Well Ok so What I've found is this. You can get pay as you go insurance plans "Individual Plan's" for a fairy low cost; That would be perfect for SRS/GRS. The way they work is that you have a deductible of say $3000. That normally alot, but it works for us. Ok so you pay $3k and then you have this thing "Coinsurance" and it's 0%-%20. What that is is how much you pay of the costs in a percent. SO!!!!
Out of pocket Cost $20,000
Pay $20,000
InsuredCost $20,000
Pay $6,400
(lets say it's 20%)
{20,000-3,000deductable=17,000}
{17,000x20%=3,400} Coinsurance is then $3.4k so
$3000 deductable + $3,400 coinsurance = $6,400
T=((P-D) x C%)+D
T=Total cost to you
P=Price before insurance
C=Coinsurance precentage
D=Deductable
See below for an explanation of terms
ANYHOW
Cigna Does pay for SRS/GRS and they have a plan for about $100 a month. I figure if I get the coverage awhile before I go in like more then a year. It would save something like $11,000 for me. And well if it works for me it will work for you girls to :
What do you think? Am I the good kind of crazy here or the bad kind. Would any one be willing to call them and check. I know it a stupid Phobia :( I jsut. Gah the more important the call the skicker I feel :( I got al my infor form the web and I don't trust it tell I've called some one and asked.
You must meet the fullowing criteria for Cigna to pay for your SRS/GRS
CIGNA covers gender reassignment surgery as medically necessary when ALL of the following criteria
are met:
• age 18 or older.
• diagnosis of gender identity disorder (GID), including a diagnosis of transsexualism with ALL of the
following criteria:
• demonstrated desire to live and be accepted as a member of the opposite sex,
Page 1 of 9
Coverage Policy Number: 0266¾ expressed desire to make his/her body as congruent as possible with the preferred sex through
surgery and hormone replacement.
• transsexual identity has been present consistently for at least two years.
• GID is not secondary to another mental disorder or chromosome abnormality.
• The individual is an active participant in a recognized gender identity treatment program and
demonstrates ALL of the following conditions:
• the individual has successfully lived and worked within the desired gender role full-time for at least
12 months (real life experience) without returning to the original gender
• initiation of hormonal therapy or breast surgery recommended by a qualified health professional with
written documentation submitted to the physician responsible for the medical treatment
• documentation of at least 12 months of continuous hormonal sex reassignment therapy, unless
medically contraindicated (May be simultaneous with real life experience.)
• recommendation for sex reassignment surgery by two qualified mental health professionals
recommend sex reassignment surgery with written documentation submitted to the physician
performing the genital surgery (At least one letter should be a comprehensive report. Two separate
letters or one letter with two signatures is acceptable. One letter from a Master's degree mental
health professional is acceptable if the second letter is from a psychiatrist or Ph.D. clinical
psychologist.)
• separate evaluation by the physician performing the genital surgery
CIGNA covers ANY of the following surgeries when performed as part of a med
• male to female reassignment:
- vaginoplasty
- colovaginoplasty
- orchiectomy
- penectomy
- clitoroplasty
- labiaplasty
• female to male reassignment:
- initial mastectomy/breast reduction
- hysterectomy
- salpingo-oophorectomy
- colpectomy/vaginectomy
- urethroplasty
- metoidioplasty combined with initial phalloplasty
Pre-existing ConditionsThis is the boogiman when it comes to SRS/GRS and insurance. You should always call the insurance provider and ask them what would qualify as pre-existing. If your concerned you can beat it one of several ways. The simplest is to get diagnosed after you start the insurance. Go to a shrink and a Doctor. After you start the plan.
But in most cases if you meet all the criteria, they won't turn you down. Pre-Exsisting is the get out of jail card insurers use when some one is trying to lie to them. Some one gets sick, THEN signs up for insurance. GID is more like diabetes. Yes you had it before but they won't try say they won't cover it. To be safe you should start your insurance plan at least a full year before you plan to go in for SRS/GRS. For 2 reasons. The first is that being on HRT and RLE are requirements to be covered for SRS/GRS. If your using the plan to see your endo they know your not faking. And the second is that starting a policy right before the Big Day. Is kind of a slap in the face to the insurer. Remember how I said they don't like you trying to pull a fast one, Hence the Pre-Existing clause? Show the company some respect an thing go much easier.
Finally There's good new on the Legal front. We can thank Obama for this one. Part of the heath care bill he pushed was a bit that said "Pre-existing" will become illegal. In 2014 and 2019 depending on your age. If you are under 18 in 2014, you will not be able to be exclude for PE. For everyone over 18 you have to wait untill 2019. But come that day PE will be gone forever.
Terms
-
Deductible:
This is the amount you have to pay out of pocket before the insurance kicks in. Say you have a bill for $2200, and you have a $2500 deductible. You will have to pay all $2200 out of your own pocket. On the other hand if you have a $3000 bill or even a $30,000 bill and a $2500 deducible you pay $2500 plus a % of the remainder. the percentage is called the Coinsurance
-
Coinsurance:
This term refers to a Percentage you have to pay. It can be 0%, 10% 20% or 30%. You may also see it written as 0/100, 20/80. Insurance does not pay all of the hospital cost. So just remember that the Coinsurance is your share of the bill and you want it low.
Source
-Cigna's current policy
http://www.cigna.com/customer_care/healthcare_professional/coverage_positions/medical/mm_0266_coveragepositioncriteria_gender_reassignment_surgery.pdf (http://www.cigna.com/customer_care/healthcare_professional/coverage_positions/medical/mm_0266_coveragepositioncriteria_gender_reassignment_surgery.pdf)
Current
A big thank you to Malachite!
See also
-Why not "To Good To Be True"
Quote from: peky on March 11, 2012, 11:38:42 AM
I beg to differ in the assessment. Say for a big company of 200,000 individuals, that is about 100,000 males, the chance of having a MTF employee is 1:30,000 or 1:100,000, or 1 to 3. Hardly any major loss for any health insurance provider. Great PR for the company that offer them though; that is why most of the top 500 companise have life insurances that cover SRS.
I think, in the USA, small companies and government do not offer health insurances that cover RS is due to ignorance, religion beliefs, hate, or a combination of all of them.
This is a bit confusing.
So you'd pay 100$ a month, that I understood. What is the deductable though?
I'm not sure now, but several years ago when Aetna announced this type of coverage there were some strings attached. The covered person had to have a documented and verifiable gender related birth issue like Klinefelter's Syndrome, AIS, mosaicism, something that caused ambiguous genitalia. You will have to contact them and find out what kind of parameters they have in place for this kind of policy to actually be worth purchasing. My gut feeling is that these companies won't be offering coverages for gender dysphoria, they'd go broke! Hate to throw cold water on you, check them out really good before signing up!
Quote from: Jennifer.L on March 10, 2012, 06:18:52 PM
I think I may be awesome but I'll have to make calls to check. Only I'm afraid of making phone calls. So I'll do it but not for like 2 weeks tell I feel bad for procrastinating. Of course if some one else wanted to call.... PLEASSSE
Well Ok so What I've found is this. You can get pay as you go insurance plans "Individual Plan's" for a fairy low cost; That would be perfect for SRS/GRS. The way they work is that you have a deductible of say $3000. That normally alot, but it works for us. Ok so you pay $3k and then you have this thing "Coinsurance" and it's 0%-%20. What that is is how much you pay of the costs in a percent. SO!!!!
Out of pocket
Cost $20,000
Pay $20,000
Insured
Cost $20,000
Pay $7,400
(lets say it's 20%)
{20,000-3,000deductable=17,000}
{17,000x20%=3,400} Coinsurance is then $3.4k so
$3000 deductable + $3,400 coinsurance = $7,400
ANYHOW Aetna & Cigna Do pay for SRS/GRS and they have a plan for about $100 a month. I figure if I get the coverage awhile before I go in like more then a year. It would save something like $11,000 for me. And well if it works for me it will work for you girls to :
What do you think? Am I the good kind of crazy here or the bad kind. Would any one be willing to call them and check. I know it a stupid Phobia :( I jsut. Gah the more important the call the skicker I feel :( I got al my infor form the web and I don't trust it tell I've called some one and asked.
You don't seem crazy to me. I can't comment about Aetna but for Cigna I heard the same thing from another person that they cover a lot of the SRS procedures and they sent me the link of this what you were referring to.
http://www.cigna.com/customer_care/healthcare_professional/coverage_positions/medical/mm_0266_coveragepositioncriteria_gender_reassignment_surgery.pdf (http://www.cigna.com/customer_care/healthcare_professional/coverage_positions/medical/mm_0266_coveragepositioncriteria_gender_reassignment_surgery.pdf)
I'm actually thinking about buying their transgender insurance before I even transition. It could save me a bit since I believe they cover therapy sessions too.
I think it's different for each state and how they do it though. Maybe you could email them?
Watch out for post-claim underwriting: basically, you have a pre-existing condition and they can deny you coverage.
A minor correction to your math- $3000 + $3400 = $6400.
Sounds too good to be true.
Quote from: Shantel on March 10, 2012, 06:59:49 PM
My gut feeling is that these companies won't be offering coverages for gender dysphoria, they'd go broke! Hate to throw cold water on you, check them out really good before signing up!
I beg to differ in the assessment. Say for a big company of 200,000 individuals, that is about 100,000 males, the chance of having a MTF employee is 1:30,000 or 1:100,000, or 1 to 3. Hardly any major loss for any health insurance provider. Great PR for the company that offer them though; that is why most of the top 500 companise have life insurances that cover SRS.
I think, in the USA, small companies and government do not offer health insurances that cover RS is due to ignorance, religion beliefs, hate, or a combination of all of them.
I'm thinking in terms of being self insured like the original post seemed to indicate. Having been a claims adjuster during my working life I had a closer than average familiarity with policies and coverages. Having been MtF since the mid 90's I have come to realize that a vast number of transitioners live and work outside of the mainstream modes of employment and often have no insurance at all. I was self employed as an independent, so although your statistics may be correct for Fortune 500 companies, they most probably don't cover the entire broad spectrum.
they have a plan for about $100 a month.
I doubt that the C-note plan is going to cover SRS, or much at all. I'd be looking at spending several times that. Individual plans, so all the cost is on you - no pooling risk or anything - probably start at 500 a month, and 700 would not surprise me. And then you get into the pre-existing conditions deal also. I'll bet the cost for a single policy covering one person that includes SRS, a real Cadillac plan, (and I would assume that you would want psychiatric coverage and prescription coverage - and I'm also assuming that you are in perfect health otherwise) is going to cost you a lot closer to $10K a year, not $1K.
If it was as easy as $100 a month and it covers everything then we wouldn't have 46,000,000 without insurance, and it would not have been a major political issue for the last 20 years.
You can't get something for nothing.
Tekla, you have no clue how insurance works do you. Did you get you fact off of a cereal box?
3 words... cupcake. (Major Medical Only) You can't use it for things like getting sick. You can't go to the dentist with it. It cover's big bills involving; Hospitalization, Surgery and the like.
State your sorce. Mine is
http://www.cigna.com/customer_care/healthcare_professional/coverage_positions/medical/mm_0266_coveragepositioncriteria_gender_reassignment_surgery.pdf (http://www.cigna.com/customer_care/healthcare_professional/coverage_positions/medical/mm_0266_coveragepositioncriteria_gender_reassignment_surgery.pdf)
epinion reviews of signa insurance. not one good review and it seems like they easily get away with avoiding coverage for anything major. like the people above mentioned, if its too good to be true, then it prolly is. welcome to america. :(
http://www.epinions.com/reviews/finc-Insurance-All-CIGNA?sb=1 (http://www.epinions.com/reviews/finc-Insurance-All-CIGNA?sb=1)
I read the review. The do seem to have very poor customer support. Mind you almost none of the reviews listed what happened or why. The only one I saw that was anything but how the person felt was one that I felt Cigna did the right thing. If a typo says you gained 300lbs. they don't know it's a typo. I'll make some calls when I can. I personally have know from the word go that all of this would be a fight and you would have to get the insurer to go on record saying they will cover SRS for you personaly before you sign up. If you don't you're a fool.
Also
I tried to find blue cross on E-opinions but that place seems to be more of a shoping mart then anything. I use Blue Cross threw my employer. I've been hospitalized and I know what they are like from the inside. So I ran a "Ripoff Report" on The insurer I know and then on Cigna. Lets Compare them.
http://www.ripoffreport.com/Search/Blue-cross.aspx (http://www.ripoffreport.com/Search/Blue-cross.aspx)
http://www.ripoffreport.com/Search/cigna.aspx (http://www.ripoffreport.com/Search/cigna.aspx)
Right of the bat you notice that theres more then double the complaints, but well blue cross is bigger.
Both have a large number of complaints about being denied for this or that reason.
The biggest differences I'm seeing as I write this is that Cigna has a much smaller number of doctor. So if you are using it for your standered every day insurance it looks pretty crappy. Your defiantly not going to find the best doctors with them.
But then neither of the two companies has any big issuse with payout for major medical and hopitalization.
Cigna is smaller. And the fight, so get things in writing first. But well you should do that anyway.
Oh and here my favorite review
"CIGNA manages employee health care and has the final approval over any doctor orders. CIGNA poioned me with phen-fen"
Phen-Fen has been illegal for over a decade. I was proscribed for rapid weight lose. And the people that used it knew it was wildly dangerous
So to sum up. Yes, Cigna will try to not pay out. If you let the, So will every other insurer. They are not by any means a horrible insurer. Just below average. But they can work.
Blue Cross Blue Sheild of Florida Covers SRS I'm looking into their "Surgical Plus" Plan. I currently have BCBS ot texas threw work. But i live in florida.
http://consumerdirect.bcbsfl.com/cws/browseplans/health (http://consumerdirect.bcbsfl.com/cws/browseplans/health)
Quote from: Jennifer.L on March 10, 2012, 06:18:52 PM
I'm alittle pissed off at you Nay sayer right now. I've just earned a super hero cape by working this all out for you and you don't read it all before you tell me I'm wrong. I'm trying really hard to calm down but you: Tekla and Shantel are on my **** list. My source was right there and you didn't care. Up to date as of 15 seconds ago and you still want to tell everyone it can't be real. Well read the "CIGNA MEDICAL COVERAGE POLICY" It's in black and white.
Ok, alright, Good job. An Atta Girl for you Jennifer! Take me off your list sweetie!
Quote from: Jennifer.L on March 10, 2012, 06:18:52 PM
Pre-existing Conditions
....
Finally There's good new on the Legal front. We can thank Obama for this one. Part of the heath care bill he pushed was a bit that said "Pre-existing" will become illegal. In 2014 and 2019 depending on your age. If you are under 18 in 2014, you will not be able to be exclude for PE. For everyone over 18 you have to wait untill 2019. But come that day PE will be gone forever.
Thank you for the informative and helpful post, Jennifer! I did want to add a slight, albeit positive correction to this part, though. The pre-existing condition loophole is already closed for those under 18; for those over 18, pre-existing ends starting Jan. 1, 2014.
http://www.csmonitor.com/USA/Politics/2010/0324/Health-care-reform-bill-101-rules-for-preexisting-conditions (http://www.csmonitor.com/USA/Politics/2010/0324/Health-care-reform-bill-101-rules-for-preexisting-conditions)
I just wanted to point out there is lots of confusion around individual health insurance, most people just have coverage thru an employer and assume private coverage is just too expensive buy. My employer provides insurance but I have found I can easily get cheaper insurance with more coverage on my own.
I can't speak for other situations, it could be that work at my company are just so much less healty than average that the rates are as high as they are, or maybe it is just because i am healthy but, in any case it can certainly be a lot cheaper than people seem to think.