Hello all,

I was wondering if anyone had successfully challenged a denied claim in the US based on the Affordable Care Act. Meaning, has anyone had a procedure or hormones paid for by their insurance after the company originally said they wouldn't cover transition expenses?

I ask because a local trans support group has a flier that says companies cannot, by law, refuse to cover procedures deemed medically necessary; a doctor's diagnosis of GD is sufficient (claim) to receive paid-for treatments.

I ask because I am seeing my Endo in a few weeks to get on hormones and have been told that my insurance won't cover it.

Thanks

Unless you are in a city or state which requires insurance companies to cover SRS, they don't have to. ACA says they can't not treat you if they would treat others the same. This means, basically, that if you broke your arm, they have to set it just as they would if you were not trans. It does not mean trans treatment is covered. The hormones are often covered because cispeople also receive hormone treatments and therefore they have to cover them for you, or face lawsuits.

Ok. Regarding hormones, can anyone speak to their experiences since this law took effect?

Even before the law, it could often be covered depending on your endos coding of the reason for the script/appointments. My insurance did not cover trans anything but it covered my T after a bit.

What state are you in?  It makes a big difference.

Also, have you looked into the specifics of your insurance policy.  Some employers pay extra to cover trans-related care.