Hey there,
I'm at the point of transition where I'm ready for the next step. I was able to meet Bowers a few weeks ago at SCC. I have chosen her for my surgery and I'm in the process of getting my documents together.
I'm working with my Endo and my therapist to draft my letters. It seems that these letters will be submitted with and for my insurance pre approval. I was wondering if anyone here has had some experience in dealing with insurance companies for their SRS/GRS. It seems as though I have a more difficult company to deal with and may experience a denial and have to go through some sort of a challenge in order to get pre approval. I know big shocker!!! The insurance will not just rubber stamp the approval.
So I was wondering is there any key phrases or wording like"medically necessary" that I should focus on?
Any help would be great! Thanks y'all!!!
Rea
Most GRS surgeons do not take insurance so you kinda pay and then submit for reimbursement. First before you spend any money i would look over your insurance policy and see if transgender surgery is in the non covered section. If it is i would say hold on a little and see if your state changes the laws to not discriminate. Also you could also ask your employer to add a rider to the policy to cover your GRS.
I fought my insurance company every single year for 4 years and just gave up trying. If it is a non covered expence in writing on the policy you are never going to get them to cover anything.
Now if you do have coverage then i would have your doctors put medically necessary as much as you can on things you submit to them.
Good luck and i hope you are covered.
Izzy
Thanks Izzy,
I'm having Marci Bowers do it. She is one of the very few that will get pre-autorization from your insurance company. It is written very vague in my policy about coverage. In the exclusions under my benefit's it does say that some of the policies exclude this. It is depending on the policy or the tier of coverage. Since my employer offer's a couple of differing tier's of coverage the exclusions section in the policy is very generic and doesn't specify as to which tier is covered and which isn't. I talked to both my employer and my insurance company. Both have asked for a doctor to submit for pre-authorization. My employer has been trying to help, but they are not very experienced in dealing with this sort of topic. They have been very supportive just not very helpful. This is why I'm seeking advise. I was just curious if anybody else had any experience dealing with this type of issue.
I do know here in the States that the Affordable Healthcare Act will be working towards more inclusive policy's regarding transgender care. This is including hormone treatments and surgeries. Some States have already passed legislation that protects transgender people from discrimination of insurance companies. Making it illegal to exclude medically necessary treatments. I think that insurance companies are going to have a rude awakening come January first when they have to begin to switch there policy from transgender exclusions to becoming more inclusive to trans people.
I wish you luck on any of this. I know everything seems to be double talk in insurance policies.
I would make sure though that everything has the medically necessary is there on anything you get to send to the insurance company.
I hope it all work out for you. Marci is one of the better surgeons in the states and i think you will be happy with her work.
Izzy
Quote from: Reagan on September 27, 2013, 09:25:12 AM
I do know here in the States that the Affordable Healthcare Act will be working towards more inclusive policy's regarding transgender care. This is including hormone treatments and surgeries. Some States have already passed legislation that protects transgender people from discrimination of insurance companies. Making it illegal to exclude medically necessary treatments. I think that insurance companies are going to have a rude awakening come January first when they have to begin to switch there policy from transgender exclusions to becoming more inclusive to trans people.
I'm really looking forward to this. I may have had crappy timing all my life, but I'm poised for really great timing between "gender transformations" and insurance. Worst case I'll have a few years of no Rx and Doctor coverage (which can be gotten around fairly easily, I hear).
My insurance is federal... so it's going to take that ENDA to push it along...