Hello there!
In topics about surgery and insurance coverage I often see people mention that luckily their state or their insurance company covers __whatever__. Sometimes there is a mention of the company and/or the state, sometimes not. I think it would be a great resource for us people seeking surgeries to have a list to see which states/companies are good/bad for attempting to get trans care and surgeries.
For me personally, I'm currently at a stage in life where I'm both requiring a change of insurance (just coming off my parents) and probably a change of location (graduating). Right now I can try to shoot to move just about anywhere. It'd be awesome if I could plan to move to a state that required companies to cover surgery, and on top of that could pick a company/policy which would provide extra assurance of this coverage.
So here are my questions to everyone: (if you don't consider them too personal.. anything you do share is highly appreciated however)
What state do you live in/are you insured in?
What are the trans insurance coverage laws in your state?
What insurance company do you have/what is the trans surgery coverage like under your policy?
- - - if its policy specific under the company, what policy do you have/what policies (that you know of) cover trans care/surgeries?
Have you attempted to utilize your coverage for a SRS? What was the result? Did they make you jump through hoops of fire to get it done?
Is there any other advice you can give as far as tackling this situation goes?
Washington State
Group Health.
What the policy and actually says and covers are two different things and this is due to a ruling that was made by the state insurance commissioner. As a result anything covered for a different reason for someone else has to be covered for us. Different companies may have handled this ruling in different ways. Group health requires for the SRS and to get the gender therapist covered as "In Network" that you are part of their Transgender Services Program, which is a case management program to help aid us in anyway they can through our transition. Everything from hormones, therapy, blood work, and even the doctor's visit's have been completely covered. I'm not to the point of the SRS yet, but they are already putting in the referral to cover the initial consult with him due to how far he is booked out. Now the only change to these docs is that all plans include it now. It used be required that an insurance rider was included in your particular plan. That is no longer a requirement.
Here is the link to the transgender services program that I mentioned is required for those wanting surgery to covered by Group health.
https://member3.ghc.org/html/public/services/transgender
criteria
https://drive.google.com/file/d/0Bz9PS7t-K30Rc2FVOWFXWHR3dXM/edit?usp=sharing
what surgical procedures are covered
https://drive.google.com/file/d/0Bz9PS7t-K30RS0xDcWItWnZYZ3M/edit?usp=sharing
As mentioned before, there are 5 states that require insurance companies to cover transgender care. Other states, it isn't the insurance company that determines if transgender care is covered, it is different for each individual policy under that company.
Quote from: LordKAT on September 28, 2014, 02:10:38 AM
As mentioned before, there are 5 states that require insurance companies to cover transgender care.
As mentioned where?
QuoteOther states, it isn't the insurance company that determines if transgender care is covered, it is different for each individual policy under that company.
Yes I am aware of this, thank you. Thats why I asked if someone did have an insurance company that did pay for them to specify which policy.
Thanks for your input though! Anything is appreciated.
And thank you Mariah! That is awesome to know!
It is hard to believe, though, that only one person on here has had experience with insurance companies covering/refusing to cover trans care.
Quick search came up with this: http://www.hrc.org/resources/entry/finding-insurance-for-transgender-related-healthcare
An insurers willingness to cover certain treatments doesn't mean that the company you work for is going to purchase a group policy that covers them as well. Good luck!
Hugs, Devlyn
The States I know of that require insurance carriers to cover our medically necessary care are California and Colorado and the Distict of Columbia. As Mariah posted, Washington State recently saw their Insurance Commission make a ruling requiring our care. Oregon had a similar ruling but in my experience it only covers HRT and mental health therapy. I am personally impacted by living in Oregon and am appealing my denial of bottom surgery by Kaiser. Kasier and other insurance carriers may have a variety of different "plans" they offer to employer groups and some come with an exclusionary rider for trans care. It is important, imo, to get a clear statement of trans care coverage before we pay for a policy.
We are in a dramatic era of change and the momentum is working in our favor but good luck with the fine print and finding a good place to live and get care.
Kentucky, Wellcare
They cover nothing at all trans related.
Specifically says that they don't cover any trans services.
I hear that if you fight through the appeals process they will cover some things, but it is an uphill battle.
Quote from: chipper on October 07, 2014, 12:55:06 PM
I live in Massachusetts but am insured in Pennsylvania.
Massachusetts is quite inclusive. Pennsylvania is not.
BlueCrossBlueShield is my insurance company. My policy has a trans exclusion policy so anything related to gender is denied, straight up. There are loopholes to exclusion policies though- think Endocrine Disorder NOS.
I attempted to utilize my coverage for HRT, no success. I also tried to get my mastectomy covered and that was unsuccessful and inevitably a waste of time.
Are you on Obamacare or through employer? If you're through obamacare, I think it should be covered as it was required for them to accept it since this summer, if not, maybe next year which is just coming right up.
Quote from: Alexis2107 on October 07, 2014, 07:40:51 PM
Are you on Obamacare or through employer? If you're through obamacare, I think it should be covered as it was required for them to accept it since this summer, if not, maybe next year which is just coming right up.
This is not accurate. Trans people may not be denied any services which are offered to non trans people. Nothing says that trans specific treatment must be covered.
Quote from: Tessa James on October 07, 2014, 12:17:05 PM
The States I know of that require insurance carriers to cover our medically necessary care are California and Colorado and the Distict of Columbia.
I guess that's one more boost for Denver as a potential out-of-state move.
Quote from: chipper on October 07, 2014, 12:55:06 PM
BlueCrossBlueShield is my insurance company. My policy has a trans exclusion policy so anything related to gender is denied, straight up. There are loopholes to exclusion policies though- think Endocrine Disorder NOS.
BCBS is awful. Just dropped my individual policy with them to jump onto MassHealth. Evidently, lower-income options for MassHealth will cover GCS costs!
http://www.bostonglobe.com/metro/2014/06/20/state-cover-gender-reassignment-surgery-and-hormone-treatment-for-transgender-patients/a9OPrvqdUPmRoiAQugVwEO/story.html (http://www.bostonglobe.com/metro/2014/06/20/state-cover-gender-reassignment-surgery-and-hormone-treatment-for-transgender-patients/a9OPrvqdUPmRoiAQugVwEO/story.html)
In Missouri with my particular plan through UHC I have had pretty good coverage of mental health, scrips, dr visits, and SRS. I have not had coverage of hair removal/replacement via electrolysis or laser, FFS or coverage for BA. There is no specific coverage or exemption on my plan for TS people.
Missouri has a reasonably strong set of regulators in the public service commission and department of insurance. Such that UHC would not fight coverage for SRS considering I have a medically necessary statement from a couple of my doctors.
Thank you guys all for your responses. I agree with Dee.. looks like Colorado might be a good direction to head... for a couple different reasons ;)
Thanks again for the replies!
- Gnome
Quote from: chipper on October 19, 2014, 11:58:44 AM
I did the same, BCBS is the worst. Really impressed with MassHealth so far, my hormones only cost $3.50 for a 4 month supply!
O,O Whoa. Gotta expedite that application, I guess!
Anthem BCBS in Indiana has my HRT medicines covered 100% and just $10 co pay to the doctor. I spoke with Anthem, and they said SRS is covered if I am pre-qualified and that just means getting letter from two therapists, show that I have had laser hair removal, living as a woman, etc... my main issue is I am moving to Harrisburg, Penn next year by the sounds of it BCBS in Pennsylvania isn't up to date with the rest of the world. Which, my therapist says there are plenty of good surgeons in Pennsylvania. I may look for other insurances, or stay covered in Indiana, or wait a little bit and see if I can find a surgeon that will accept Medicare when I am eligible for it.
On a lighter note, someone in this forums told me they had a terrible time finding a surgeon that will accept Medicare. My therapist said she wrote her first letter to a surgeon who accepted one of her client's medicare insurance. If you PM me I will ask her who the surgeon was and let you know. This is in Indianapolis, Indiana.
I'm in CA and have BS health coverage, haha.
So far, I have had only one visit specifically for trans-related care, and my doctor coded it in a way that resulted in no coverage. Unfortunately, he has since left that practice. I have made about four calls to get this coding changed and the visit covered, and my second or third insurance contact bluntly told me that the visit wasn't covered because it was for trans services. I snapped and, equally bluntly, told her that I had chosen this policy specifically because it DOES cover trans stuff, and that such exclusions are ILLEGAL in CA. She put me on hold and sang a different tune after that . . . but nothing came of it. I have still received no refund for the services. I will probably call again this week. I am swiftly losing patience.
In a separate phone call, I was told that my surgeries would be covered, but I was given no procedure to follow and no knowledgeable representative to talk to. I was told to get an "evidence of coverage" document from my benefits office, but I can get that document online, and it says nothing about how to actually get the procedures covered or whom to talk to.
I'll eventually let y'all know how it turns out. I don't really have the time or the brain cells to deal with these things right now.
I wouldn't think in terms of "insurance companies" that cover trans care, I would think in terms of the states that require insurance companies cover it.
California, Colorado, Oregon, Vermont, Connecticut
http://www.advocate.com/politics/transgender/2013/12/31/connecticut-becomes-fifth-state-require-transgender-medical-coverage
Quote from: Brett on October 22, 2014, 07:19:29 PM
I wouldn't think in terms of "insurance companies" that cover trans care, I would think in terms of the states that require insurance companies cover it.
California, Colorado, Oregon, Vermont, Connecticut
http://www.advocate.com/politics/transgender/2013/12/31/connecticut-becomes-fifth-state-require-transgender-medical-coverage
But that's not written in stone either. I have friends in MN an IL that have had insurance cover SRS without specific coverage. The only commonality is we all have medical nessessity on our letters from our therapists.
You need to add Washington state and DC to that list.