Kaiser permanente will cover it where in California, but yes the bay area is the center of transgender health care for them, mostly because well, the bay area is kinda the center of the LGBT community in California. 

It is still Kaiser so, even though it's a different area, you should still have access to that area as long as you are in the area.

Quote from: TiffanyT on March 11, 2014, 02:22:30 AM
I'm sorry but I don't have any experience beyond the Bay Area. My therapist does do phone sessions though. Send me a pm if you'd like her info as she could be really helpful n getting you moved through their system. Especially if your endo is on board.

Thanks to info from Tiff, I was able to get some more detail from Kaiser.  First, the nurse I spoke with said she didn't know that Kaiser transgender coverage now applies to California Federal employees and she would like me to follow up with one of their insurance specialists to confirm.  I'll do that next week and post what I find out.

When I asked her about doctors, she told me they have several that are WPATH trained and trans friendly.  As part of the service, she would work with me to select the right doctor, once I am in the Kaiser plan.  One surprise, she told me Dr. Toby Meltzer is doing the transition surgeries for Kaiser.

The OPM should be reviewing the legality of denying transition coverage to Federal Employees this month (March 2014).  So hopefully All Federal employee health benefit plans will cover transition care in the next open enrollment.

Freya

Hi all,

Another Fed here. Thanks everyone for the updates. So far, I have had no questions about therapy from my healthcare provider and am charged regular copay. Will be discussing HRT in a couple weeks, but I am not too concerned with cost of meds because it is budgeted. What is concerning is the unknown costs for tests/labwork and whether it is covered. I wanted to hear from others on this. I am sure each provider has their own policies, so there probably is not one simple answer (that is until there is universal coverage).

Julia

Quote from: Stochastic on March 15, 2014, 07:11:54 AM
Hi all,

Another Fed here. Thanks everyone for the updates. So far, I have had no questions about therapy from my healthcare provider and am charged regular copay. Will be discussing HRT in a couple weeks, but I am not too concerned with cost of meds because it is budgeted. What is concerning is the unknown costs for tests/labwork and whether it is covered. I wanted to hear from others on this. I am sure each provider has their own policies, so there probably is not one simple answer (that is until there is universal coverage).

Julia

I got a referral to see an endo, when my T level tested as slightly low.  When I saw the endo, I told him I'd rather transistion, so he switched my water pill I was taking for another issue, to Spironolactone from Lasix.  Later he prescribed Estradiol, when I asked for it.  I have had an ongoing referral to the endo for about a year and a half and insurance has covered all costs except for the Estradiol. When I was prescribed the Estradiol, I just paid for it out of pocket to avoid raising any concerns with the insurance company.  It hasn't been very expensive, I think about $20 every 60 days.

My endo hasn't had my hormone levels tested since I started seeing him, but I do get blood work done about once every 3 months to make certain I am not getting sick in other ways.  I haven't had any issues so far.  My endo said the insurance company wasn't likely to be concerned about the lab work or Spiro, since they are used for other medical issues, and even felt I would probably get the Estradiol covered too, if I went that way.

I hope that helps some,
Freya

Quote from: Stochastic on March 15, 2014, 07:11:54 AM
Hi all,

Another Fed here. Thanks everyone for the updates. So far, I have had no questions about therapy from my healthcare provider and am charged regular copay. Will be discussing HRT in a couple weeks, but I am not too concerned with cost of meds because it is budgeted. What is concerning is the unknown costs for tests/labwork and whether it is covered. I wanted to hear from others on this. I am sure each provider has their own policies, so there probably is not one simple answer (that is until there is universal coverage).

Julia

Good point ^^^ I wonder what would be the extent of the coverage: SRS, breast implants, FFS, voice surgery, electrolysis, laser, ?

the devil is in the detail... but at the end of the day if all I get is my new purse, if I was a Fed... I will be totally delighted.. LOLO

Quote from: peky on March 15, 2014, 03:53:45 PM
Good point ^^^ I wonder what would be the extent of the coverage: SRS, breast implants, FFS, voice surgery, electrolysis, laser, ?

the devil is in the detail... but at the end of the day if all I get is my new purse, if I was a Fed... I will be totally delighted.. LOLO

From the Kaiser website:
"Kaiser Permanente members needing hormone consultations, gynecologic care, psychological services and surgical evaluations for transition and sexual reassignment surgeries."

From the Kaiser Plan:
"Not covered
• Services for the promotion, prevention, or other treatment of hair loss or hair growth
• Cosmetic services that are intended primarily to change or maintain your appearance, such as breast augmentation, reduction of Adam's apple or facial feminization surgery
• Transgender surgical services, other than genital surgery and mastectomy"

So it seems it covers the non-cosmetic costs.  I sure wish it covered electrolysis/laser.

Freya

For the hair loss aspect.  Most of the policies will cover the basic for Male pattern baldness.  Such as propecia and such.  The services they cover for the general male population.  Things like hair implants won't be covered.

Quote from: Freya on March 15, 2014, 04:10:12 PM
From the Kaiser website:
"Kaiser Permanente members needing hormone consultations, gynecologic care, psychological services and surgical evaluations for transition and sexual reassignment surgeries."

From the Kaiser Plan:
"Not covered
• Services for the promotion, prevention, or other treatment of hair loss or hair growth
• Cosmetic services that are intended primarily to change or maintain your appearance, such as breast augmentation, reduction of Adam's apple or facial feminization surgery
• Transgender surgical services, other than genital surgery and mastectomy"

So it seems it covers the non-cosmetic costs.  I sure wish it covered electrolysis/laser.

Freya

Awesome information! Thanks Freya!

I've posted a bunch of information in this thread about the FEHBP trans exclusion that will be of interest to trans Federal employees. Indeed, right now, only Kaiser in Northern California actually covers trans procedures, and they're a lone anomaly as OPM explicitly instructs all other insurers not to cover them. There's no sign yet as to whether this will change in 2015, but we can continue to work to get this changed.

Why they didn't remove the exclusion back in 2011, when they released that excellent guidance on trans employees, really boggles my mind; not only would it have been the right thing to do, they could've limited the inevitable right-wing tantrum over trans Feds to a single news cycle.

Quote from: บ้านสิริรอดชีวิต on March 31, 2014, 12:23:39 AM
I've posted a bunch of information in this thread about the FEHBP trans exclusion that will be of interest to trans Federal employees. Indeed, right now, only Kaiser in Northern California actually covers trans procedures, and they're a lone anomaly as OPM explicitly instructs all other insurers not to cover them. There's no sign yet as to whether this will change in 2015, but we can continue to work to get this changed.

Why they didn't remove the exclusion back in 2011, when they released that excellent guidance on trans employees, really boggles my mind; not only would it have been the right thing to do, they could've limited the inevitable right-wing tantrum over trans Feds to a single news cycle.

Thanks for the additional info!

Both High and Standard plans for NorCal and SoCal have the Exclusion removed, but nowhere else that I have seen by looking at some others.  The only reason I can think of that the exclusion was removed for Kaiser in CA, is that they may be following the 2014 DHMC ruling for all CA health plans because they are headquartered there.  But that's just conjecture.

Hopefully the OPM review that should have happened this month will go in our favor, but I haven't seen any news on this yet.

Freya

Hi again,

I wanted to get back to everyone about my recent Federal health care coverage experience. I have the basic option for Blue Cross/Blue Shield. When I went to my pharmacist to fill my first HRT prescription (Spiro and patches), I requested that I pay out of pocket because my insurance did not cover it. I came back later to pick up the meds. They had run the meds through my insurance, and I only had to pay the copay. This applied for both meds.

I later called BC/BS customer service to be honest in that I was improperly discounted for my meds. They could not be of assistance because they subcontract the pharmacy portion of their service. I was transferred to the phone line for the pharmacy subcontractor. While on the automated phone line, I was not given an option to talk to a customer service representative. Recently, my second round of meds were also discounted.

I do not feel as if I won the HRT lottery because I am sure there will be an audit. A bill for $1,000 will surely end up on my mailbox sometime by the end of the year. I do feel as if I made an honest effort to contact the program's customer service reps.

Quote from: Stochastic on April 25, 2014, 02:54:17 PM
I do not feel as if I won the HRT lottery because I am sure there will be an audit. A bill for $1,000 will surely end up on my mailbox sometime by the end of the year. I do feel as if I made an honest effort to contact the program's customer service reps.

I don't think you'll have any problems. I've belonged to two different FEHB plans now, and both fully covered my HRT as long as my doctor coded it properly. They're unlikely to challenge and audit you because OPM and its contracted carriers are seriously walking on eggshells and know that an audit would open themselves up to another EEO complaint.

In fact, when I was looking for a new plan last open season, I called CareFirst BC/BS and asked about HRT coverage, and they were very candid in admitting they will cover it as long as the doctor codes it as something like "endocrine disorder NOS" or "hypogonadism" instead of for transsexualism/GID/GD. And indeed, they have, with no co-pay.