I've been in talks with my hmo and my medicaid in my state and they gave me some solid advice. My hmo people had no clue what to do or say when I was calling them,so I went directly to the state and asked them. I was really upfront about what I wanted from them, and the woman I was put in contact with gave me hope. Getting hysto isn't out of the question because I haven't got my gender marker changed just yet and even if I do I just have my doctor talk to my insurance about it. She even hinted that they might help cover top surgery costs because I get a lot of back pain no matter what I do. My T will be covered once my gender marker is changed, but even if it wasn't changed they just would have my doctor explain about how it's medically necessary.

She hooked me up with my hmo people and they gave me a case manager for the future so I won't have to search in the dark anymore for answers. I'm so relieved about it and I still need to talk to my primary doctor about getting prior authorization for him through my hmo but I'm so much less confused.

I was really afraid that I wouldn't be covered and would have to go to Planned Parenthood. The ones in my area always do tests that I don't authorize and tried to bully me into taking HBC after I told them why I wouldn't consider it for any reason and was seeking to get on T.

If you don't mind me asking, which state are you in?
I only know of 5 states that have passed rulings for medicaid to cover trans related healthcare costs but as far as I know any other state run medicaid won't. If though it's possible to give a little push though and possibly request a case manager, I might just attempt this instead of giving up so easily lol. I really don't want to wait till I have cysts or worse in my downstairs plumbing just to get a hysto and I'd be elated if top surgery was actually covered.

Quote from: Hex on June 13, 2014, 08:12:10 PM
If you don't mind me asking, which state are you in?
I only know of 5 states that have passed rulings for medicaid to cover trans related healthcare costs but as far as I know any other state run medicaid won't. If though it's possible to give a little push though and possibly request a case manager, I might just attempt this instead of giving up so easily lol. I really don't want to wait till I have cysts or worse in my downstairs plumbing just to get a hysto and I'd be elated if top surgery was actually covered.

For my own safety I don't say publicly what state I'm in and try to keep the private details very vague, but I can give you a pm if you'd like to let you know how my medicaid worked with me on it so you can try it too. In my case my family has some wonky history with the plumbing downstairs and here they are being super vague about 'medically necessary' so that might be to my advantage. Not even the medicaid people are solid about what they will and won't cover upfront because of the wording lol. Like upfront they say 'no trans surgeries' but they know people medically need certain things.

I go to a LGBT clinic where all the doctors are super on top of their trans issues so my gyno's office is simply amazing about not asking those pesky 'are you sure' questions. My doc was asking me my first visit who I was going to for bottom when he saw my charts. They have informed consent for hystos in our medicare so I'm trying to hurry up and push it through before I chicken out. Got my appointment in two weeks to ask.

I'm praying for a miracle for medicaid to at least think about paying partially.

Ah it's no problem! I just had a ultrasound to try and spot anything down there that might slide me by in order to get medicaid to pay for the hysto. It came back perfectly normal though (both good and bad feelings on that lol) When I tried getting T covered all they would ever tell me was the coding had to be correct in order for the system to cover it but wouldn't tell me what coding and my dr had no clue. On a bright note my dr is willing to work around things as long as we both know which direction to go though. I'll have to poke around and call my insurance again and see where I can get with them.

I wish you luck! And thanks for the help!

Quote from: Hex on June 13, 2014, 08:37:02 PM
Ah it's no problem! I just had a ultrasound to try and spot anything down there that might slide me by in order to get medicaid to pay for the hysto. It came back perfectly normal though (both good and bad feelings on that lol) When I tried getting T covered all they would ever tell me was the coding had to be correct in order for the system to cover it but wouldn't tell me what coding and my dr had no clue. On a bright note my dr is willing to work around things as long as we both know which direction to go though. I'll have to poke around and call my insurance again and see where I can get with them.

I wish you luck! And thanks for the help!

Oh I know the coding they use for T if you aren't listed as male-it's for gender therapy. Medicaid will refuse on that front. If you are getting your marker changed-that will push it along faster because they won't process cross sex hormones in most cases. It sucks that they won't tell you that though-I found out by hounding my hmo first and seeing what it the code was billed as when I had an order for T in their pharmacy. 

Thank you, wish you all the best in the future.

Quote from: campenella on June 13, 2014, 08:41:35 PM
Oh I know the coding they use for T if you aren't listed as male-it's for gender therapy. Medicaid will refuse on that front. If you are getting your marker changed-that will push it along faster because they won't process cross sex hormones in most cases. It sucks that they won't tell you that though-I found out by hounding my hmo first and seeing what it the code was billed as when I had an order for T in their pharmacy. 

Thank you, wish you all the best in the future.

There are multiple possible codings for T being prescribed for female bodied people. That is just one of them. Mine was different so it got covered. If it had been for gender, it would be denied.

Quote from: LordKAT on June 13, 2014, 09:06:46 PM

There are multiple possible codings for T being prescribed for female bodied people. That is just one of them. Mine was different so it got covered. If it had been for gender, it would be denied.

This is true, I hadn't thought of that. Mine was under something else when I was on a different program. I was still denied because the way the pharmacy was coding it vs what my doctor was prescribing it for.