michelle666 on November 02, 2011, 10:06:20 PM
Does anyone know about the Interpublic Group and the UnitedHealthcare PPO that they offer? I've found mixed answers online about it.
If you work for them, the best thing to do is to contact your benefits coordinator for the health care contact number and then ask a specialist if they cover SRS.
But I am not finding anything
I wonder if they consider transsexualism a "preexisting condition"
Anybody know?
Quote from: Butterflyhugs on November 02, 2011, 11:22:05 PM
I wonder if they consider transsexualism a "preexisting condition"
Anybody know?
It varies from company to company.
If you were being covered by insurance by going to a Gender Therapist for Gender Identity Dysphoria and/or gate keeping reasons, and then get another job then your new Medical Insurance provider
may deny you under the pre-existing clause.
Also, some Insurance Providers will see the Pre-existing clause for transsexualism/->-bleeped-<- under a different clause. This is usually the more common of the pre-existing clauses:
Let's say you got an orchi under another insurance provider (or you paid out of pocket). Then you got medical insurance that covered transsexualism/->-bleeped-<- and a few months after you signed on (or however long) you develop an infection from the orchi. Your insurance provider will not pay to have you correct this as it was a pre-existing condition prior to enrolling within their policy contract. (if you appeal this through the State level insurance board you will more than likely get approved....this argument holds very little water these days for the Insurance Companies).
However, all of this will be pretty mute because the AMA is putting pressure on Insurance Companies to eradicate the pre-existing clause....especially with transgender people
Source: http://www.tgender.net/taw/ama_resolutions.pdf (http://www.tgender.net/taw/ama_resolutions.pdf)
Also, President Obama signed a bill that makes pre-existing denials extremely difficult for the Health Insurance Companies to enforce:
Source: http://www.familiesusa.org/health-reform-central/september-23/Pre-Existing-Conditions.pdf (http://www.familiesusa.org/health-reform-central/september-23/Pre-Existing-Conditions.pdf)
In conclusion, I would not worry too much about it. The first step is to see if your company will even carry coverage for transgender people and then worry about the specifics later.
Well if I was going to pick an insurance plan based on if they cover SRS or not, I'd want to know the specifics before signing up with them :P
Quote from: Butterflyhugs on November 02, 2011, 11:46:16 PM
Well if I was going to pick an insurance plan based on if they cover SRS or not, I'd want to know the specifics before signing up with them :P
Well if you are privately buying the Insurance you can request a comprehensive list of all benefits, exclusions, etc and find the one that fits for you.
You would want to look at the pre-existing language in whatever insurance company you look at for coverage. Every single Insurance Company is different with this and you will not know for sure until you call the companies you are interested in and ask for information on their pre-existing clauses, contractual and policy language, etc.
Quote from: Michelle. on November 01, 2011, 07:43:13 PM
Could we sticky this thread, please?
Thanks ladies for your research.
Ask and you shall receive.
Annah, you rock.
I have yet to see an American insurance company that will cover FFS or BA, they consider them both cosmetic.
-Lef
Quote from: leflauren678 on November 04, 2011, 05:10:15 PM
I have yet to see an American insurance company that will cover FFS or BA, they consider them both cosmetic.
-Lef
Thank you captain obvious! :o
This is about SRS and HRT
I imagine that's yet to cover at a price that makes economical sense.
At some point the cost you pay for the insurance is going to be nearly equal to the cash cost.
That and I'm not sure that the top surgeons would be willing to discount their fees to what the insurance company is willing to pay out.
Quote from: leflauren678 on November 04, 2011, 05:10:15 PM
I have yet to see an American insurance company that will cover FFS or BA, they consider them both cosmetic.
-Lef
this thread was abut srs and insurance.....not ffs or ba and insurance.
I think they are equally if not more important (especially FFS) parts of surgical transition and should be included in this sticky. I personally don't see them as anymore "cosmetic" than breast reconstruction following mastectomy, which insurance is required to pay for in New York, New Jersey, and most if not all other states.
-Lef
Quote from: Annah on November 04, 2011, 10:54:48 PM
this thread was abut srs and insurance.....not ffs or ba and insurance.
Quote from: Butterflyhugs on November 04, 2011, 07:23:42 PM
Thank you captain obvious! :o
This is about SRS and HRT
Quote from: leflauren678 on November 06, 2011, 02:35:42 PM
I think they are equally if not more important (especially FFS) parts of surgical transition and should be included in this sticky. I personally don't see them as anymore "cosmetic" than breast reconstruction following mastectomy, which insurance is required to pay for in New York, New Jersey, and most if not all other states.
-Lef
If you can't see the difference there I'm not sure how to help you out.
Quote from: leflauren678 on November 06, 2011, 02:35:42 PM
I think they are equally if not more important (especially FFS) parts of surgical transition and should be included in this sticky. I personally don't see them as anymore "cosmetic" than breast reconstruction following mastectomy, which insurance is required to pay for in New York, New Jersey, and most if not all other states.
-Lef
I understand, but this thread was concerning Insurance covered by various companies and which companies has it and which does not for srs
Also, many insurance that covers breast reconstruction after a mastectomy is due to breast tissue having to be removed after breast cancer or breasts that were so large, the patient's spine was in jeopardy. Unless you specifically pay through a private insurer, companies has those procedures as an exclusion (unless you can prove that your physical health is at stake).
I am sure that FFS and BA may be covered one day but right now, advocate groups are trying to get companies on board with SRS. FFS and BA coverages may come on the table for US companies for transgender people in about 10-15 years.
But for the time being, this sticky was made to post US companies who has SRS in their medical coverages.
Right on Sisters!!
Annah, once again thanks for sharing your "insider" knowledge.
Quote from: Michelle. on November 06, 2011, 10:20:09 PM
Right on Sisters!!
Annah, once again thanks for sharing your "insider" knowledge.
And just think, me managing insurance claims....I would often sit there and think "what in the world would this do for me in the future other than typical medical procedures?"
Those years in the field became more valuable to me now more than ever.
Right now at my work is open enrollment for our insurance plans. Tomorrow, I'm going to see if I can get the detailed coverage documents for each policy. There must be something in at least one of the policies. On the Human Rights Campaign site, my company is listed in the Best Places to Work 2011. The coverage is a bit confusing.
My company is listed like this;
TRANSGENDER BENEFITS
Benefits
Insurance Available to Employees Transgender Treatment Covered
Short-term Leave After Surgical Procedure X x
Mental health counseling x x
Hormone therapy x -
Medical visits x -
Quote from: michelle666 on November 06, 2011, 11:16:55 PM
Right now at my work is open enrollment for our insurance plans. Tomorrow, I'm going to see if I can get the detailed coverage documents for each policy. There must be something in at least one of the policies. On the Human Rights Campaign site, my company is listed in the Best Places to Work 2011. The coverage is a bit confusing.
My company is listed like this;
TRANSGENDER BENEFITS
Benefits
Insurance Available to Employees Transgender Treatment Covered
Short-term Leave After Surgical Procedure X x
Mental health counseling x x
Hormone therapy x -
Medical visits x -
Best places to work for LGBT people does not mean SRS is covered by that company. It means that your company is very open and embraces LGBT people. I will explain what that chart means for you that was put in place by your company:
According to your chart, your company has a disability insurance contract that covers disability leave from SRS (which is very very good. Many companies do not have that in their disability language).
Mental Health Counseling means that your doctor can diagnose your visits as transgender related and your insurance will cover it. Typically, people who are insured has their therapist list your visits as "clinical depression" so you can be covered while doing your WPATH requirements.
Your company does not cover insurance that facilitates the prescription costs of estrogen, anti androgen, and other medications a doctor would prescribe to you during your transition.
Your company does not cover the costs of endocrinology appointments or any lab work that is in relation to hormonal replacement therapy. Your policy in this same relation, also does not cover orchi under transgender diagnosis.
Based on the last two sections of your company's chart, I am pretty sure they do not cover SRS. But nevertheless, call your HR Director. Their policies may have changed since HRC's last publication.
Keep in mind the Target/WalMarts of the world 'script drug plans. Estrogen and Spiro are on there.
Also run a spreadsheet. At what point are you better off getting the cheapest HMO and paying out of pocket for some things. Does work offer a Health Savings Account? Etc etc.
Quote from: Annah on November 06, 2011, 11:25:28 PM
Best places to work for LGBT people does not mean SRS is covered by that company. It means that your company is very open and embraces LGBT people. I will explain what that chart means for you that was put in place by your company:
According to your chart, your company has a disability insurance contract that covers disability leave from SRS (which is very very good. Many companies do not have that in their disability language).
Mental Health Counseling means that your doctor can diagnose your visits as transgender related and your insurance will cover it. Typically, people who are insured has their therapist list your visits as "clinical depression" so you can be covered while doing your WPATH requirements.
Your company does not cover insurance that facilitates the prescription costs of estrogen, anti androgen, and other medications a doctor would prescribe to you during your transition.
Your company does not cover the costs of endocrinology appointments or any lab work that is in relation to hormonal replacement therapy. Your policy in this same relation, also does not cover orchi under transgender diagnosis.
Based on the last two sections of your company's chart, I am pretty sure they do not cover SRS. But nevertheless, call your HR Director. Their policies may have changed since HRC's last publication.
I got my plan descriptions from my HR department yesterday, they're only 3 pages long and don't go into anything trans. How would I find out what exactly is covered, just call the insurance company?
While looking at all this yesterday, I got the details on the disability leave for surgery. I can take 13 weeks at full pay, then 13 more at 50% pay and then up to a year more at 50% on long term leave. I also found out that we also have a legal plan for all civil matters, so I signed up for that. At $3 a week, it's worth it.
yes, usually the fine print isn't in the booklets you get at work so you will have to call....or you can tell me where you work and I can tell you right away if your company covers srs
Quote from: Annah on November 08, 2011, 07:12:38 AM
yes, usually the fine print isn't in the booklets you get at work so you will have to call....or you can tell me where you work and I can tell you right away if your company covers srs
i work for the interpublic group. We have Aetna and UnitedHealthcare. Wiht united, we have two PPO choices and Aetna, I think it's and EPO or something like that.
Quote from: michelle666 on November 08, 2011, 05:33:52 PM
i work for the interpublic group. We have Aetna and UnitedHealthcare. Wiht united, we have two PPO choices and Aetna, I think it's and EPO or something like that.
Unfortunately, Interpublic Group of Companies Inc does not have SRS/GRS/GCS on their policy.
Aetna has this procedure on their list of coverable procedures, but Interpublic Group of Companies Inc has chosen to make it an exclusion at this time.
You should contact your HR to discuss any opportunities to add SRS/GRS/GCS to the policy when benefits are renewed.
Quote from: Annah on November 08, 2011, 09:50:17 PM
Unfortunately, Interpublic Group of Companies Inc does not have SRS/GRS/GCS on their policy.
Aetna has this procedure on their list of coverable procedures, but Interpublic Group of Companies Inc has chosen to make it an exclusion at this time.
You should contact your HR to discuss any opportunities to add SRS/GRS/GCS to the policy when benefits are renewed.
Thanks for checking! I had a feeling that they didn't. It is nice that they do cover therapy and the leave after surgery though. The 13 weeks leave at full pay and 13 at half pay is going to help a lot. I was planning on saving money to get me through the recovery period, which would make me put surgery off for an extra year.
Quote from: michelle666 on November 08, 2011, 09:55:07 PM
Thanks for checking! I had a feeling that they didn't. It is nice that they do cover therapy and the leave after surgery though. The 13 weeks leave at full pay and 13 at half pay is going to help a lot. I was planning on saving money to get me through the recovery period, which would make me put surgery off for an extra year.
yup. Make sure you sit down with your HR concerning your Disability Insurance too. Get to know your disability contract very intimately before going out on leave. I would also heavily suggest to call your disability carrier directly and talk to them before the procedure is even done.
When I was with Liberty Mutual I cannot tell you how many times the HR did not know their contract that they put together with us. Some things I would ask your disability provider:
1. The contract covers disability leave for sexual reassignment surgery correct?
2. Are there any special provisional requirements to make myself eligible for disability after the surgery or is there anything I should know about that could hinder the approval process of the claim?
3. Is the disability contract valid if my surgery was done out of the country? (if you are getting it done out of the country)...if this is the case make sure you communicate with your foreign doctor about sending your medical records promptly to your disability provider.
4. Make sure you know your length of time at your job, make sure your fulltime status is known and understood and make sure your 13 weeks full pay and 13 weeks half pay will apply to you.
About step number 4, your time out will be determined by your job occupation activity level. If you worked in a factory doing heavy machinery, your time out will be longer. If you sit all day with occasional walking (Sedentary) then your time out will be much shorter. 13 weeks full and 13 weeks half simply means this is the maximum amount of time as provided in the contract that your disability company will pay for. 26 weeks is for those who had MAJOR surgery with a Heavy Job occupation (such as a Quintiple Heart Bypass Surgery and a rotator cuff surgery done on the same person in the same time). The maximum is also for those who have stage four cancer where they know that the heavy chemo treatments and therapy will put them out of work (and possibly terminal).
If you have a Sedentary job position where you do occasional walking, your time out of work is typically Five to Eight week for SRS. If you think you need more time out then your disability carrier will need medical documentation from doctors to medically prove you are unable to meet your job requirements. The longest I had approved anyone for SRS was 12 weeks because she had Vaginal Prolapse, meaning her bladder pushed its way into the vaginal wall and obstructed her urine. Under those circumstances, then 12 weeks is granted (she had medical documentation to prove the complications).
Remember....26 weeks of disability access does not mean you will get 26 weeks. 26 weeks is for worse case scenarios and very serious surgery where recovery time is VERY long to the point where long term disability may be needed.
Just wanted to mention that just because a particular insurer covers SRS that does not mean a particular company's plan with that insurer will include SRS coverage; it depends on what type of corporate insurance plan the company was willing to pay for. In my case, my employer offers 3 different levels of coverage through BCBS, but none of them include coverage for SRS even though BCBS does have such coverage available as an option for its corporate customers. (I'm nowhere near ready for SRS, but I wanted to know what my plan included. I'm hoping to be working somewhere (anywhere) else by the time SRS entires my timeline, so no biggie for me just now.)
Definitely read your detailed benefits explanation. If necessary, call the insurer and ask them to clarify the specifics of the plan you are on with respect to SRS. Sometimes, you really have to push to find out if SRS coverage is in your plan and what the criteria are for invoking that coverage.
Annah, thanks so much for bringing information to the huddled masses. I have a multi-employer/union health plan which uses Blue Cross Anthem, Plan 040, but my primary is Medicare. What can you tell me about my SRS coverage?
:) Lallie
Last week I asked my HR person for the detailed plan description. They pretty much refused to give it to me. They said "that will be a couple of hundred pages" you dont need all that. >:(
Quote from: Lallie on November 30, 2011, 04:01:55 PM
Annah, thanks so much for bringing information to the huddled masses. I have a multi-employer/union health plan which uses Blue Cross Anthem, Plan 040, but my primary is Medicare. What can you tell me about my SRS coverage?
:) Lallie
Even Blue Cross plan 040 has the options to be tailored as to what can be included or excluded. The best thing to do is PM your company's name and I can tell you if they cover SRS or any other transgender benefits.
Quote from: michelle666 on November 30, 2011, 09:13:06 PM
Last week I asked my HR person for the detailed plan description. They pretty much refused to give it to me. They said "that will be a couple of hundred pages" you dont need all that. >:(
yeah they probably wont. It would be considered a waste of resources to them (i.e., paper).
Your company does not cover SRS surgery specifically, but the best thing you can do (if you need to know the exact coverages) is to contact your healthcare insurer and ask them questions about what you want to know about coverages.
From looking at your company, you have coverage for short term disability leave from SRS surgery or gender related depression and you have coverage for gender related mental health counseling. You do not have coverage for HRT and surgery transgender related procedures.
Quote from: michelle666 on November 30, 2011, 09:13:06 PM
Last week I asked my HR person for the detailed plan description. They pretty much refused to give it to me. They said "that will be a couple of hundred pages" you dont need all that. >:(
easier to ask for certificate of coverage since it's usually less then 50 pages and shows exactly what's covered or not
My ex told me the other day that the payroll/human resources company, Automatic Data Processing (ADP) now covers "transgender stuff." Don't know if that includes SRS, but I hope it does. ADP uses Aetna. A friend who is employed by Sprint also told me that this coming year they will have transgender coverage.
Quote from: Melody Maia on December 23, 2011, 10:01:17 PM
My ex told me the other day that the payroll/human resources company, Automatic Data Procession (ADP) now covers "transgender stuff." Don't know if that includes SRS, but I hope it does. ADP uses Aetna. A friend who is employed by Sprint also told me that this coming year they will have transgender coverage.
correct, ADP has added transgender medical benefits, including srs to their 2012 policy :)
UPDATE with 2012 Transgender Benefits with SRS:
3M Co.
A.T. Kearney Inc.
AAA Northern California, Nevada & Utah
Insurance Exchange
Abercrombie & Fitch Co.
Accenture Ltd.
Aetna Inc.
Akin, Gump, Strauss, Hauer & Feld LLP
Alcatel-Lucent
Alcoa Inc.
Alston & Bird LLP
American Express Co.
Ameriprise Financial Inc.
AMR Corp. (American Airlines)
Aon Corp.
Apple Inc.
AT&T Inc.
Automatic Data Processing Inc.
Avaya Inc.
Avon Products Inc.
Bain & Co. Inc.
Baker & McKenzie LLP
Bank of America Corp.
Bank of New York Mellon Corp., The
(BNY Mellon)
Barclays Capital
Barnes & Noble Inc.
Best Buy Co. Inc.
Bingham McCutchen LLP
BlackRock
Blue Cross Blue Shield of Florida Inc.
Blue Cross Blue Shield of Minnesota
BMO Bankcorp Inc.
Booz Allen Hamilton Inc.
Boston Consulting Group
Bristol-Myers Squibb Co.
Broadridge Financial Solutions Inc.
Brown Rudnick LLP
Brown-Forman Corp.
Bryan Cave LLP
Caesars Entertainment Corp.
Campbell Soup Co.
Capital One Financial Corp.
Cardinal Health Inc.
CareFusion Corp.
Cargill Inc.
Carlton Fields PA
Chapman and Cutler LLP
Charles Schwab Corp., The
Chevron Corp.
Choate, Hall & Stewart LLP
Choice Hotels International Inc.
Chrysler LLC
Chubb Corp.
Cisco Systems Inc.
Citigroup Inc.
Clifford Chance US LLP
Clorox Co.
Coca-Cola Co., The
Comerica Inc.
Corning Inc.
Covington & Burling LLP
Credit Suisse USA Inc.
Crowell & Moring LLP
Cummins Inc.
Davis Wright Tremaine LLP
Debevoise & Plimpton LLP
Delhaize America Inc.
Dell Inc.
Deloitte LLP
Deutsche Bank
Dewey & LeBoeuf LLP
Diageo North America
DLA Piper
Dorsey & Whitney LLP
Dow Chemical Co., The
Dykema Gossett PLLC
E. I. du Pont de Nemours and Co.
(DuPont)
Eastman Kodak Co.
eBay Inc.
Edwards Angell Palmer & Dodge LLP
Eli Lilly & Co.
EMC Corp.
Ernst & Young LLP
Exelon Corp.
Faegre & Benson LLP
Federal Home Loan Mortgage Corp.
(Freddie Mac)
Fenwick & West LLP
Ford Motor Co.
Fried, Frank, Harris, Shriver & Jacobson LLP
Gap Inc.
Genentech Inc.
General Mills Inc.
General Motors Co.
Gibson, Dunn & Crutcher LLP
GlaxoSmithKline plc
Goldman Sachs Group Inc., The
Google Inc.
Group Health Cooperative
Group Health Permanente
Herman Miller Inc.
Hewlett-Packard Co.
Hinshaw & Culbertson LLP
Hogan Lovells US LLP
Hyatt Hotels Corp.
ING North America Insurance Corp.
Intel Corp.
International Business Machines Corp. (IBM)
Intuit Inc.
Jenner & Block LLP
Johnson & Johnson
JPMorgan Chase & Co.
K&L Gates LLP
Kellogg Co.
Kimpton Hotel & Restaurant Group Inc.
Kirkland & Ellis LLP
KPMG LLP
Kraft Foods Inc.
Levi Strauss & Co.
Limited Brands Inc.
Littler Mendelson PC
Lockheed Martin Corp.
Marsh & McLennan Companies Inc.
McDermott Will & Emery LLP
McKinsey & Co. Inc.
Medtronic Inc.
MetLife Inc.
Microsoft Corp.
MillerCoors LLC
Mitchell Gold + Bob Williams
Morgan Lewis & Bockius LLP
Morgan Stanley
Morrison & Foerster LLP
Nationwide
Navigant Consulting Inc.
Nike Inc.
Nixon Peabody LLP
Nordstrom Inc.
Northern Trust Corp.
Office Depot Inc.
Oracle Corp.
Orbitz Worldwide Inc.
Orrick, Herrington & Sutcliffe LLP
Owens Corning
Patterson Belknap Webb & Tyler LLP
Paul Hastings LLP
Paul, Weiss, Rifkind, Wharton
& Garrison LLP
Pearson Inc.
PepsiCo Inc.
Perkins Coie LLP
Pfizer Inc.
PG&E Corp.
Pillsbury Winthrop Shaw Pittman LLP
PricewaterhouseCoopers LLP
Prudential Financial Inc.
Raytheon Co.
Replacements Ltd.
Robins, Kaplan, Miller & Ciresi LLP
Rockwell Automation Inc.
Ropes & Gray LLP
Schiff Hardin LLP
Sears Holdings Corp.
Sedgwick, Detert, Moran & Arnold LLP
Sempra Energy
Seyfarth Shaw LLP
Shearman & Sterling LLP
Sheppard, Mullin, Richter & Hampton LLP
Shook, Hardy & Bacon LLP
Sidley Austin LLP
Simpson, Thacher & Bartlett LLP
Sodexo Inc.
Southern California Edison Co.
Sprint Nextel Corp.
Squire, Sanders & Dempsey LLP
Staples Inc.
Starwood Hotels & Resorts Worldwide
State Farm Group
Sun Life Financial Inc. (U.S.)
Supervalu Inc.
Sutherland Asbill & Brennan LLP
Symantec Corp.
TD Bank, N.A.
Teachers Insurance and Annuity Association
- College Retirement Equities Fund
Tech Data Corp.
Thompson Coburn LLP
Thomson Reuters
Tiffany & Co.
Time Warner Inc.
TJX Companies Inc., The
Toyota Financial Services Corp.
Toyota Motor Sales USA Inc.
Troutman Sanders LLP
U.S. Bancorp
UBS AG
Unilever
United Continental Holdings Inc.
United Parcel Service Inc. (UPS)
United Technologies Corp.
UnitedHealth Group Inc.
Volkswagen Group of America Inc.
Wachtell, Lipton, Rosen & Katz LLP
Walt Disney Co., The
Wells Fargo & Co.
Whirlpool Corp.
White & Case LLP
Wilmer Cutler Pickering Hale & Dorr LLP
Winston & Strawn LLP
Xerox Corp.
Yahoo! Inc.
as you compare the first list with this list i made, there has been a 35% increase in the last year.
Sadly, not one single company I have ever worked for is on that list.
One question about insurance. My insurance policy covers therapy and I'm going to start in Feb, does the insurance company send anything regarding what I'm doing to my company? I'm not out at work yet and want to do that on my own terms.
Wow, that list is impressive! I think we are well on our way to getting to the point that most major companies will have this coverage.
Quote from: Annah on October 31, 2011, 11:59:16 PM
Here is a list I compiled last July. I know there's about 15 more companies added in the next quarter so I haven't been able to add them in yet:
Coca Cola
Campbells Soup
Walt Disney
State of Conn. Teacher Association
The Government of Louisana
HRC
Johnson and Johnson
Aetna Insurance (private plan)
AmeriHealth
Anthem Blue Cross Blue Shield
Blue Cross Blue Shield for:
Massachusetts
Minnesota
Michigan
Ameriprise Financial Inc
Avaya Inc.
Barclays Capital
Bingham McCutchen LLP
Booz Allen Hamilton Inc.
Cardinal Health Inc.
Chrysler LLC
Cisco Systems Inc.
Clifford Chance US LLP
Covington & Burling LLP
Cummins Inc.Deloitte LLP
Deutsche Bank
Diageo North America
DLA Piper
E. I. du Pont de Nemours and Co. (DuPont)
Eastman Kodak Co.
Ernst & Young LLP
Exelon Corp.
Faegre & Benson LLP
Food Lion LLC
Ford Motor Co.
Fried, Frank, Haris, Shriver & Jacobson LLP
Genentech Inc.
General Motors Corp.
Google Inc.
Herman Miller Inc.
Intel Cigna
International Business Machines Corp. (IBM)
Katten Muchin Rosenman LLP
Kimpton Hotel & Restaurant Group Inc.
Kirkland & Ellis LLP
KPMG LLP
Kraft Foods Inc.
Latham & Watkins LLP
Littler Mendelson PC
Marsh & McLennan Companies Inc.
McGraw-Hill Companies Inc., The
Microsoft Corp.
Morrison & Foerster LLP
Nike Inc.
Northern Trust Corp.
PG&E Corp.
Pillsbury Winthrop Shaw Pittman LLP
Replacements Ltd.
Robins, Kaplan, Miller & Ciresi LLP
Shearman & Sterling LLP
Sonnenschein, Nath & Rosenthal LLP
Sun Microsystems Inc.
Sutherland Asbill & Brennan LLP
White & Case LLP
Yahoo! Inc.
Cigna Private plan
Emblem Health
HealthNet
Health Partners (Minnesota)
Medica
University of Pennsylvania
Penn State
Goldman Sachs
Bank of America
City and County of San Francisco
IBM
AmEx
AT&T
Wells Fargo
Eastman Kodak
Sears
Morgan Stanley
Price Waterhouse
State Farm
New York Life Insurance
Angell Palmer and Dodge Law Firm
City of Berkley
All of these have GRS/GCS/SRS included in their policies.
However, getting disability insurance (i.e., paychecks while you are out recuperating) is at the discretion of your specific company's individual Disability Carrier Contract Guidelines.
Are not this the 1% so despised by the OWS :laugh:
Quote from: jesse on October 31, 2011, 11:46:15 PM
you do not need to work for sears to get this insurance it is available as private purchase threw anthems site here are the policies related to gender reassignment coverage as pulled from their policies page but you also need to remember that most grs surgeons do not currently take insurance so you will still have to pay up front then file for reimbursement.
On page 14 of their online benefits guide, it clearly states that Sex change surgery is an exclusion.
Corporations who take out large group policies can decide to either include, or exclude GRS and hormones from their list of covered conditions. They have to pay extra to get this coverage.
To my knowledge, there is no private insurance available on the market which is available to individuals and covers GRS. Your use of hormones and seeing a gender therapist would be considered a pre-existing coverage. There are datebases which track which meds you are on, and what your doctor notes about your condition.
Once PPCA (Obama's healthcare bill takes full effect in 2014), I believe it may POSSIBLY be covered. My hunch is no, at least for individual plans.
I have an insurance background, and have some familiarity with the situation. We'll have to see how the new healthcare bill all plays out.
you can get srs coverage through a cigna private plan. I know two girls who did that.
Quote from: michelle666 on December 24, 2011, 07:46:00 AM
One question about insurance. My insurance policy covers therapy and I'm going to start in Feb, does the insurance company send anything regarding what I'm doing to my company? I'm not out at work yet and want to do that on my own terms.
In the U.S., medical privacy is a big deal. According to my therapist, the insurance company cannot share the details of my diagnosed conditions and treatments with anyone outside the medical care community. As long as your employer and your insurance company know you by the same name and SSN, there shouldn't be an issue.
If your job requires you to get a government security clearance, things may get a little more tricky but that's kind of a "special case" and can still be handled with discretion in most cases.
Even if you aren't a signed-up member yet, you could try calling the insurance provider's help line (check their website) and asking to what extent diagnosis and treatment information is shared with an employer. You shouldn't need to explain specifically why you want to know. If they ask, just say that as a new/potential customer you have concerns about the privacy and security of your medical information. That's a real hot-button issue these days, so they should be more than willing to discuss it at length until you understand what you need to know.
I'd say it's about 98% that there is nothing to worry about as far as the insurance company goes. (Nothing is ever 100% in my experience.)
Quote from: juliekins on December 24, 2011, 06:59:19 PM
There are datebases which track which meds you are on, and what your doctor notes about your condition.
How would that pertain to my situation? I'm assuming that the typical time span from pre to post is usually around 2-4 years, but I've been at this for a decade. Is there a time limit on the available history like a credit bureau? I got the letter under my mother's insurance in 2002 and don't know if it the diagnosis was ever mentioned or not. She was with Sprint until I got my own job with benefits. I've been careful to make sure anything trans was never ever mentioned in my records. I did technically switch on the job at BR(GAP) in 03, but did not get any benefits until I was upgraded from part time to full time work after my name change was complete (but with M). And because I've been fulltime and fully legal ever since 2003, and with an F since 2004, does that serve as evidence of a "preexisting condition" if I do get hired by one of the companies on the list?
Quote from: juliekins on December 24, 2011, 06:59:19 PM
Once PPCA (Obama's healthcare bill takes full effect in 2014), I believe it may POSSIBLY be covered. My hunch is no, at least for individual plans.
Ah I guess someone else heard that rumor too, but I'm hopeful given Obama's track record being pro trans
Anyone know if United Healthcare or if Highmark bluecross and blueshield covers srs'?
Quote from: Gadgett on May 02, 2012, 07:29:52 PM
Anyone know if United Healthcare or if Highmark bluecross and blueshield covers srs'?
From what I've read, it depends on your employer and what options they choose. I have united and they cover therapy but not srs.
Happy to know some companies are offering this, Here in Wisconsin Title 19 does not cover GRS United Healthcare was the HMO I had it was not the best. They fought with me to get my medical stuff done they don't cover GRS.
Hate to say it but that list of companies is flawed- not all of them include GRS, just the other necessary health needs like hrt... Even though they're on the list, GAP Inc DOES NOT currently cover GRS* >:( :'(
(*although I hope its being worked on for next year)
Quote from: jesse on October 31, 2011, 11:46:15 PM
you do not need to work for sears to get this insurance it is available as private purchase threw anthems site here are the policies related to gender reassignment coverage as pulled from their policies page but you also need to remember that most grs surgeons do not currently take insurance so you will still have to pay up front then file for reimbursement.
Jessi
Medically Necessary:
Gender reassignment surgery* is considered medically necessary when all of the following criteria are met:
The individual is at least 18 years of age; and
Not Medically Necessary:
Gender reassignment surgery is considered not medically necessary when one or more of the criteria above have not been met.
The age requirement is the only one I don't meet. :( I am having mine next year and my family can pay for it but it would be nice if insurance covered it...
I have a Aetna policy Choice II PPO plan that covers Therapy, Hormones and SRS. Of course out of network would only cover like 40 percent. For the surgery I will need to be pre certified for care. I was wondering if anybody has ever dealt with Aetna and how difficult they are. I have heard horror stories about this.
Quote from: Reagan on September 08, 2012, 12:30:00 PM
I have a Aetna policy Choice II PPO plan that covers Therapy, Hormones and SRS. Of course out of network would only cover like 40 percent. For the surgery I will need to be pre certified for care. I was wondering if anybody has ever dealt with Aetna and how difficult they are. I have heard horror stories about this.
Where you seeing that??? I see Aetna Open Access® Managed Choice® with several premium/deductible options, but nowhere on the website do I see anything about GRS/GCS/SRS... walk me through what you did to look that up cause quite frankly few of us want to call the number and ask a representative, we should be able to see it in writing first!
Quote from: Reagan on September 08, 2012, 12:30:00 PM
Of course out of network would only cover like 40 percent. For the surgery I will need to be pre certified for care. I was wondering if anybody has ever dealt with Aetna and how difficult they are. I have heard horror stories about this.
I have the same question. In January I have access to an Aetna administered plan that includes transgender surgical coverage. However, I have been unable to locate an Aetna preferred specialist for FtM SRS (bottom) surgery. It would be hard to believe that the plan was set up to provide a "gold star" to the sponsoring institution without any real substance that makes it usable. I made a number of calls and am having a very difficult time getting answers. Insurance is an interesting thing because pur->-bleeped-<-s don't get access to the details of what they are buying until after they buy it.
It is my expectation that Aetna will provide in-network coverage when a specialist is not available, but still that is only at the usual and customary rate. I have the LGBT director at the institution talking to the insurance specialist and will get back to me. I'll report back if I learn anything useful.
I have been researching again and it's been a few months. I know that most policy's by Aetna will not cover GRS. I know I saw it covered on mine. I have a top tier plan. I hope that it's still covered. Insurance is such a racket. I'm afraid to contact them and out myself yet. I'm still getting my endo and hormones covered. I would hate to all of a sudden have to start paying for that.
Well I just found out that SRS is now under General Exclusions in my policy.
I called Aetna last week after reading this post and was told that individual plans do not cover GRS. The rep said some group plans might but you can't buy a private plan with GRS coverage.
Quote from: Annah on October 31, 2011, 11:59:16 PM
Here is a list I compiled last July. I know there's about 15 more companies added in the next quarter so I haven't been able to add them in yet:
Coca Cola
Campbells Soup
Walt Disney
State of Conn. Teacher Association
The Government of Louisana
HRC
Johnson and Johnson
Aetna Insurance (private plan)
AmeriHealth
Anthem Blue Cross Blue Shield
Blue Cross Blue Shield for:
Massachusetts
Minnesota
Michigan
Ameriprise Financial Inc
Avaya Inc.
Barclays Capital
Bingham McCutchen LLP
Booz Allen Hamilton Inc.
Cardinal Health Inc.
Chrysler LLC
Cisco Systems Inc.
Clifford Chance US LLP
Covington & Burling LLP
Cummins Inc.Deloitte LLP
Deutsche Bank
Diageo North America
DLA Piper
E. I. du Pont de Nemours and Co. (DuPont)
Eastman Kodak Co.
Ernst & Young LLP
Exelon Corp.
Faegre & Benson LLP
Food Lion LLC
Ford Motor Co.
Fried, Frank, Haris, Shriver & Jacobson LLP
Genentech Inc.
General Motors Corp.
Google Inc.
Herman Miller Inc.
Intel Cigna
International Business Machines Corp. (IBM)
Katten Muchin Rosenman LLP
Kimpton Hotel & Restaurant Group Inc.
Kirkland & Ellis LLP
KPMG LLP
Kraft Foods Inc.
Latham & Watkins LLP
Littler Mendelson PC
Marsh & McLennan Companies Inc.
McGraw-Hill Companies Inc., The
Microsoft Corp.
Morrison & Foerster LLP
Nike Inc.
Northern Trust Corp.
PG&E Corp.
Pillsbury Winthrop Shaw Pittman LLP
Replacements Ltd.
Robins, Kaplan, Miller & Ciresi LLP
Shearman & Sterling LLP
Sonnenschein, Nath & Rosenthal LLP
Sun Microsystems Inc.
Sutherland Asbill & Brennan LLP
White & Case LLP
Yahoo! Inc.
Cigna Private plan
Emblem Health
HealthNet
Health Partners (Minnesota)
Medica
University of Pennsylvania
Penn State
Goldman Sachs
Bank of America
City and County of San Francisco
IBM
AmEx
AT&T
Wells Fargo
Eastman Kodak
Sears
Morgan Stanley
Price Waterhouse
State Farm
New York Life Insurance
Angell Palmer and Dodge Law Firm
City of Berkley
All of these have GRS/GCS/SRS included in their policies.
However, getting disability insurance (i.e., paychecks while you are out recuperating) is at the discretion of your specific company's individual Disability Carrier Contract Guidelines.
From what i understand i have Amerihealth or whatever *was given to me due to being on disability* it stated on their booklet when i got it that it did have GRS listed but of course it must not be cosmetic in nature but medical *diagnosed through mental health*
I think my insurance covers surgery so I called them to ask about a specific code, 57292(as I asked about separately), and I've confirmed this is the right code. It seems like it's covered by my insurance based on that call. I have CIGNA but my plan is privately funded. Is there any possibility that even with the call to my insurance that somehow it's not covered?
I've been waiting and whining about not having insurance covering it for 18 years now so it's hard for me to accept that my new insurance actually will cover it(outside of co-pays,etc). Oh and I work for a relatively small company so it's not big enough to be on the HRC list.
I had my surgery covered by CIGNA. Ask for a case worker who can help you jump through the hoops. There are quite a few that they require.
Bump
So, I was wondering if anyone could help me with this. I found this thread after some google searches so that's why I ask.
I plan to begin University next fall and I'm trying to create a tentative date for SRS so that everything down the road falls into place regarding education/career. The university has an Aetna group plan that does cover SRS, 80% plus copay if it's in network/ 60% plus copay out of network. Since I'm still new to looking this stuff up, and since health insurance is a cluster-mess, how would I find an in-network doctor that performs SRS? Also what is the difference between the two (in/out-of-network)?
I would ideally like to start looking up the doctors, their procedures, and their results now as opposed to later when I'm neck deep in course work.
Thanks for any help. It really is appreciated.
Quote from: Kayla on March 07, 2013, 02:15:01 PM
Bump
So, I was wondering if anyone could help me with this. I found this thread after some google searches so that's why I ask.
I plan to begin University next fall and I'm trying to create a tentative date for SRS so that everything down the road falls into place regarding education/career. The university has an Aetna group plan that does cover SRS, 80% plus copay if it's in network/ 60% plus copay out of network. Since I'm still new to looking this stuff up, and since health insurance is a cluster-mess, how would I find an in-network doctor that performs SRS? Also what is the difference between the two (in/out-of-network)?
I would ideally like to start looking up the doctors, their procedures, and their results now as opposed to later when I'm neck deep in course work.
Thanks for any help. It really is appreciated.
This is probably the biggest problem with coverage because only a small number of surgeons accept insurance (Metzeler, Mcginn?, and one in Detroit whose name escapes me). Guessing only way to know is throw a couple emails out to either the insurance company or the surgeons if they accept Aetna.
"In-network" is an insurance term meaning basically "we negotiated preferential deals with this doctor, so it's in our best interests to steer members there." (There are more complicated technical definitions, but that's the upshot.) From where you sit, the only thing that matters is what they already told you - in-network means they pay 80% + copay, out-of-network means 60% + copay. So you have an incentive to find an in-network doctor, but they will still pay a huge chunk regardless, which is cool. (You may want to clarify whether it's limited to US doctors/surgeons; they may pay zero for someone out of the US.)
The only real way to find out whether a doctor is covered, and how, is to contact that doctor's office and ask. This is true in general, not just for surgeons. I know someone who swears Dr. Rumer in Philly takes a bunch of different insurance plans, but she had Blue Cross so I don't know offhand about Aetna. The good news is that I think these days you can email them all, so you really only have to put together a very simple query ("Do you take Aetna Plan X, and if so, do they consider you in-network for them?") and draw up a short list from whichever ones say yes and/or yes.
I am not a professional nor do I play one on the internet, but I have spent a LOT of time arguing with insurance companies. Be persistent, if the doctor says they are covered and Aetna refuses, and find out directly which precise hoops they want you to jump through.
Quote from: Flan on March 07, 2013, 02:42:16 PM
Guessing only way to know is throw a couple emails out to either the insurance company or the surgeons if they accept Aetna.
Ah, that works. I was really hoping there was some kind of list or something I could look up on-line, but I'll manage. Thanks Blue & Flan for the help.
I work for Walmart and they expanded their "transgender" exclusions this year (which pretty much act like we are not here and have no health concerns or problems). Second, I was with Blue Cross Blue Shield and they told me that they only have limited coverage for trans* people in a company policy ( a no-go for me) and that I am unable to secure an individual policy for SRS or other related medical treatment (I was promptly dropped after changing my gender marker because it fell under the "pre-existing condition clause" and I somehow fraudulently withheld pertinent information from the insurance company). I cannot wait for the new healthcare provisions to go into effect (for 2014) because I am going to have fun with both of my employer and BCBS.
Hi possibly a silly question but this insurance ,isit available only for US citizens living there I live in South Africa and I've been trying to research but I can't find any insurance that covers SrS please help thanks Mash
Does anyone know if when they do the healthcare reform if they will still be able to exclude us?
Yes, exclusions are allowed, preexisting clauses are not.
Yay, another company just added transgender coverage for their insurance policy: NVIDIA (my company). Coverage goes into effect as of Jan 2014. Now to work out which surgeons accept Cigna insurance for SRS...
Lucky girl!
I am a FtM person, can someone please tell me if Sears still covers the plan with SRS insurance, and what other companies offer it?
This is desperately important as with the new ObamaCare law I am going to be fined money I do not have and cannot afford for insurance I cannot afford, unless I find a way to get out of it.
Quote from: RomanHyena on November 15, 2013, 07:49:33 AM
I am a FtM person, can someone please tell me if Sears still covers the plan with SRS insurance, and what other companies offer it?
This is desperately important as with the new ObamaCare law I am going to be fined money I do not have and cannot afford for insurance I cannot afford, unless I find a way to get out of it.
If it's a retail position there's a good chance the medical insurance contracts they offer don't cover surgery. And for those who can't be on Medicaid (too much income or in a state that "op'ed out") there are exemptions to the corporate welfare tax https://www.healthcare.gov/exemptions/
BCBS of NJ says they cover GRS. (I have NJ Direct.) Does anyone have experience with them or have heard of others successfully getting coverage? - FTM or MTF - if so, please share or PM me, thanks.
I actually just spoke with someone at Anthem Blue Cross who said that under the Affordable Care Act, all pre existing conditions are covered.
That interested me, as I swore I read that under the Affordable Care Act, that which stipulates that all pre existing conditions be covered, it also stated that SRS is indeed a medical necessity?
The representative I spoke to seemed a bit hesitant to assure me that my SRS would in fact me covered, but I think they and their manager were confusing SRS with the cosmetic aspects of the whole subject. I work in a hospital where we deal with precerting in-patients all the time, so now I'm just trying to figure out that process... of getting the SRS authorized by their, "member services" department.
Quote from: teeg on December 09, 2013, 03:40:29 PM
That interested me, as I swore I read that under the Affordable Care Act, that which stipulates that all pre existing conditions be covered, it also stated that SRS is indeed a medical necessity?
ACA has nothing on transition related care specifically because insurance companies and contracts in general are still allowed to deny coverage for therapies (alleged to be cosmetic or experimental). It's AMA and WPATH that were lobbying that surgery (when recommended) is "necessary" for the well-being of the patient.
I just had a friend of mine confirm that Target now covers GRS, and secondary sexual characteristics like Breast Augmentation and possibly FFS too as part of their insurance policies.
Hmm, a pay downgrade but insurance that actually covers stuff. I may have to check this out after January as all insurances seem to be raising deductible amounts.
Does anyone know about the Massachusetts ConnectorCare plans? I got approved for the subsidized Type 3a plan and am having problems finding a detailed summary of the plans. The choices they gave me are;
BMC Healthnet Plan - BMCHP ConnectorCare 3
Network Health - Network Health Direct ConnectorCare 3
Neighborhood Health Plan - NHP Prime HMO ConnectorCare 3 15/22
CeltiCare - CeltiCare ConnectorCare 3
Minuteman - MyDoc SilverCare 3
The only thing that I could find was that Network Health doesn't cover surgery. I'm expecting that from them all. Just wondering about therapy, prescriptions and endo visits, all that fun stuff.
I'm also curious about coverage through Mass. Connector plans. I'd also like to clarify on the list from page 2, that at least BCBS/MA does NOT necessarily cover surgeries, only if it's through a group policy. I have an individual BCBS/MA policy, and it specifically does not cover surgery. AETNA is the same too, I believe, and likely also other insurers follow similar models.
And just to throw it out there, any ideas what precedent the Kosilek ruling means for MA residents insured through state plans?
IDK about MASS as i moved from there a long time ago now, but I have been working with an agent here in GA and at the moment it would appear that most plans will say they exclude any surgeries and in some cases hormones. It is our understanding that if you gather paperwork showing this is medically necessary and submit it to them, it can be granted. Not sure why this is still an issue for us considering preexisting conditions are wiped out, you don't have to be a policy holder for a certain amount of time, etc. I wish they would just cut down on exclusions already. I am gathering paperwork from therapists and my endo and GP and we (agent and I) are going to submit it and see what we can get done. If it fails we will try something else he says. I will let everyone know if this works out. I certainly hope it does!
does any one know of any insurance that covers GCS in PA. I currently have UPMC health plan. and after a theral search, havent called, i have found a little section that has exclusions.... GCS is on the list. so i may be on the hunt for new insurance besides what is offered by my employer.
So these are a few things I've found out so far from annoying insurance providers for a little bit concerning GRS coverage I wanted to share...
Please remember that at the end of the day all of these insurance companies are just that, 'companies.' With the right case worker on your side and good dialog between you and the company, a lot of things are possible, especially in this case where it's obvious GRS certainly isn't cosmetic and most people know it's medically necessary. Most companies that I've looked into cover it in some form or another but only after certain criteria are met or proven like documentation from mental health professionals outlining their agreement to the validity of the patient's diagnosis.
For every diagnosis from a sore throat to knee pain to GRS, there's a code doctors and hospital billing offices use - these are called CPT codes, ICD-9 codes, etc. A good thing to do is call your insurance company and ask them for their, "exclusion list" that lists which conditions are covered or not. Once you find that GRS is not excluded you can go from there.
The most important thing is creating a dialog between you and your company before your surgery. I work in a hospital dealing with a lot of this every day and there's been so many instances of insurance providers denying coverage simply because they weren't notified or per-certified before the patient came in. Keep a diary of your interactions with your insurance provider. Write down who you spoke with, when, what they said, and ideas and stuff you have about solidifying your coverage. I write things like, "spoke with (name) and they talked about an exception to reimbursement percentage limits." There's been many times an insurance company has told me that they don't require per-authorization for so and so patient, then they later say they do, but I remind them of the name of their employee who said otherwise, and they then honor their mistake simply because I had that information. It's hard how ever to get a confirmation of how much they'll cover before your surgery. This is something I'm personally trying to do as I don't want to pay out of pocket for the whole thing, only to then have a small amount reimbursed.
I may be mistaken, but I don't believe there are any GRS surgeons who directly accept insurance. They only offer assistance in helping you with obtaining reimbursement from your insurance provider, and rightly so to cover themselves with such a variance in coverage or non-coverage between so many companies that patients could potentially have.
Where this creates confusion for insurance providers however is like someone mentioned above companies like to keep their customers within their network of approved healthcare providers. Like I've explained to my insurance provider, as none of the surgeons really accept their coverage, there theoretically then is NO network. And then, while they might say they do cover GRS, they actually can't directly cover it so it would then have to be through reimbursement. This then opens a can of worms of certain rules pertaining to reimbursements. Usually a reimbursement occurs when a patient visits an out of network physician, and then only a certain percentage is covered. However, like mentioned above with there being no network to work with, this then can become an exception to that rule and any other company specific guidelines they may have pertaining to reimbursements.
One thing to keep in mind though is that every company has different tiers of plans that then yield a certain amount of coverage for any kind of surgeries or inpatient visits. This might then create a problem where even though the company might agree to cover it through reimbursement, they might only cover whatever your plan normally allows. My plan covers 100% of any surgery costs no matter the cost once my deductible is met, but certain plans only cover 80% leaving the patient to cover the other 20% out of pocket, and so on. So as much as you want to watch if it'll be covered, you also want to see HOW it will be covered...
Hope this helps!
Quote from: teeg on February 22, 2014, 11:20:43 AM
I may be mistaken, but I don't believe there are any GRS surgeons who directly accept insurance. They only offer assistance in helping you with obtaining reimbursement from your insurance provider, and rightly so to cover themselves with such a variance in coverage or non-coverage between so many companies that patients could potentially have.
Dr Bowers is part of several insurance networks that do have coverage for GRS. with my cigna hmo plan through disney it will cover it in full directly without any deductible or reimbursement. with that, I have to wait at least 45 days to be pre-authorized before i can buy a date for my GRS. but there is the catch: after at least 5 years of transitioning and paying for GRS out of pocket, I could go with just one letter. but with insurance, I need to have two letters regardless- one of those two issued within a year of the surgery date, and both preferably within 5 years of that same date... IOW, if you can afford it, pay out of pocket- but for many of us, thats just not an option on minimum wage jobs.
Dr. Rumer also takes insurance directly and is in-network for at least some Blue Cross plans. (Didn't use her myself, but I have several friends who did.)
Quote from: JackieMarie on January 24, 2014, 10:54:28 PM
IDK about MASS as i moved from there a long time ago now, but I have been working with an agent here in GA and at the moment it would appear that most plans will say they exclude any surgeries and in some cases hormones. It is our understanding that if you gather paperwork showing this is medically necessary and submit it to them, it can be granted. Not sure why this is still an issue for us considering preexisting conditions are wiped out, you don't have to be a policy holder for a certain amount of time, etc. I wish they would just cut down on exclusions already. I am gathering paperwork from therapists and my endo and GP and we (agent and I) are going to submit it and see what we can get done. If it fails we will try something else he says. I will let everyone know if this works out. I certainly hope it does!
1 month later, how did it go or how is it coming?
Just an update for us Maryland trans folk: State of Maryland employee insurance plans are now required to cover all different forms of gender reassignment procedures as well as HRT! This also extends to spouses and dependants of said state employees under these plans, and at least for my insurance if the provider is in network there is no deductible and the surgeries are simply covered. :) Of course they require 1 year on hormones, medical and psychological letters of recommendation, etc. etc. but I´m still so excited that I could have my vagina 18 months from now... O, O
http://freestatelegal.org/victory-maryland-to-provide-nondiscriminatory-health-coverage-for-transgender-employees/
Yeah Maryland! Also, I'll add that Massachusetts now includes transgender-related coverage (including GCS) as part of their lower income MassHealth plans:
http://www.bostonglobe.com/metro/2014/06/20/state-cover-gender-reassignment-surgery-and-hormone-treatment-for-transgender-patients/a9OPrvqdUPmRoiAQugVwEO/story.html
What if you are younger than 18 with your parents concent
Quote from: Dandy Dunker on November 02, 2014, 09:09:37 AM
What if you are younger than 18 with your parents concent
Reputable surgeons are very hesitant to do GRS on minors, regardless of parental consent. It's so far fairly rare for anyone under 18 to have the surgery.
Does anyone know which surgeons in the US accept insurance? I finally have a plan that covers it and I wanted to go to McGinn, but she doesn't participate in any plans. They do help with getting the reimbursement from the insurance after surgery, but the whole problem is coming up with almost 20k in cash.
Quote from: michelle666 on November 19, 2014, 01:44:33 PM
Does anyone know which surgeons in the US accept insurance? I finally have a plan that covers it and I wanted to go to McGinn, but she doesn't participate in any plans. They do help with getting the reimbursement from the insurance after surgery, but the whole problem is coming up with almost 20k in cash.
Of the several US doctors that I've contacted the only one that bills insurance is Bowers and, per her office staff, they attempt to bill as in-network.
Quote from: michelle666 on November 19, 2014, 01:44:33 PM
Does anyone know which surgeons in the US accept insurance? I finally have a plan that covers it and I wanted to go to McGinn, but she doesn't participate in any plans. They do help with getting the reimbursement from the insurance after surgery, but the whole problem is coming up with almost 20k in cash.
Bowers, Meltzer, and Rumer all are on various health plan networks.
Kami
Quote from: Wynternight on November 19, 2014, 02:31:25 PM
Of the several US doctors that I've contacted the only one that bills insurance is Bowers and, per her office staff, they attempt to bill as in-network.
I would love to have Bowers do mine. I thought it would be restrictive with her being on the opposite side of the country, but if they can somehow bill it in-network, that would make things so much easier to handle.
Quote from: Wynternight on November 19, 2014, 02:31:25 PM
Of the several US doctors that I've contacted the only one that bills insurance is Bowers and, per her office staff, they attempt to bill as in-network.
My old insurance demanded it be done by Meltzer. Literally he was the only one who they would cover, for breasts, or grs. (small insurance plan before the Health Care Act).
I know of two girls who had insurance with Rumer.
Bowers is listed as in network through Premera plans at the very least, visiting the Premera site and searching for in network providers helped me a ton. Premera for instance only lists Bowers. - https://healthsearch.eproviderdirectory.com/Results?PlanId=premera&ProductId=premerawa&BrandingId=premera&DirectoryType=provider&NetworkID=ALL&QSCorrected=Y234JU&Prefix=AGL&Accordion=1&Distance=10000&Zip=94010&SearchTerm=Marci%20Bowers
I cannot find an entry for Toby Meltzer or Kathy Rumer for Premera.
Other than those three and the fact McGinn does not do insurance but rather tries to get you reimbursed is about all I know for NA and insurance, hope that helps at all.
Kami
Another question regarding insurance. I live in Massachusetts and surprisingly for a state that made it law that insurance companies have to cover trans related care, there are no surgeons here. If there isnt a surgeon in my network do I still get charged out of network rates?
Quote from: michelle666 on November 20, 2014, 02:46:27 PM
Another question regarding insurance. I live in Massachusetts and surprisingly for a state that made it law that insurance companies have to cover trans related care, there are no surgeons here. If there isnt a surgeon in my network do I still get charged out of network rates?
That is something I have no clue about and is a question I myself as a Washington resident, where a similar law was passed am also curious about.
Kami
Quote from: michelle666 on November 20, 2014, 02:46:27 PM
Another question regarding insurance. I live in Massachusetts and surprisingly for a state that made it law that insurance companies have to cover trans related care, there are no surgeons here. If there isnt a surgeon in my network do I still get charged out of network rates?
If you're referring to private insurance policies (ie, not MassHealth), then yes, I believe doctors outside of MA are considered in-network. At least, this was true a couple years ago- someone I knew (also from MA) was covered through insurance, and went to McGinn. So I guess that kinda muddles it, since she now doesn't accept payment through insurance. Unless if I misunderstood this person.
I actually sent an email to her staff about a week ago, as well, and received the same response...
Quote from: michelle666 on November 20, 2014, 02:46:27 PM
Another question regarding insurance. I live in Massachusetts and surprisingly for a state that made it law that insurance companies have to cover trans related care, there are no surgeons here. If there isnt a surgeon in my network do I still get charged out of network rates?
I would think it depends on your policy...for me, if there are no qualified Dr's "in network" for your needs then the out-of-network docs get the in-network rate.
Often insurances will have an "800" number for info etc. Maybe call and see what they say?
I'm a Federal Employee, and they lifted the required exclusion for GRS beginning 2015. They didn't, however, require providers for Federal Employee Health Benefits to cover it. I currently have Blue Cross Blue Shield but will switch to Aetna, since Aetna is the only choice of plans in my region that will now cover GRS (for us Feds). I am now in the process of getting things set up to have surgery this coming year. Yay!! It's open season right now for us Federal employees, where we chose the health plan we want for the coming year, so it wont take affect till January. But I want to go ahead and choose a surgeon, get the letters sent, and a consultation set up now. There is a long wait list for some of the surgeons.
I have discovered that even tho I am now (or will be Jan. 1) covered, most surgeons require their fee up front, and you get reimbursed by insurance afterwards. Since I am unable to do that I have to find one that accepts and is in network with my insurance. I have found two so far.
It is such a wonderful feeling, knowing this is available for me!
OK while it is a ways off, Id like to do GCS in the fall 2015...
My current "provider" (freaking rip off United Healthcare/Golden Rule) is leaving my state, SD... I have to decide between BCBS, Avera, Dakotacare, or Sanford Health plan...
Im just looking to buy private insurance like I have now because my income will be too high to get "Obamacare" tax break... I just get SCREWED as usual...
I have a "diagnosis" of GD and they are currently paying for a good portion of my doc visits, lab testing, HRT, psych visits, ect...
First I cant figure out whether I tell them Im male or female.... Im female with SSA, but pre op so not 100% on my documents....
Next Id think with buying my own policy Id get to decide if GCS is covered.... I figure if Im gonna get raped paying them they can pay for my surgeries when the time comes.... That includes trying to get my planned FFS with Dr Z covered just because.... Im fortunate to be able to pay out of pocket and take whatever I can get for reimbursement.... My first choice for GCS would be Brassard, not only "out of network" but out of the country, could be a problem???... Im not sure I can wait wait the LONG waiting times Bowers and the like have for surgery though... I still donno how long Brassards waiting list is anyway... For all I know its too long for me as well....
So I guess the question is how do I find out what transition expenses my new policy covers before buying???
All I can think of is just call them and ask them ???
Any advice would be appreciated because I dont have much longer to make up my mind on a policy....
I just picked out my plan for 2015, went over the docs for anything that could be considered an exclusion and there was nothing that specifically excluded anything related to being trans! As soon as I get my card in the mail and the plan is in effect, I'm contacting Dr Bowers to have her people start working on getting my surgery covered!
Well from what I gather in my state anyway you cant buy an individual policy that doesnt exclude it... BUT who knows, I got nowhere calling them and asking them and that really sucked >:(
They also do have a page online that pretty much says the WPATH requirements are all thats required ::)
http://www.wellmark.com/Provider/MedpoliciesAndAuthorizations/MedicalPolicies/policies/Gender_Reassignment.aspx#__utma=149406063.1878386947.1416934638.1416934638.1416934638.1&__utmb=149406063.1.10.1416934638&__utmc=149406063&__utmx=-&__utmz=149406063.1416934638.1.1.utmcsr=google|utmccn=%28organic%29|utmcmd=organic|utmctr=%28not%20provided%29&__utmv=-&__utmk=32890558
So since I need insurance anyway I went with Wellmark BCBS, I guess I'll find out soon how their gonna treat me... Id think my psych and HRT and doctor and lab tests will be covered anyway... They are now but Golden Rule is pulling out of my state so I gotta get new insurance...
Since Im pre op I got to give them my female name and had to check "male" on the application fearing they might cancel it or use it in the future to deny a claim >:(
I just did a search on my new provider and found this doc;
https://www.harvardpilgrim.org/pls/portal/docs/PAGE/PROVIDERS/MEDMGMT/MEDICAL_REVIEW_CRITERIA/FULLY_INSURED_TRANSGENDER_CRITERIA_0714.PDF
It appears they cover FFS. I never thought of having that because of cost but now I'm considering it.
Quote from: michelle666 on November 20, 2014, 02:46:27 PM
Another question regarding insurance. I live in Massachusetts and surprisingly for a state that made it law that insurance companies have to cover trans related care, there are no surgeons here. If there isnt a surgeon in my network do I still get charged out of network rates?
I've not found a good listing of what a plan covers- it's not on my portal, my GP wasn't sure (she's trans herself) and so on. What am I missing? How can we find out?
The company I work for just switched to United Healtcare, does anyone know if the cover SRS?
My insurance added GRS this year. The only problem is that there is a 50k lifetime cap on it. After consulting with two surgeons it appears that they offer two different pricings. One is a cash option of around 20k to 25k the other if you use insurance. It seems that hospitals will charge over triple the amount of a cash negotiated price if you use your insurance. So in my circumstance I am still better off paying out of pocket. Can someone explain this to me. I'm looking at Meltzer and he charges 23k as a cash negotiated price, but if I use my insurance it will cost upwards of 70k. His fee is the same no matter what. It's the hospital that added the extra cost. So it will end up costing me after deductible almost 30k out of pocket. ->-bleeped-<-ing hospitals!!! I still don't understand how they can charge so much to the insurance company and get away with it. It's criminal!
Quote from: Reagan on February 23, 2015, 06:48:41 AM
My insurance added GRS this year. The only problem is that there is a 50k lifetime cap on it. After consulting with two surgeons it appears that they offer two different pricings. One is a cash option of around 20k to 25k the other if you use insurance. It seems that hospitals will charge over triple the amount of a cash negotiated price if you use your insurance. So in my circumstance I am still better off paying out of pocket. Can someone explain this to me. I'm looking at Meltzer and he charges 23k as a cash negotiated price, but if I use my insurance it will cost upwards of 70k. His fee is the same no matter what. It's the hospital that added the extra cost. So it will end up costing me after deductible almost 30k out of pocket. ->-bleeped-<-ing hospitals!!! I still don't understand how they can charge so much to the insurance company and get away with it. It's criminal!
Who is your insurance company? Please tell me it's not Aetna. I will scream loudly and at great length if it is.
Quote from: Wynternight on February 23, 2015, 08:10:17 AM
Who is your insurance company? Please tell me it's not Aetna. I will scream loudly and at great length if it is.
YES!!! How did you know!
Quote from: Reagan on February 23, 2015, 06:56:37 PM
YES!!! How did you know!
Because I changed to them since they added GRS this year...**facepalm**
Craptastic. I have Aetna PPO. Guess it's time to get my legal ducks in a row.
Quote from: Wynternight on February 23, 2015, 07:15:43 PM
Because I changed to them since they added GRS this year...**facepalm**
Check your summary of benefits. You will need at least 70k in coverage.
Wow. I was going to switch to Aetna too, purely for the sake of taking advantage of their GRS coverage. But if it's merely a vehicle for hospitals to screw the system and generate some rather large profits, I'll not bother. The devil is in the details, I guess, and I appreciate the insight into the screwed-up system we have in the US.
It'll be interesting to see how this continues to play out. My guess is that nothing will change: if it's cheaper to the patient to pay out of pocket, then the insurance companies will never end up paying a dime to the hospitals for GRS. Aetna isn't likely to complain since it will rarely pay these inflated fees to hospitals for niche surgery that relatively few people ever undergo. Quite a clever strategy, and I wouldn't be surprised if the insurance companies are working behind the scenes to engineer this particular pricing issue.
Quote from: Brenda E on February 23, 2015, 09:20:00 PM
Wow. I was going to switch to Aetna too, purely for the sake of taking advantage of their GRS coverage. But if it's merely a vehicle for hospitals to screw the system and generate some rather large profits, I'll not bother. The devil is in the details, I guess, and I appreciate the insight into the screwed-up system we have in the US.
It'll be interesting to see how this continues to play out. My guess is that nothing will change: if it's cheaper to the patient to pay out of pocket, then the insurance companies will never end up paying a dime to the hospitals for GRS. Aetna isn't likely to complain since it will rarely pay these inflated fees to hospitals for niche surgery that relatively few people ever undergo. Quite a clever strategy, and I wouldn't be surprised if the insurance companies are working behind the scenes to engineer this particular pricing issue.
Always check with you insurance. You may have the option of paying out of pocket, then submitting it back to your insurance for reimbursement. You may not get it all back, but you will most likely get a huge chunk of it.
Ah, I see. Pay out of pocket up front, then approach insurance company and say, "Just had GRS. You cover it. Here's the bill - I'll need a check for the 80% (or whatever) that you typically reimburse."
I'm fairly certain that the plan I was looking at required pre-authorization for GRS. My knowledge of the ins and outs of insurance are fairly poor, so not sure how this'll factor into the equation.
Anyway, it's at least a 18 months away for me, so not an urgent problem. But glad to have a heads up about how the game is played when it comes to GRS so I can do my research and formulate a strategy.
I'm insured through CareFirst BlueChoice HSA Bronze, when asking them about GRS they said that I would need the procedure codes and diagnosis codes to determine whether or not I'm covered. My doctor then informed me that I would need to speak to the surgeon I choose to get those. Is there a better way to figure this garglemesh out, or should I start looking for surgeons who preform this work in my area?
Quote from: michelle666 on November 20, 2014, 02:46:27 PM
Another question regarding insurance. I live in Massachusetts and surprisingly for a state that made it law that insurance companies have to cover trans related care, there are no surgeons here. If there isnt a surgeon in my network do I still get charged out of network rates?
There are actually a few. Dr. Melissa Johnson in Springfield MA did my surgery and I was covered 100% under MassHealth. There's also Dr. Richard Bartlett, Dr. Paul Costas, and Dr. Simpone Topal, all in Massachusetts. There are probably others I am forgetting.
Quote from: mooncab on March 25, 2015, 11:06:45 PM
There are actually a few. Dr. Melissa Johnson in Springfield MA did my surgery and I was covered 100% under MassHealth. There's also Dr. Richard Bartlett, Dr. Paul Costas, and Dr. Simpone Topal, all in Massachusetts. There are probably others I am forgetting.
I was just looking at Dr Johnson's site and cant find anything about GRS on there, just breast augmentation and I'm doing fine on my own with that. If you dont mind me asking, how were your results if it was grs that you had. If you dont want to share publicly, please send me a pm.
Quote from: Jaelithe on March 25, 2015, 01:39:10 PM
I'm insured through CareFirst BlueChoice HSA Bronze, when asking them about GRS they said that I would need the procedure codes and diagnosis codes to determine whether or not I'm covered. My doctor then informed me that I would need to speak to the surgeon I choose to get those. Is there a better way to figure this garglemesh out, or should I start looking for surgeons who preform this work in my area?
55970 is the cpt code I had for my GRS with Bowers... it should be the same code regardless of doctors. I have the diagnosis code too somewhere but that is the important one for the cost of surgery... but that doesn't include hospital or anesthesia cost.
BTW from the AMA Website: https://ocm.ama-assn.org/OCM/CPTRelativeValueSearchResults.do?locality=8&keyword=intersex
QuoteThe figures presented below are based on 2015 CPT codes and Medicare payment information.
55970 Intersex surgery; male to female
55980 Intersex surgery; female to male
56805 Clitoroplasty for intersex state
57335 Vaginoplasty for intersex state
There is also this little tidbit. ICD coding is set to supplement (if not replace) CPT coding, but unfortunately the ICD coding still references the DSM-IV, including typing transvestism as a fetish ::)
http://www.icd10data.com/ICD10CM/Codes/Z00-Z99/Z77-Z99/Z87-/Z87.890
QuoteSpecific code icon 2015 ICD-10-CM Diagnosis Code Z87.890
Personal history of sex reassignment
2015 Billable Code POA Exempt
Z87.890 is a billable ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes.
On October 1, 2015 ICD-10-CM will replace ICD-9-CM in the United States, therefore, Z87.890 - and all other ICD-10-CM codes - should only be used for training or planning purposes until then.
This is the American ICD-10-CM version of Z87.890. Other international ICD-10 versions may differ.
Description Synonyms
History of intersex surgery
History of intersex surgery (situation)
History of sexual reassignment surgery
Hx of sexual reassignment surgery
Present On Admission
Z87.890 is considered exempt from POA reporting.
ICD-10-CM Z87.890 is grouped within Diagnostic Related Group (MS-DRG v30.0):
887 Other mental disorder diagnoses (http://www.icd10data.com/ICD10CM/DRG/887)
Quote
F64.1 Gender identity disorder in adolescence and adulthood (http://www.icd10data.com/ICD10CM/Codes/F01-F99/F60-F69/F64-/F64.1)
F64.2 Gender identity disorder of childhood (http://www.icd10data.com/ICD10CM/Codes/F01-F99/F60-F69/F64-/F64.2)
F64.8 Other gender identity disorders (http://www.icd10data.com/ICD10CM/Codes/F01-F99/F60-F69/F64-/F64.8)
F64.9 Gender identity disorder, unspecified (http://www.icd10data.com/ICD10CM/Codes/F01-F99/F60-F69/F64-/F64.9)
F65.1 Transvestic fetishism (http://www.icd10data.com/ICD10CM/Codes/F01-F99/F60-F69/F65-/F65.1)
Thanks muchly, I've sent those back to my insurance company. Now we play the waiting game...
Sent from my iPhone using Tapatalk
I had a consultation with Dr Rumer today. After being initially told that she accepts insurance, it turns out that she takes cash up from and then gives you a paper for reimbursement from you insurance company.
Finally got word back from my insurance. It turns out that in-network they absolutely cover GRS. I've requested a list of in-network surgeons who preform that procedure, but they don't have the best track record of responding in a timely fashion. Would any of you lovely people be able to provide me with people who accept Carefirst Blue Cross Blue Shield, so I can further put together my plans?
Okay, disregard last request. Got all that worked out. At this point I think I'm set aside from making sure I have everything that Carefirst Blue Cross Blue Shield might want to approve coverage. Going in, I'm expecting to bring letters from 2 therapists, my medical history records for general health and hormone therapy reports, and a form from my electrologist about the clearage there. Is there anything else I should be doing before my consultation to make sure I have everything set to go?
Quote from: michelle666 on April 16, 2015, 05:19:19 PM
I had a consultation with Dr Rumer today. After being initially told that she accepts insurance, it turns out that she takes cash up from and then gives you a paper for reimbursement from you insurance company.
That's what i'm finding; the surgeons are more than happy to give you codes and hope it works out for you, but don't work with insurance at all and expect lots of monies up front.
Hi AncientMyth, welcome to Susan's. I look forward to seeing you around the forums. Good luck and Hugs
Mariah
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Is there any insurance (in California) that covers doctors overseas?
I'm looking at dr Miro, but not sure which insurance to switch to get it covered
Quote from: Myers on May 29, 2015, 10:47:02 AM
Is there any insurance (in California) that covers doctors overseas?
I'm looking at dr Miro, but not sure which insurance to switch to get it covered
I dont think you'll find any american insurance company that will cover overseas.
Quote from: Amy1988 on February 10, 2015, 02:16:52 PM
The company I work for just switched to United Healtcare, does anyone know if the cover SRS?
United Healthcare seems to be like every other company so far this year anyways. They have coverage available, but only if it hasn't been excluded from your plan.
My employer is signed up through United Healthcare, and I had to go back and forth with my HR Department to get them to add coverage for even basic diagnosis and treatment of GID. As of July 1st of this year (enacted retroactively), they cover the diagnosis, therapy, and hormones at least, so I just pay copays for office visits and prescriptions.
I'm hoping with the new legislation coming through this year or next that by July 1, 2016, GRS will be added to that list at least, maybe BA or FFS too. I'm the only trans person at my company it seems, so I'll be fighting every step of the way. I will be specifically saying I want to have McGinn's services covered, lol. No surprises!
Quote from: Annah on November 06, 2011, 10:59:05 PM
And just think, me managing insurance claims....I would often sit there and think "what in the world would this do for me in the future other than typical medical procedures?"
Those years in the field became more valuable to me now more than ever.
Annah,
Right now I have BCBS of Oklahoma.. which denies coverage of course specifically for SRS. I have a great uncle begging me to move to Colorado.. He is 87 and needs help.
Anyway they have anthem BCBS Bronze plans only in the Colorado Springs area.. and no one can tell me if they would cover a surgery in California or if the DR. is in network.. and its a PPO..
I have basically given up on getting coverage.. and will have to pay out of pocket.
I thought about paying out of pocket in Oklahoma then getting an attorney to go after BCBS especially if the new HHS laws pass.. What do you think
Keri AKA Dodie
Open Season for Federal Employees is upon us again, does anyone know whether more plans are covering the surgery this year? I've personally looked at Blue Cross Blue Shield and it looks to me that they are continuing to not cover reassignment surgery. As I am presently scheduled with Dr. Bowers in May of 2016, I think I'm willing to change plans for a year to get my surgery covered.
Sarah
Quote from: SarahJ on October 28, 2015, 03:15:35 PM
Open Season for Federal Employees is upon us again, does anyone know whether more plans are covering the surgery this year? I've personally looked at Blue Cross Blue Shield and it looks to me that they are continuing to not cover reassignment surgery. As I am presently scheduled with Dr. Bowers in May of 2016, I think I'm willing to change plans for a year to get my surgery covered.
Sarah
I was hoping BCBS would actually decide to follow the law this year so I could change back to them but I guess they think they're above it. Looks like I have to stick with Aetna.
I got so frustrated I gave up and am going to Thailand..
One day every insurer with have to pay.. we deserve to be treated like anyone else
Urrrrrrrrr and that is a polite way to say it.
Keri
Found out today that BCBS has denied my pre-authorization request for surgery. >:( Their excuse was that 55970 is a non covered code. So I've broken out pen and paper and am going to appeal their decision. I'll keep everyone apprised as it to how it is going. I just wish there was a way to appeal directly to OPM without all the games first!
Sarah
I need to find an insurance that fits me. I'm FTM 19 and live in Cali. I also go too college so I'm practically broke all the time.
Quote from: SarahJ on March 09, 2016, 05:19:20 PM
Found out today that BCBS has denied my pre-authorization request for surgery. >:( Their excuse was that 55970 is a non covered code. So I've broken out pen and paper and am going to appeal their decision. I'll keep everyone apprised as it to how it is going. I just wish there was a way to appeal directly to OPM without all the games first!
Sarah
Any news, Sarah?
Quote from: Annah on October 31, 2011, 11:59:16 PM
Here is a list I compiled last July. I know there's about 15 more companies added in the next quarter so I haven't been able to add them in yet:
Coca Cola
Campbells Soup
Walt Disney
State of Conn. Teacher Association
The Government of Louisana
HRC
Johnson and Johnson
Aetna Insurance (private plan)
AmeriHealth
Anthem Blue Cross Blue Shield
Blue Cross Blue Shield for:
Massachusetts
Minnesota
Michigan
Ameriprise Financial Inc
Avaya Inc.
Barclays Capital
Bingham McCutchen LLP
Booz Allen Hamilton Inc.
Cardinal Health Inc.
Chrysler LLC
Cisco Systems Inc.
Clifford Chance US LLP
Covington & Burling LLP
Cummins Inc.Deloitte LLP
Deutsche Bank
Diageo North America
DLA Piper
E. I. du Pont de Nemours and Co. (DuPont)
Eastman Kodak Co.
Ernst & Young LLP
Exelon Corp.
Faegre & Benson LLP
Food Lion LLC
Ford Motor Co.
Fried, Frank, Haris, Shriver & Jacobson LLP
Genentech Inc.
General Motors Corp.
Google Inc.
Herman Miller Inc.
Intel Cigna
International Business Machines Corp. (IBM)
Katten Muchin Rosenman LLP
Kimpton Hotel & Restaurant Group Inc.
Kirkland & Ellis LLP
KPMG LLP
Kraft Foods Inc.
Latham & Watkins LLP
Littler Mendelson PC
Marsh & McLennan Companies Inc.
McGraw-Hill Companies Inc., The
Microsoft Corp.
Morrison & Foerster LLP
Nike Inc.
Northern Trust Corp.
PG&E Corp.
Pillsbury Winthrop Shaw Pittman LLP
Replacements Ltd.
Robins, Kaplan, Miller & Ciresi LLP
Shearman & Sterling LLP
Sonnenschein, Nath & Rosenthal LLP
Sun Microsystems Inc.
Sutherland Asbill & Brennan LLP
White & Case LLP
Yahoo! Inc.
Cigna Private plan
Emblem Health
HealthNet
Health Partners (Minnesota)
Medica
University of Pennsylvania
Penn State
Goldman Sachs
Bank of America
City and County of San Francisco
IBM
AmEx
AT&T
Wells Fargo
Eastman Kodak
Sears
Morgan Stanley
Price Waterhouse
State Farm
New York Life Insurance
Angell Palmer and Dodge Law Firm
City of Berkley
All of these have GRS/GCS/SRS included in their policies.
However, getting disability insurance (i.e., paychecks while you are out recuperating) is at the discretion of your specific company's individual Disability Carrier Contract Guidelines.
Are you sure about 'Government of Louisiana'? Where did you get this information if you don't mind me asking. If this is true, it's great news for me and my spouse, but I was unaware of this coverage.
BCBSNC is covering surgery this year. Most of their plans anyways, from what I hear. I know that the State Employee's Health Plan (which is with BCBSNC) is covering it. I'm scheduled for this summer!
This might be helpful for billing codes and general GCS coverage information. It's the link to the Aetna BCBS insurance guidelines for Sex Reassignment Surgery. Your company would still need to add this coverage specifically to the policy for coverage if you have Anthem BCBS so you would need to check on those details.
https://www.anthem.com/medicalpolicies/guidelines/gl_pw_a051166.htm
It's current and valid for 2017. At least in Indiana. Verified it myself. ;D
Emma
I'm a bit confused on how the 55970 and 55980 are applicable to individuals who are transgender but not intersex. Are insurance companies treating them as the same diagnosis?
~Brooke~
Yes, absolutely, insurance will cover SRS. A lot of BCBS plans will cover it, but since each state (and sometimes individual cities) has their own BCBS, it varies depending on your plan.
For the past year, I've been working for BCBS for TX, IL, OK, MT and NM doing preauthorizations. I've learned a lot about insurance, how it works and how it applies to us as trans people and I'm using that knowledge to get surgery taken care of this coming summer. Honestly, I've been tempted to do a bit of an AMA on it.
As far as the CPT codes, they aren't that big a deal. In all honesty, the specific CPT codes aren't generally that important. I mean, if you have a doctor who has you set up insurance yourself, absolutely, you want to find out what codes they use. But when you look at the CPT codes, some of them are so similar to the next that it's really hard to tell the difference (on occassion, we actually have to change CPT codes when setting up preauthorizations).
If you do have to set up the insurance yourself and you REALLY want to surprise the person on the other end of the line, I can tell you exactly the information they're going to need for a preauthorization. First, best thing you can do is make sure all the providers are in network; if you have a PPO policy and a provider is out of network, call them up and ask about a waiver and you might be able to get them in network.... eventually. Besides the CPT codes (which are codes for the specific procedures or treatments), you're going to need diagnosis codes (or DX codes, which in our case would probably be gender dysphoria) and lastly you would need NPI numbers for both the doctor and the hospital where they're operating (NPI number is just a simple identification number for healthcare providers). The preauthorization will probably pend and you'll probably have to do a predetermination and to get that approved, they'll need clinical documentation that this procedure is medically necessary; for us that means the therapist letters. Generally you have to fax those in.
Sorry if it sounds a little complicated. I spend 8 hours a day doing this (sometimes longer). It's not complicated for me because of experience. But if anyone is having issues with insurance or has any questions, I'd be happy to help.
I have several questions.
1) I have HealthNet Medi-Cal by River City Medical Group. I have this because of my income through IHSS in Sacramento County California. I believe I am eligible for another insurance through SEIU Local 2015, but I don't remember. Does anyone know or if SRS or whatever it is called now is covered or how I can find out?
2) I am 64, and thanks to my first wife, I have genital herpes. Will I be eligible for the surgery with it?
3) I know I had another question, but all the yelling and fighting is distracting me. So let me ask, what is FFS and BA?
4) I am legally male right now, but I have the papers to change that on my birth certificate and ID. Can I still qualify for the surgery and have the insurance pay for it if I do that?
With love, ReubyLouise
Quote from: ReubyLouise on February 15, 2019, 09:28:16 AM
I have several questions.
1) I have HealthNet Medi-Cal by River City Medical Group. I have this because of my income through IHSS in Sacramento County California. I believe I am eligible for another insurance through SEIU Local 2015, but I don't remember. Does anyone know or if SRS or whatever it is called now is covered or how I can find out?
2) I am 64, and thanks to my first wife, I have genital herpes. Will I be eligible for the surgery with it?
3) I know I had another question, but all the yelling and fighting is distracting me. So let me ask, what is FFS and BA?
4) I am legally male right now, but I have the papers to change that on my birth certificate and ID. Can I still qualify for the surgery and have the insurance pay for it if I do that?
With love, ReubyLouise
I can help with #3:
FFS = Facial Feminization Surgery
BA = Breast Enhancement
Stephanie
Quote from: ReubyLouise on February 15, 2019, 09:28:16 AM
I have several questions.
1) I have HealthNet Medi-Cal by River City Medical Group. I have this because of my income through IHSS in Sacramento County California. I believe I am eligible for another insurance through SEIU Local 2015, but I don't remember. Does anyone know or if SRS or whatever it is called now is covered or how I can find out?
2) I am 64, and thanks to my first wife, I have genital herpes. Will I be eligible for the surgery with it?
3) I know I had another question, but all the yelling and fighting is distracting me. So let me ask, what is FFS and BA?
4) I am legally male right now, but I have the papers to change that on my birth certificate and ID. Can I still qualify for the surgery and have the insurance pay for it if I do that?
With love, ReubyLouise
Not 100% certain on all of this, but best guess?
1) State laws have a big impact on what kind of coverage various insurance plans will offer. California is a pretty liberal, trans friendly state so, yeah, I'd be surprised if they didn't cover surgery. If you'd like, I could try to do a little research on your company website and see what I can find out.
2) I believe Herpes is mostly a skin condition, so it would be easy enough to avoid by simply using a skin graft from another part of your body. Admittedly, this has all the fun involved with a skin graft. And it would depend somewhat on where the herpes are; if it's on the head of the penis, well, that's the part that is used as the clitoris so there's no skin graft that can be used for that.
3) Facial feminization surgery and breast augmentation
4) Again, I'd be amazed if your insurance can't find a way to get around that.
I am running into the problem to find a surgeon/facility who/that accepts my insurance. I have a Humana Medicare Advantage plan, which is a PPO. It seems that most SRS surgeons don't accept this insurance plan. I know that the plan would cover the surgery etc. as long as I find an entity who will accept the plan!
I know of some other people on Susan's who have he same plan, and are also struggling to find a surgeon.
If anybody here knows of an SRS surgeon accepting a PPO plan, please let me know.
I have now a very cooperative person in the transgender department of my Humana insurance. But the only list for transgender surgeons they have to go by is the WPATH listing, and that is helplessly outdated. That listing still has the University of Miami surgeon who was sacked for ethics violations.
Anyway, my insurance person will look up any doc who I ask her to lock up for possible coverage.
Do you folks know of any current listing of surgeons who do gender reassignment surgery?
Or can you let me know who did your surgery, and we could start to compile a list here on Susan's?
I can't help you with Humana specifically, but when I get home I can supply a list of surgeons I considered who are in-network with Florida Blue. It might be a starting point.
- Stephanie
Quote from: steph2.0 on May 24, 2019, 04:43:30 PM
I can't help you with Humana specifically, but when I get home I can supply a list of surgeons I considered who are in-network with Florida Blue. It might be a starting point.
- Stephanie
That would help. So far the only surgeons I was able to locate was Dr Kim of the University of Minnesota, and the Team of the Mayo Clinic in Minnesota. I bet that there are some on the way between Fort Myers and Minneapolis!
Quote from: Linde on May 24, 2019, 06:03:41 PM
That would help. So far the only surgeons I was able to locate was Dr Kim of the University of Minnesota, and the Team of the Mayo Clinic in Minnesota. I bet that there are some on the way between Fort Myers and Minneapolis!
Here is the list of doctors I'd compiled who were in-network with my insurance:
Rachel Bluebond-Langner, New York
Jess Ting, Mt Sinai Hospital, New York
Sidhbh ("Seev") Gallagher, Eskenazi Health Center, Indianapolis, IN
William Kuzon, Ann Arbor, MI
Loren Schechter, Chicago, IL
Robert Oates, Boston, MA
Kathy Rumer, Ardmore, PA
I know nothing about Oates and Kuzon. I don't have any direct experience with Dr. Rumer but have been cautioned about her. Nothing specific, so you'd want to do your own research.
I had in-person consultations with Dr. Ting's staff and they were great, but I'd gone there thinking he was an expert in the peritoneal method I'd read about, and it wasn't what I'd thought. Considering the cost of having it done in New York City and the long wait, I looked around some more. I had some interaction with Dr. Gallagher's team in Indianapolis, and had decided to go with her until I ended up with Dr. Bowers instead. @Denise was happy with Dr. Schechter, and we'll actually be visiting with him in August for a consultation for Cassie.
I hope that helps!
- Stephanie
Quote from: steph2.0 on May 25, 2019, 11:42:49 AM
Here is the list of doctors I'd compiled who were in-network with my insurance:
Rachel Bluebond-Langner, New York
Jess Ting, Mt Sinai Hospital, New York
Sidhbh ("Seev") Gallagher, Eskenazi Health Center, Indianapolis, IN
William Kuzon, Ann Arbor, MI
Loren Schechter, Chicago, IL
Robert Oates, Boston, MA
Kathy Rumer, Ardmore, PA
I know nothing about Oates and Kuzon. I don't have any direct experience with Dr. Rumer but have been cautioned about her. Nothing specific, so you'd want to do your own research.
I had in-person consultations with Dr. Ting's staff and they were great, but I'd gone there thinking he was an expert in the peritoneal method I'd read about, and it wasn't what I'd thought. Considering the cost of having it done in New York City and the long wait, I looked around some more. I had some interaction with Dr. Gallagher's team in Indianapolis, and had decided to go with her until I ended up with Dr. Bowers instead. @Denise was happy with Dr. Schechter, and we'll actually be visiting with him in August for a consultation for Cassie.
I hope that helps!
- Stephanie
Thanks Stephanie! I will give that list to my insurance, and they can tell me if they are in network for me!