ok, earlier this month, i went to see the ob-gyn to start my hrt. i have the ohio medical and i read on another site to have them code it as hormonal imbalance. i've received no phone call, bill from the doc, or denial letter from the medical card. usually, if they are not going to cover it, they tell you right away. so we're assuming for the time being that they paid for it.
we went to the pharmacy to get my meds filled, and i was hoping a certain girl was there to help me out. cuz i was going to fill it, but she knew if my insurance wasn't going to cover it, she would have called me back in automotive to tell me that it wouldn't be covered and i would have waited till i had the money to buy it. which my guess would have only been about another week.
Brittiney paid for it, violently pissed about it, not even bothering to use my discount to save like $7, even tho she had no problem remembering to use it for her boyfriends meds. grr!!!
what i don't understand is why they would pay for the damned doctors visit but not pay for the medicine for the treatment, other than this special pharmacy coding, that she told me about today. can anyone explain?
I don't remember all of your details:
have you done name and gender marker changes yet on DL, SS, etc?
My guess: they've got something somewhere that shows you were a male, and that your HRT (which presumably includes estrogen) is disallowed.
I believe my own insurance does something similar (I'm back on Pacificare after we lost our coverage with Aetna).
A doctor's appointment being covered is much different than a medication. especially if you're male on your health ins, you may not be automatically covered for estrogen. you may need your doctor to write a letter of necessity and petition to have estrogen covered.
Some meds are flagged for a specific gender and will automatically kick out if the flags do not match. You can sometimes get around it, depending on the coding the doctor's office uses.
Good luck! :)