Ladies,

This comes directly from a Customer Care Manager from Cigna that reviews and pushes transgender surgery claims to the proper departments for approval.

She is working with me on my case and I asked if I could share her info with the community and she said yes.

If you have Cigna Health Insurance AND your customer ID number begins with a "1" then this info is for you.  Your id number is on the front of your insurance card.


Jasmin L. Fort
Customer Service Supervisor-Escalated Call Team
CIGNA
13045 Tesson Ferry Road F2-33
St. Louis MO 63128
PH (570) 342-8443
FX (860) 735-7733
E-mail: jasmin.fort@CIGNA.com

New legislation has gone into effect on 01/01/2017 that removes most if not all of the loopholes that were allowing health insurers to continue denying our surgeries.






Cigna IS now approving gender reassignment surgeries and they have approved mine as well a week ago.

They are still denying breast implants as a cosmetic procedure.  However, I found a pdf and some language of their own to fight that. (I will attach the pdf in my next post.)


I have been on hormones for 4 1/2 years with no significant development. So by their own language it should be approved,  Currently it is in appeal review status.  Fingers crossed.

To my knowledge, FFS is NOT being covered at this time.


Now the bad news:

I have reached my max out of pocket already ($5550 deductible + 20% copay) of $6550.

Cigna is NOT reimbursing for any expenses that exceed your max out of pocket such as airfare, transportation, paying someone to go with you, their airfare, and over the counter medications, diapers, bed pads or feminine wipes. You are your own if you have to travel out of state because a provider isnt available to you locally.  It's complete garbage and it shows there is still much progress to be made.

They will reimburse for prescriptions as long you have exceeded the annual max out of pocket.

The good news is you can claim every expense on your taxes and you SHOULD exceed the standardized deduction I believe but not 100% as I am not a CPA.

If I can answer any questions let me know, otherwise contact Jasmin with questions how to get your claim started.  She is a wonderful and compassionate lady just from our cconversations on the phone regarding my case.  She has been very helpful, considerate and incredibly knowledgeable so be nice to her and be patient with her, she deals with a lot of people daily so she cant always get back to you right away but she will get to you.


Transmen: They are now approving bottom surgery (phalloplasty) but they sadly are not approving top surgeries (mastectomy) for transmen. It's sad, but progress has been made.


Final note:  ALL 2017 health insurance contracts are GUARANTEED through Dec 31, 2017.

After that all bets are off due to the new presidential administration.  We have absolutely NO idea whether this precedence will stand or not.

If you have Cigna, and the means available, I suggest you move things up to be done with by the end of the year.  The reason I suggest this is, there may not be another opportunity to do so for the next 4 years if transgender inclusive healthcare rights aren't preserved.  Borrow the money from family, get a loan, whatever you have to do!

Now we do have some things working for us.

1.) Trump allowed a transwoman (Jenna Talackova) to compete in his Miss Universe Beauty Pageant in 2012 after she appealed.

2.) He was on 60 minutes saying he wouldnt try to have Gay Marriage revoked.

3.) It is not the policy of the SCOTUS to take a case they have already ruled upon and reconsider it.  Not how they work.

4.) Trump knows the LGBT community is good for the economy. We spend money and lots of it. He knows this. He is a businessman.

These are NOT guarantees, but they are my observations and I am hopeful and optimistic.

Finally, Republicans do NOT hold 60 seats in the Senate, therefore they do NOT hold the Supermajority in the Senate.  If they want something they have to negotiate with the Dems and give concessions in order to get what they want.

I URGE you all to write your Democratic Senate reps and DEMAND they preserve our transgender inclusive healthcare rights in the new health care platform being proposed by the Republicans.

Audrey,  this is great info,  I've been pushing my employer to talk with Cigna about their coverage,  I shall renew my efforts! Let us know how your efforts on BA go.  X

Sent from my MI 5s using Tapatalk

Quote from: meganjames2 on January 31, 2017, 01:31:44 AM
Audrey,  this is great info,  I've been pushing my employer to talk with Cigna about their coverage,  I shall renew my efforts! Let us know how your efforts on BA go.  X

Sent from my MI 5s using Tapatalk

im just glad I can share and help others.

Stand alone plans are easier to get it approved and get your surgery done.

Company provided policies through Cigna are still allowed to deny.  Its really crappy how it all works.

Quote from: Cannabliss on January 31, 2017, 01:35:28 AM
​I have been having problems with my health insurance. Before I was insured through my Dad and his job but he lost his job and I lost my insurance as a result. So I switched to Medi-Cal, a government paid insurance in California. I just got my Medi-cal recently and refilled my Spironolactone (Testosterone blockers) without a problem and it was free compared to the 5$ I paid for my old insurance. However, when it came time to refill my Estrogen Patches I was informed that I was denied coverage because of my gender. It's been a stressful day on the phone with my DR. and Pharmacy all day trying to find a temporary work around. Which I was able to get a generic brand which is cheaper but my insurance still denied to cover that. With the app GoodRX I was able to find a coupon for 40$ a week (when you pay out of pocket). As opposed to 100-300$ a week for the Minivelle patches (out of pocket). I was wondering what insurance covers the implants, lasers. etc. ? I am starting the process to officially have my gender changed legally so that they can no long deny me for my "gender". What concerns me is when I do that, will I then be denied coverage for the testosterone blockers? Ugh. SO stressed over all of this. I've been on HRT for 1 Year and 5 Months. Not having access to my patches has been driving me nuts. The generic brand (Estradiol) is a HUGE patch compared to the one I was taking for so long and may even fall off when it gets wet. I would really appreciate any advice! xo

no idea what this has to do with my post. sounds like a lot of off topic rambling

Quote from: audreytn on January 31, 2017, 01:41:25 AM
im just glad I can share and help others.

Stand alone plans are easier to get it approved and get your surgery done.

Company provided policies through Cigna are still allowed to deny.  Its really crappy how it all works.



no idea what this has to do with my post. sounds like a lot of off topic rambling

I'm sorry. I'm new here and just desperate for some kinda guidance and I saw that it was related to health insurance. I thought this was a friendly place...

well this is a friendly place, but this thread wasnt the place for that. 

have you tried to start a thread pertaining to your issue?

not trying to be mean

 

Leave moderating to Mods please.

Cindy.

Quote from: audreytn on January 31, 2017, 02:00:27 AM
well this is a friendly place, but this thread wasnt the place for that. 

have you tried to start a thread pertaining to your issue?

not trying to be mean

You did come across a bit mean. I am new here and am not familiar with all the rules yet. I'll figure it out. Thanks for the help. Again, sorry for posting here.

Quote

Company provided policies through Cigna are still allowed to deny.  Its really crappy how it all works.

Look for the language in the plan terms that says "except where required by law" then check your state for insurance antidescrimination laws. Illinois has outlawed most of the exclusions insurance companies use. My employer policy is from Miss probably the most discriminatory state possible. My policy has the except where required wording in it. I expect to test this soon 

Quote from: josie76 on January 31, 2017, 05:34:59 AM
Look for the language in the plan terms that says "except where required by law" then check your state for insurance antidescrimination laws. Illinois has outlawed most of the exclusions insurance companies use. My employer policy is from Miss probably the most discriminatory state possible. My policy has the except where required wording in it. I expect to test this soon 

Colorado is the same way, but up until this yesr when the Federal Mandate came down, they all could still deny.

And as I understand it, under company provided policies, they can still deny because the plans arent offered through the Connect for Colorado Market Exchange and therfore arent subjected to the same provisions as a single payer policy on the exchange.

Single payer policies like the one I bought on the exchange are supposed to be protected but until this year, companies denied because they exploited loopholes, one of which was well our headquarters isnt located in your state, so we arent subject to your policies.  Then it would get tied up in court for months and years. 

But good luck, keep us posted here and let us know how it goes for you.

I am under an employer provided self-funded plan.  Great news for others, and I am truly happy for you, but my coverage still denies it.  Not all loopholes were closed.  I am thinking of pushing it through my local association (read as union) to see if we can change it...but I am not hopeful even in the progressive state I live in.

Quote from: NikkiB51 on January 31, 2017, 03:52:40 PM
I am under an employer provided self-funded plan.  Great news for others, and I am truly happy for you, but my coverage still denies it.  Not all loopholes were closed.  I am thinking of pushing it through my local association (read as union) to see if we can change it...but I am not hopeful even in the progressive state I live in.

That's the point I was just making in my last post.  It sucks for you guys, and its why I rejected my companies insurance.

The good news is with the federal mandate, you might able to buy a single payer plan and cancel yours with your work.  But check first before you cancel anything.

Quote from: audreytn on February 01, 2017, 12:09:22 PM

That's the point I was just making in my last post.  It sucks for you guys, and its why I rejected my companies insurance.

The good news is with the federal mandate, you might able to buy a single payer plan and cancel yours with your work.  But check first before you cancel anything.

Not possible with a family.

ooooh that sucks. [emoji20]

Quote from: audreytn on February 01, 2017, 12:09:22 PM

That's the point I was just making in my last post.  It sucks for you guys, and its why I rejected my companies insurance.

The good news is with the federal mandate, you might able to buy a single payer plan and cancel yours with your work.  But check first before you cancel anything.

I've been looking into that possibility as well. It appears like with BCBS IL we can get better overall coverage except for the out of pocket amount for the family with the federal discounts for a bit less than $200 a month more than what we pay now for BCBS MS. However if we don't qualify for those discounts it would be over $800 a month more. And that is the cheapest plan BCBS offers.

Hi Audrey,

You mentioned they are covering phalloplasty for transmen. Are they also covering metoidioplasty? It's a less invasive alternative to phalloplasty (and also much, much less expensive). I'm an admin for several bottom surgery groups off site and would love to be able to share this with members there. Thanks for your efforts with this!

Quote from: audreytn on February 01, 2017, 03:10:31 PM
ooooh that sucks. [emoji20]

Yes, it does, but I can do hrt with target or walmart generic plans for 4 dollars a month for e and another for Spiro.  Oral estradiol Valera tell, hopefully I can take it orally.  52 you before I can start...not sure if oral will be a good due to concerns with dvt.  Other surgeries I can pray will eventually be covered.  I do live in a progressive state....so there is hope.

Quote from: FTMax on February 01, 2017, 09:30:04 PM
Hi Audrey,

You mentioned they are covering phalloplasty for transmen. Are they also covering metoidioplasty? It's a less invasive alternative to phalloplasty (and also much, much less expensive). I'm an admin for several bottom surgery groups off site and would love to be able to share this with members there. Thanks for your efforts with this!

I have no clue to be honest.  feel free to use the contact info in the initial post and ask Jasmin.

Hi Everyone,

Thank you all for such good info in this thread.

I have a basic question: I'm covered under Cigna, and my plan states that they cover 80%.

I have my letters and have all the check-boxes covered.

I'm meeting with my Surgeon next week, with a surgery date in the next three months.

What do I do now with regard to Cigna? I called them and asked if they have a Trans-specific facilitator and got the " Duh ? " response after two separate calls...

I want to try to make sure I get this right on the first cut so as to go thru as friction free as possible...

Grateful for any guidance and deep respect for you gals....

Geeta