I am currently waiting for a response from my doctor's scheduler. I have been denied coverage for my Orchiectomy that is scheduled for 5/15. The doctor that is working on the insurance companies behalf of the approval process is willing to do a Peer to Peer review of the case and possibly overturn his decision. I have not heard from the scheduler since this morning after she called me to inform me that the procedure is not being covered. I have attempted to call the doctor myself as suggested by the scheduler, but it took me to a voicemail system that the individual may never get. What else can I do in order to overturn this decision?
The decision was made due to a lack of evidence since I've only had a week to attempt to find another psychologist for the second letter of recommendation.
Is there anyone in Lake County, Illinois that knows someone that would be able to see me within the next 2 days in order to obtain said letter?
Maybe find a provider who does Skype sessions? Try here: https://www.susans.org/links/Healthcare//Therapists_&_Counselors//USA//Illinois//
and here: https://www.susans.org/wiki/List_of_healthcare_providers
Good luck and keep us posted. :)
Hugs, Devlyn
The ACA requires coverage for transgender care including gender confirming surgery.
Now for the problematic part, the current administration removed transgender individuals from a protected class with the dept of health, so what this means for us is while there is a requirement to cover it we have no recourse outside of a private law suit to enforce coverage with health insurance.
Here is a link on an article covering the subject, best of luck.
https://intomore.com/impact/Despite-Looming-Threats-Insurers-Are-Still-Required-to-Cover-Trans-Healthcare/590af729e39b41dd
Thank you guys for the advice. Unfortunately the insurance company I have does not allow for video conferencing with a psychologist for the second letter of recommendation; I asked. The final shot that we have due to the timetable is a peer to peer review of the case with my surgeon and the insurance companies deciding physician.
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