Well since BCBS is not going to pay for any of my transgender care I have to ask myself why keep paying them. It's like paying someone to rob you. I could take that money and put it in a savings account and use it to pay for meds and doctor visits since it's coming out of my pocket anyway. Doesn't that make sense?
But keep in mind that you could have other health issues that may crop up from time to time that it would pay for. So you have to decide if canceling is really worth it in the long haul. There are a lot of things concerning our health that is not trans related.
doesnt insurance pay if the doctor puts hormone imbalance for the reason? technically it is hormone imbalance so that in itself makes it become medically necessary
You have tunnel vision Amy. What if you are in a car wreck or have to have an appendix or gall bladder removed? You need to keep your insurance sweetie. If you cancel you will have a heck of a time getting it in the future. That is why when employers change insurance policies they have to give you a letter stating you were previously insured so the next one they find will pick you up easier. As a Paramedic I saw people every day on my unit who had cancelled for some reason or another and then been injured. BCBS is a great company, you would be not too wise to cancel them. :)
Quote from: Jaime R D aka big head horsey-face on May 25, 2014, 02:11:18 PM
But keep in mind that you could have other health issues that may crop up from time to time that it would pay for. So you have to decide if canceling is really worth it in the long haul. There are a lot of things concerning our health that is not trans related.
Yeah it could definately be risky but so far the only problems I've had have been very minor.
Quote from: Brianna Umiko Liliana on May 25, 2014, 02:15:35 PM
doesnt insurance pay if the doctor puts hormone imbalance for the reason? technically it is hormone imbalance so that in itself makes it become medically necessary
I don't know but I'd say not likely.
Quote from: Jessica Merriman on May 25, 2014, 02:22:58 PM
You have tunnel vision Amy. What if you are in a car wreck or have to have an appendix or gall bladder removed? You need to keep your insurance sweetie. If you cancel you will have a heck of a time getting it in the future. That is why when employers change insurance policies they have to give you a letter stating you were previously insured so the next one they find will pick you up easier. As a Paramedic I saw people every day on my unit who had cancelled for some reason or another and then been injured. BCBS is a great company, you would be not too wise to cancel them. :)
Yeah it's just something I'm thinking about but I probably won't.
I'm going to play the devil's advocate here due to my severe distrust towards American insurance companies. I haven't had health insurance in 7 years.
I usually pay $120 for a visit to urgent care once a year for common cold infections.
Do I worry about it? No, not really ever. Yes I could get in a terrible accident, but I am still young healthy as far as I know so I'm not worried about disease. Major accidents are the only one I could possibly worry about, but I have had several friends who have the same general distrust (and lack of insurance thereof) and HAVE gotten in accidents. They still get treated, and they end up paying nothing in the end. It's remarkable if you ask me.
I know I may get flamed for saying this, but I think the way insurance companies get off is instilling fear in people- making them think they need to pay thousands of dollars for "security". When, in fact, everyone has the same amount of security when in dire need of emergency healthcare.
Jessica, you probably have a very different viewpoint on this being that you used to deal with emergencies and accidents all the time? Hopefully what I just said isn't too upsetting :-X
Quote from: Jennygirl on May 25, 2014, 05:01:38 PM
Jessica, you probably have a very different viewpoint on this being that you used to deal with emergencies and accidents all the time? Hopefully what I just said isn't too upsetting :-X
After getting slammed in a topic earlier (which no one reported), it just shows I have outlived any usefulness I have tried to have here. Maybe it is time I moved on. I am not upset with you Jenny, just realizing I am obsolete and outdated. I guess it's just a brave new world that I don't understand anymore. :(
Before deductibles of $6000+, Insurance was worth it, but with that deductible plus premiums, not worth it for the most part.
Are transgender issues still considered experimental in the US and the reason insurance won't cover it?
or cosmetic morelike.
I had $150k in hospital bills a couple of years back. I will never go without insurance.
they are starting to calm down on that a little but they still consider ffs and vfs cosmetic
even SRS though, which makes no sense. They are debating the wording on that for medicare/medicaid. If that changes, insurance companies will likely follow suit shortly after.
Marci Bowers apparently will take my insurance policy.
Personally, I hated bluecross/blueshield when I used them. They found a way to deny almost all of my medical bills and I'm still paying off 2 months of "coverage" with them. In any case, having insurance is very important. One bill that you didn't expect could end your life. Hell, medical bills are one of the biggest contributors to poverty in this country, so they aren't odds worth playing. It's fine to consider getting a different policy, but I would recommend finding an alternative rather than getting rid of medical completely.
I can agree with having it, I'm more upset that I can't get insurance until next year unless I'm willing to pay $350/month plus have a deductible of $6350. I can get emergency help to cover if I need to, but I can't afford the insurance.
Quote from: LordKAT on May 25, 2014, 06:15:43 PM
I can agree with having it, I'm more upset that I can't get insurance until next year unless I'm willing to pay $350/month plus have a deductible of $6350. I can get emergency help to cover if I need to, but I can't afford the insurance.
That's an insane deductible, but sadly that's becoming standard as there are little safeguards to prevent increased premiums and deductibles. In any case, I can see why you are reluctant to take that policy. That really sucks, sorry you are going through this.
Unfortunately, it is a common deductible with the Unaffordable care act in place.
Quote from: Jessica Merriman on May 25, 2014, 05:19:20 PM
After getting slammed in a topic earlier (which no one reported), it just shows I have outlived any usefulness I have tried to have here. Maybe it is time I moved on. I am not upset with you Jenny, just realizing I am obsolete and outdated. I guess it's just a brave new world that I don't understand anymore. :(
Jessica, whoa now we live in the same world the last I checked! I may be in a neighboring age bracket but that doesn't mean that you are somehow obsolete? Especially since we have people from all walks of life on the site. Just offering a different viewpoint from the hippie commune I live in ;)
And really age or obsoleteness has nothing to do w/ it. My whole family thinks I'm crazy for not having insurance. And I suppose I am ;D But I embrace my inner craze. I'm definitely not telling anyone here that they shouldn't have insurance, it's just a decision they'll have to make on their own and I consider myself to be outside of the standard deviation on this one. Maybe I shoulda not spoken out about it
Quote from: LordKAT on May 25, 2014, 06:27:21 PM
Unfortunately, it is a common deductible with the Unaffordable care act in place.
I work in a doctor's office (well, I will once again in exactly one week from tomorrow) and it seems to be a common complaint all around. However, I've learned to shut my mouth on this topic here, lol, so I'm going to refrain from any ACA discussions. It's a very controversial issue with many grey areas in my opinion and I'll leave it with that.
Quote from: Jessica Merriman on May 25, 2014, 05:19:20 PM
After getting slammed in a topic earlier (which no one reported), it just shows I have outlived any usefulness I have tried to have here. Maybe it is time I moved on. I am not upset with you Jenny, just realizing I am obsolete and outdated. I guess it's just a brave new world that I don't understand anymore. :(
I don't think Jenny intended to discredit your view. It's just you are more likely to consider the risk of insurance considering you worked in medical. My whole family is in medical for the most part, and that's probably why getting insurance is seen as so important. When you see what can happen and how expensive it is, it's something that you don't forget. On my part, a poor girl like me has seen how important medical can be with my treatment history the past year.
Quote from: Jennygirl on May 25, 2014, 06:27:39 PM
Jessica, whoa now we live in the same world the last I checked! I may be in a neighboring age bracket but that doesn't mean that you are somehow obsolete? Especially since we have people from all walks of life on the site. Just offering a different viewpoint from the hippie commune I live in ;)
And really age or obsoleteness has nothing to do w/ it. My whole family thinks I'm crazy for not having insurance. And I suppose I am ;D But I embrace my inner craze. I'm definitely not telling anyone here that they shouldn't have insurance, it's just a decision they'll have to make on their own and I consider myself to be outside of the standard deviation on this one. Maybe I shoulda not spoken out about it
I see where you are coming from, but please be careful. Life is so unexpected and that one stroll out on the street could become a life ending day. Medical costs in this country are crazy and really inflated. You don't want to one day be on the recieving end of one of those bills and sadly many Americans are living in poverty because of just that. Just be careful and take care of yourself.
Quote from: LordKAT on May 25, 2014, 05:58:23 PM
even SRS though, which makes no sense. They are debating the wording on that for medicare/medicaid. If that changes, insurance companies will likely follow suit shortly after.
I thought only older people were entitled Medicaid and Medicare. If so that wouldn't do young people any good.
Quote from: LordKAT on May 25, 2014, 06:27:21 PM
Unfortunately, it is a common deductible with the Unaffordable care act in place.
I think the unaffordable care act is going to make everything worse.
Quote from: Amy1988 on May 25, 2014, 07:07:43 PM
I thought only older people were entitled Medicaid and Medicare. If so that wouldn't do young people any good.
Medicaid is for low income people and the threshold has been increased under the ACA. Depending on what state you live in and whether they have decided to expand their medicaid program through the ACA subsides, you may be eligible for it (depends on your income). Medicare is more of a program for seniors, though I believe you can get it if you are disabled.
I found myself unexpectedly loaded in the back of an ambulance on a high speed ride to the hospital one day. I had experienced a major medical situation that resulted in a 3 day hospital visit, many unpleasant medical procedures, and 7 weeks off from work to recover. It wound up being a $30,000 event that insurance paid most of. Since I was self employed at the time a $30k hit that I would have had to pay out of pocket + the 7 weeks of no income would have bankrupted me. Health insurance seems like something you can do without but it doing without IMO is a HUGE gamble.
I don't like going without, I just can't pay rent and insurance. I have to eat and live somewhere.
Quote from: LordKAT on May 25, 2014, 06:15:43 PM
I can agree with having it, I'm more upset that I can't get insurance until next year unless I'm willing to pay $350/month plus have a deductible of $6350. I can get emergency help to cover if I need to, but I can't afford the insurance.
:icon_yikes: That's an insane deductible :(
Mine is $363 (living in Norway), though a bit higher for services like physiotherapy. With my current income the monthly pay is around $225. The good thing is that if you have no income (or below around $3000), the state covers everything except the deductible. The bad thing is that it can't be opted out of, and there are no private alternatives. Additionally, dentist services, my psychologist and some medication (including future HRT, since I wont even bother trying to get it covered by welfare) aren't covered, so any serious dental problems would leave me bankrupt. But at least a medical emergency wouldn't.
Quote from: Amy1988 on May 25, 2014, 07:07:43 PM
I thought only older people were entitled Medicaid and Medicare. If so that wouldn't do young people any good.
Medicare is the insurance provided by the SSA, and that's what's limited to old (and certain disabled who are also getting SS benefits) people. Medicaid is the low-income program; before the ACA a childless adult was generally ineligible, but in the States that chose to expand anyone with an income below 133% of the federal poverty level is eligible (if you live in one of the states that didn't expand the old rules probably still apply).
Is it possible to switch your plan? I have BCBS and they cover me. I haven't looked into SRS coverage yet, but my hormones have all been covered. I was denied an increase in patch frequency (to twice a week) for my estradiol patches a few months ago but they accepted it after my endo resubmitted the paperwork the way BCBS wanted it filled out. They seem to be really picky with paperwork -I think it took her more than one attempt.
Quote from: Jill E on May 26, 2014, 09:50:04 AM
Is it possible to switch your plan? I have BCBS and they cover me. I haven't looked into SRS coverage yet, but my hormones have all been covered. I was denied an increase in patch frequency (to twice a week) for my estradiol patches a few months ago but they accepted it after my endo resubmitted the paperwork the way BCBS wanted it filled out. They seem to be really picky with paperwork -I think it took her more than one attempt.
Well I'm With BCBS of NC but isn't it all the same?
Quote from: Amy1988 on May 26, 2014, 11:00:42 AM
Well I'm With BCBS of NC but isn't it all the same?
No, there are different policies and they differ from one another. It's the same company, but there are many different kinds of policy. I was covered by BCBS when my dad had them and they don't cover these things. However, I know people around me (in NY) that are covered by Blue Cross/Blue shield, so I think it the individual policy and perhaps locality matter. The thing is my father was actually also working in North Carolina at the time and I believe he had BCBS of Illnois (?). Not sure (it was confusing as hell), but they denied me while I covering other people around me for the same stuff, so I imagine your individual policy is what matters.
Horizon BCBS of NJ doesn't cover but Amerihealth does and when I can change providers at the end of the year, I will switch. The Healthcare Act actually helped us. My wife and I pay about $250/month total, plus our deductible is about $600 and covers prescriptions. It really depends on the state. My cousin in TN is 26 and she can't get anything cheaper than $400/month and $1500 deductible for her budget. The Red states tend to have the worse deals and the blue ones have better ones overall. FL is pretty bad too as my sister is covered by her employer, but they are wanting everyone to switch next year and her options are pretty bad.
Have been through bankruptcy a year and a half ago (had a family business that went belly up, family partners took the money and left me the bills and I had hardly any personal debt in comparison) and many of the cases I heard were from medical bills in the 50k to 200k range. Bankruptcy was the only way for many of these people to escape from the massive bills for many middle class people. It's frustrating that if your middle class and don't have insurance, you can loose everything. Yet, if your low income and no insurance, you basically get free healthcare in (at least in NJ.) However, there is a caveat to that. If you have a serious illness like cancer that is treatable or even curable, your odds of surviving are a lot better if you have good insurance (or a lot of money.)
Quote from: LordKAT on May 25, 2014, 05:21:34 PM
Before deductibles of $6000+, Insurance was worth it, but with that deductible plus premiums, not worth it for the most part.
Do you people not go doctors or something? Do you know what deductibles are? How little subsidies did you all qualify for?
Mind you, I've had my share of grinds with Coventry before, but so far after only 2 months, they've saved me thousands more than what I've had to pay out of pocket.
To see my physician, I pay 5 bucks copay.
Then I pay 20% of whatever's left, which is usually another 20 or something. (edit: just looked at my bill, it's zero, so apparently I don't owe any more than the copay) The deductible only goes towards things like emergency room visits, urgent care, surgeries, etc.
I pay about $20 a month for insurance with subsidies. I got the gold plan which covers 80% of hospital costs and a $1750 deductible and a $250 pharmacy deductible (which they neglected to show on the website which was an aggravating surprise)
How much a month do you pay for insurance to justify cancelling it? How often do you see your doctor? Who is gonna pay when you get in a car wreck and can't afford the bill?
I would run up the $1750 deductible, then quickly reach the 5k maximum I have to pay out of pocket a year.
You, however, would be stuck with hundreds of thousands of dollars in medical bills which you would then either apply for aid from the hospital and beg them to forgive the bill or hope the government picks up the tab.
Quote from: Hideyoshi on May 26, 2014, 01:33:58 PM
Do you people not go doctors or something? Do you know what deductibles are? How little subsidies did you all qualify for?
Mind you, I've had my share of grinds with Coventry before, but so far after only 2 months, they've saved me thousands more than what I've had to pay out of pocket.
To see my physician, I pay 5 bucks copay. Then I pay 20% of whatever's left, which is usually another 20 or something. (edit: just looked at my bill, it's zero, so apparently I don't owe any more than the copay) The deductible only goes towards things like emergency room visits, urgent care, surgeries, etc.
I pay about $20 a month for insurance with subsidies. I got the gold plan which covers 80% of hospital costs and a $1750 deductible and a $250 pharmacy deductible (which they neglected to show on the website which was an aggravating surprise)
How much a month do you pay for insurance to justify cancelling it? How often do you see your doctor? Who is gonna pay when you get in a car wreck and can't afford the bill?
I would run up the $1750 deductible, then quickly reach the 5k maximum I have to pay out of pocket a year.
You, however, would be stuck with hundreds of thousands of dollars in medical bills which you would then either apply for aid from the hospital and beg them to forgive the bill or hope the government picks up the tab.
A lot of this depends on what plan you have. My current plan is amazing, but I've had terrible coverage in the past and the bills to prove it. The fact is deductibles, premiums and even copays have increased for quite a few people out there. While insurance is important to have, some people really may not be able to afford it. I know my sister would lose an insane portion of her paycheck if she were to get her employers plan, so she decides to risk it. Not a great idea on her part, but I understand where she is coming from.
Quote from: learningtolive on May 26, 2014, 02:06:07 PM
A lot of this depends on what plan you have. My current plan is amazing, but I've had terrible coverage in the past and the bills to prove it. The fact is deductibles, premiums and even copays have increased for quite a few people out there. While insurance is important to have, some people really may not be able to afford it. I know my sister would lose an insane portion of her paycheck if she were to get her employers plan, so she decides to risk it. Not a great idea on her part, but I understand where she is coming from.
Well I think I'll just email them and ask directly and report back.
The only things covered before the deductible are one well doctor visit and some discounts on scripts. All the rest is out of pocket until the deductible is met.
@Amy1988 I'm with BCBS in Minnesota. I haven't submitted my own claims yet, but understand that they will accept claims for HRT and SRS provided your doctor submits paperwork deeming the treatment medically necessary. I'll report back here after I've submitted claims, but right now I'm feeling optimistic.
Quote from: Will on May 27, 2014, 11:58:42 PM
@Amy1988 I'm with BCBS in Minnesota. I haven't submitted my own claims yet, but understand that they will accept claims for HRT and SRS provided your doctor submits paperwork deeming the treatment medically necessary. I'll report back here after I've submitted claims, but right now I'm feeling optimistic.
I've been with health partners and medica and neither cared about hrt meds (as in no pre-auth). Getting srs covered however is a lot of paperwork because they use older standards of care and having to make sure whatever contract you're with has it included. If you're with medicaid don't bother as it'll be rejected per state law on funding for services.
http://notes.bluecrossmn.com/web/medpolman.nsf/8178b1c14b1e9b6b8525624f0062fe9f/7af983e72d2d786186256e5f005bbf09/$FILE/Surgical%20%20Treatment%20Gender%20Dysphoria.pdf (http://notes.bluecrossmn.com/web/medpolman.nsf/8178b1c14b1e9b6b8525624f0062fe9f/7af983e72d2d786186256e5f005bbf09/$FILE/Surgical%20%20Treatment%20Gender%20Dysphoria.pdf)
I had BCBS of Minnesota for years. No surgeries covered. It really does depend on your own policy.