Not sure if this is the right place to post or if transexual talk would be better.

I just looked over my insurance benefits and found this under exclusions and limitations

transsexual surgery including medical or psychological
counseling and hormonal therapy in preparation for, or
subsequent to, any such surgery.

I live in a progressive state (Maryland) and work for the local government.  Not sure whether I can afford the expenses to pursue hrt without insurance benefits.  Do I have any options or alternatives?  What are the options for going through Planned Parenthood...if they even provide that service here? 

Completely deflated and not a happy camper right now.

Truly sad and i'm really sorry. Some states including Oregon my own, mandate coverage by law. Any flexibility to move some place else?

Absolutely none.  My employer does offer other plans, but this is the best of the bunch.  My wife would not consider going HMO because she loves the kid's doctors so much.

Edited to add the other plan Kaiser Permanente excludes it also.  I am on Cigna.

Just got off the phone with my insurance and they said since this is self-funded plan, they do not have to follow any state or federal mandates for coverage.  So basically, I am screwed and have to live with the increasingly more debilitating dysphoria. There is no way my wife would agree to out-of-pocket expenses for hrt.

Talk about your world crashing down upon your head.  My wife had just opened up about low-dose hrt and now I find out it isn't covered.

HRT costs are actually pretty low.

If I recall correctly, my spiro and E was about $24 a month when I was up to full power...

When I started I paid less than $10 a month at Walmart for intro dosages.

Hope this helps..

Missy

Yeah i'd definitely look into the total costs and shop around. I do not know for sure because i pay nothing at present for mine but it seems to me when i was buying them at full retail it was something like $125-$150 per month. That amount may be palatable or at least low enough that an additional part time job, or activities like selling stuff on eBay, could cover it.

Also check with your doctor, he or she may know of clinics or options like planned parenthood and others that offer HRT free, discounted or on a sliding scale.

Thanks, Missy.  How much was your doctor's visit for the script, if you don't mind me asking?

Quote from: RobynD on January 20, 2017, 03:37:51 PM
Yeah i'd definitely look into the total costs and shop around. I do not know for sure because i pay nothing at present for mine but it seems to me when i was buying them at full retail it was something like $125-$150 per month. That amount may be palatable or at least low enough that an additional part time job, or activities like selling stuff on eBay, could cover it.

Also check with your doctor, he or she may know of clinics or options like planned parenthood and others that offer HRT free, discounted or on a sliding scale.

Unfortunately, I already work a part-time job.  And my wife would not go for 125 -150 a month.  She is the family comptroller...

Quote from: dbramer on January 20, 2017, 03:38:30 PM
Thanks, Missy.  How much was your doctor's visit for the script, if you don't mind me asking?

The endo I saw used a sliding scale, and it included a full body exam, and was still only $80, if I remember correctly. I am intersex and a DES daughter, so he wanted to 'have a look', lol. Later check-ups, every three months or so were $26. By year two I only saw him every 6 months...

Missy

Ugh, is your company based in Maryland?  If so that's kind of shocking.  I work for a company that is based in Maryland.  Luckily we're too small to be self-funded for insurance so we have a Maryland based insurance plan that has all the coverages. 

What about an FSA/HSA to help reduce the costs.  They may not be covered by insurance but I'm pretty sure HRT is still considered an eligible expense for spending accounts.  I know, not ideal, but might help deflect some of the financial pain.

Walmart includes Estrogen and Spironolactone in their $4 a month/no insurance program.

Call the local Wally World to be sure.

Missy

Quote from: MissGendered on January 20, 2017, 03:45:08 PM
Walmart includes Estrogen and Medroxyprogesterone in their $4 a month/no insurance program.

Call the local Wally World to be sure.

Women's Health
$4, 30-day Supply $10, 90-day SupplyOther
Estradiol 0.5mg30 tablets90 tablets–
Estradiol 1mg30 tablets90 tablets–
Estradiol 2mg30 tablets90 tablets–
Medroxyprogesterone Acetate 2.5mg30 tablets90 tablets–
Medroxyprogesterone Acetate 5mg30 tablets90 tablets–
Medroxyprogesterone Acetate 10mg10 tablets30 tablets–

* Prices may be higher in CA, HI, MN, MT, PA, TN and WI.
** Home Delivery Service is not available through SamsClub.com.
† Prepackaged drugs are covered only in unit sizes specified on Drug List. See Program Details or your Walmart Pharmacist for details

Missy

Quote from: lisawb on January 20, 2017, 03:44:23 PM
Ugh, is your company based in Maryland?  If so that's kind of shocking.  I work for a company that is based in Maryland.  Luckily we're too small to be self-funded for insurance so we have a Maryland based insurance plan that has all the coverages. 

What about an FSA/HSA to help reduce the costs.  They may not be covered by insurance but I'm pretty sure HRT is still considered an eligible expense for spending accounts.  I know, not ideal, but might help deflect some of the financial pain.

Yes' I work for a local government agency.  I could look into a FSA...

So is Spironolactone..

Heart Health & Blood Pressure
$4, 30-day Supply $10, 90-day SupplyOther
Atenolol 25mg30 tablets90 tablets–
Atenolol 50mg30 tablets90 tablets–
Atenolol 100mg30 tablets90 tablets–
Benazepril 5mg30 tablets90 tablets–
Benazepril 10mg30 tablets90 tablets–
Benazepril 20mg30 tablets90 tablets–
Benazepril 40mg30 tablets90 tablets–
Bisoprolol-HCTZ 2.5mg-6.25mg30 tablets90 tablets–
Bisoprolol-HCTZ 5mg-6.25mg30 tablets90 tablets–
Bisoprolol-HCTZ 10mg-6.25mg30 tablets90 tablets–
Carvedilol 3.125mg60 tablets180 tablets–
Carvedilol 6.25mg60 tablets180 tablets–
Carvedilol 12.5mg60 tablets180 tablets–
Carvedilol 25mg60 tablets180 tablets–
Clonidine 0.1mg30 tablets90 tablets–
Clonidine 0.2mg30 tablets90 tablets–
Enalapril-HCTZ 5mg-12.5mg30 tablets90 tablets–
Furosemide 20mg30 tablets90 tablets–
Furosemide 40mg30 tablets90 tablets–
Furosemide 80mg30 tablets90 tablets–
Guanfacine 1mg30 tablets90 tablets–
Hydralazine 10mg30 tablets90 tablets–
Hydralazine 25mg30 tablets90 tablets–
Hydrochlorothiazide(HCTZ)12.5mg30 capsules90 capsules–
Hydrochlorothiazide (HCTZ) 25mg30 tablets90 tablets–
Hydrochlorothiazide (HCTZ) 50mg30 tablets90 tablets–
Indapamide 1.25mg30 tablets90 tablets–
Indapamide 2.5mg30 tablets90 tablets–
Isosorbide Mononitrate 30mg ER*30 tablets90 tablets–
Isosorbide Mononitrate 60mg ER*30 tablets90 tablets–
Lisinopril-HCTZ 10mg-12.5mg30 tablets90 tablets–
Lisinopril-HCTZ 20mg-12.5mg*30 tablets90 tablets–
Lisinopril-HCTZ 20mg-25mg*30 tablets90 tablets–
Lisinopril 2.5mg30 tablets90 tablets–
Lisinopril 5mg30 tablets90 tablets–
Lisinopril 10mg30 tablets90 tablets–
Lisinopril 20mg30 tablets90 tablets–
Methyldopa 250mg*60 tablets180 tablets–
Metoprolol Tartrate 25mg60 tablets180 tablets–
Metoprolol Tartrate 50mg60 tablets180 tablets–
Metoprolol Tartrate 100mg*60 tablets180 tablets–
Sotalol HCL 80mg*30 tablets90 tablets–
Spironolactone 25mg*30 tablets90 tablets–

Thanks again, Missy.  I will look into it.  I was hoping to see Dr. Westrick (sp?) here in Maryland.  He is an informed consent doctor.  Maybe he is not too expensive.

The Walmart no insurance plan sounds like an awesome option.

Quote from: dbramer on January 20, 2017, 03:52:22 PM

Thanks again, Missy.  I will look into it.  I was hoping to see Dr. Westrick (sp?) here in Maryland.  He is an informed consent doctor.  Maybe he is not too expensive.

Good luck, hun!

I can say from my own experience that I was afraid of a LOT of things before starting, but my fear about HRT costs were unfounded. The peace gained was immeasurable, and for the less than I was paying for soda pop each month, lol..

The meds are relatively cheap, as everyone pointed out, but an uninsured visit to a GP could run about $250, and the labs around $300.

Since you live in Maryland, you might consider going to Whitman-Walker in DC.  They operate under informed consent. See: https://www.whitman-walker.org/service/medical/transgender-care/.

With kindness,

Terri

Quote from: Maybebaby56 on January 20, 2017, 04:06:12 PM
The meds are relatively cheap, as everyone pointed out, but an uninsured visit to a GP could run about $250, and the labs around $300.

Since you live in Maryland, you might consider going to Whitman-Walker in DC.  They operate under informed consent. See: https://www.whitman-walker.org/service/medical/transgender-care/.

With kindness,

Terri

I wonder if the doctors visit and blood work would be covered...hmmm...it is just an office appointment and labs are covered 100 percent without co-pay under my plan.  Does a doctor need to say what the labs are for?

It looks like Target has the same plan and they cover finasteride also.

You all know how to lift a girl's spirits