Hey all! It's me, ol Flighty here back to help a friend in need!

He wants to go through his insurance to get his top surgery. Does anyone know the process that can help us figure out how to navigate it? He is making his own account right now but wasn't exactly sure what to ask, so I figured it would be okay if I stepped in for him. I'll have him post in this thread when he makes his account.

Anyways, he has Anthem Blue Cross HMO. The requirements of getting top surgery covered are pretty easy, be on T for a year and not have any mental conditions that prevent him from making his own decisions. What I dont understand is two things:

"The transsexual identity has been present persistently for at least two years;"
He's got this one covered, but will he need to prove that? How do they know if it's been there for two years? Or is it just based on honor system?

and

"Two referrals from qualified mental health professionals who have independently assessed the individual. If the first referral is from the individual's psychotherapist, the second referral should be from a person who has only had an evaluative role with the individual. Two separate letters, or one letter signed by both (for example, if practicing within the same clinic) are required."
Would this be two different therapists? In California, you don't need a therapists letter to start T or be seeing a therapist regularly. Would he need to go to two therapists for an evaluation, or could one come from say a therapist and the other the doctor that prescribed his hormones?

Thanks so much for helping out, anything i learn here will go towards me helping out trans people in the future! I'd like to be the go to guy in my area for helping trans people out, but i have no idea how to go about doing that since my local LGBT Center has some SERIOUS transphobic issues i will not even get into!

I've got a Blue Cross plan, myself. Innit fun.

The easiest way to demonstrate "transsexual identity" is probably to have a doctor's note saying when he started T (if that's been 2yrs by the time he gets done with gender-psych people). If there was some extensive time between first talking with his doc about it and beginning hormone replacement, that should be in his chart and could be documented instead. Failing that, you might see if the psych is willing to accept old photographs of him presenting as male (if he's been doing so for 2yrs) as evidence and document that.

Also, yes, they're likely to insist on assessments by two different licensed psychologists. You should be able to find a listing of trans-friendly ones online. (Transition-related surgeries are expensive; this hurdle exists to give the insurer a reason not to pay.)

Good luck to him!

Hi there flighty I am on the same insurance, I had a bit of a struggle at first getting coverage for anything related to transitioning, including my therapy to start with, I did need medical validation along with therapist to get them to assign a case manager for managing my claims, the biggest issue is that they do not have codes for most of our needs that define coverage.
as far as full time proof, change of gender on ID, employer validation, or have it defined in the therapist and psychologist letters perhaps may be enough.
I am working my pre-approval for GRS, with the coverage I find it very hard to find a facility withing any reasonable range from my home and that pushes the doctors to out of network, they do have provisions to allow for in network billing if that service is not provided by a local facility, bottom line is be ready to have to explain most of the process and teach the insurance provider how to process claims and approvals. It can be done and the same as the rest of our processes it just takes time

If he's been on T for a year I don't see a reason why a therapist would not write a letter for the boobs to come off.

I had excellus blue cross. All I had to submit was a letter from my T Dr, saying that I had been on T since whenever and stating that I had been living as male since I was whatever age. The other letter was from my old therapist who stated that I don't have any mental disorder that would cause me to not be sure about transitioning (not sure how to phrase that) and she also stated how long I had been living as male, and she put that she thought surgery would be an excellent next step for me. Then I also sent the insurance company a copy of my name change papers to prove that I had been living as male for at least that long.

I don't remember what their minimum requirements were though. I think at least a year on T and 2 years living in the male role? The insurance company could tell you exactly

We're not allowed to post outside links are we? I have a link to all of the specifications about blue cross coverage for trans stuff

Quote from: jumpthenexttrain on June 27, 2015, 01:27:40 AM
We're not allowed to post outside links are we? I have a link to all of the specifications about blue cross coverage for trans stuff

You can PM me if you can do it that way. That would be Hella helpful! It'll be a journey for me to help him out but I'll hopefully be able to help others from it.

Sent from my HTC0P4E1 using Tapatalk

Thanks!!! I appreciate your responses, I plan on going through my insurance for my surgery and I was a bit confused, but it makes much more sense now!

Quote from: FlightyBrood on June 27, 2015, 01:04:25 PM
You can PM me if you can do it that way. That would be Hella helpful! It'll be a journey for me to help him out but I'll hopefully be able to help others from it.

Sent from my HTC0P4E1 using Tapatalk

The man of the hour everyone! Lol

Forward this to him: These letters are the key factor. Your identity being present for two years has to come through the letters. Whoever writes your letter should incorporate and address every bullet point of your insurance policy clauses. So the psychotherapist should explicitly state this point, and make sure it's clear if they reword things. Secondly, yes that does mean having two letters each from a different person, it could be two therapists if your policy doesn't go into further detail. There are experienced therapists out there who will see you once or twice and then write you a letter, there are even some who do long-distance Skype sessions, if you find it difficult to find providers in your area. Some policies are more detailed, for example, requiring 18 months of therapy for the primary letter and that the secondary letter must come from someone with a Phd, in my case. Make sure you get to read these letters before they get sent off, and ask for a revision if it seems necessary!