I've been trying to figure out the whole insurance thing in the United States and I'll be honest it just really confuses me. I currently am in the Midwest but it is very likely I will end up on the West Coast (California, Oregon, Washington) within a month or two. I understand insurance varies by state so I know the answers may vary?
My main three questions are:
1) What transition expenses health insurance cover and what doesn't it cover?
2) What companies are the best to be insured through? (Basically what will generally be accepted the most through surgeons or pharmacies, etc)
3) It it cheaper in the long run to pay for insurance or to pay for everything without it?
I'm trying to make the best decision for my future that I can and I'm sure there are people on here who have used insurance to pay for a great deal of their transition expenses. If you would be willing to share your story and any tips/info that I would find helpful, I would greatly appreciate it.
Insurance varies by locality. It isn't even the same throughout my state. Providers typically have multiple plan offerings, and what they cover will vary by plan.
The best way to get an answer to your question would be to make a list of what insurance options are available in the places you're hoping to live (either through the Affordable Care Act or your employer), and list them here. Chances are, someone has worked (or tried to work) with them before.
Ultimately if you get a plan that covers everything or even a percentage of things, it's less expensive in the long run. I think the only thing transition related for MTFs that may not be covered is FFS, but I'm not entirely sure.
When I looked at insurance, I first narrowed it down to what the clinic I go to for hormones accepts. Then I did some math to see how much I'd spend out of pocket annually without insurance. That helped me figure out what kind of coverage I wanted to pay for. My insurance is through DC, where trans-related coverage is required. I have not needed to use it for any procedures yet, so I can't tell you what that process looks like.
Based on my research Cigna cover trans related things no matter the location. I live in Texas and I have the plan through my job. However I called Cigna directly and confirmed that its covered even if its purchased directly though them.
1. Usually hormones and doctor visits. Maybe GRS. Rarely FFS, VFS or anything else. Rarely hair removal and cosmetic treatments.
2. I will Leave that for others to answer. I'm with emblem health (GHI) in an employer sponsored plan.
3. It's always good to have insurance. In fact it's the law and you can be fined if you don't have it. That said the premiums can be almost nothing to very high. Employer sponsored plans typically have lower premium cost for you. Those on the private market cost more. Then there are deductibles, limits, exclusions, co-pays and such.
I have Cigna through my employer (I have the more expensive plan that is supposed to pay 100% of any of my surgerys). I just had my top surgery a couple of weeks ago and I had to pay out of pocket because the surgeon did not take my insurance. I am still waiting on getting my $8450.00 back from them. I called Cigna prior to my surgery and asked what steps I needed to take to get covered. The girl wasn't very helpful and said "Oh uh, you just fill out a claim form". I filled out a claim form then they sent me a list of everything my doctor needed to send them. I gave that stuff to my doctor and they said that they would fill it out and send it in for me.
I did not go through Cigna to find a surgeron because I didn't see anyone reputable in my area to do my surgery. I wanted to go to someone who was well known and gave great results. Yes it was definitely worth the money and I am very happy with my results so far. I'm still waiting on my money though :P