Glad to be of assistance. I get perscriptions for different things at different places. When I started on patches (which I've since replaced), the place that I had got a perscription already had me on file. I was plesantly surprised when they didn't question anything at all, including insurance. It's a big discount too.

Thank you again everyone. Are you getting tired of me saying that? 

But seriously, when I first posted my question, I was quite anxious and worried about what I had to do next. Now, after ALL your advice and stories, I'm feeling pretty good about what I now know and what to watch out for and how to proceed.

I meet with my therapist tomorrow and we'll talk about all this. BTW - I plan on going in a skirt. First time out and about in anything but girl jeans and girl top. It's a two hour drive, so I'm mostly worried about a "COPS"  scenario where I run a red light or stop sign and I panic. They chase me at high speeds for 50 miles and then tackle me in the snow because I haven't learned how to run in heels and a skirt yet.   

Debbie

Posted on: February 18, 2008, 10:51:56 AM

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Update!!!!!!!!!!!!

I picked up my first months supply of HRT from the Pharmacist this morning. Insurance did not question it, the Pharmacist did not question it, the clerk said nothing more than "Have a wonderful day".  I am!!!!

I am also starting to sign my notes as Dee. When I change my name it will be Dee Ellen but my friends will call me Dee,

Hugs to all my friends,

Dee

It is not just the Insurance Company that is manipulating the system. In my state known for big payouts to individuals because of uneducated juries that side with a common people,  one of the famous tobacco case lawyer's Scruggs, Trent Lott's brother in-law has pleaded guilty to bribing a judge in a large suit against a large insurance company.

Quote from: lisagurl on April 29, 2008, 02:26:49 PM
It is not just the Insurance Company that is manipulating the system. In my state known for big payouts to individuals because of uneducated juries that side with a common people,  one of the famous tobacco case lawyer's Scruggs, Trent Lott's brother in-law has pleaded guilty to bribing a judge in a large suit against a large insurance company.

No ->-bleeped-<-?  Have you ever read The Runaway Jury by John Grisholm?  Life really does imitate art!

Posted on: 29 April 2008, 19:03:44

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Quote from: Sarah Louise on February 07, 2008, 04:41:53 PM
Usually your insurance provider will give you a book that shows what is covered and what is not.

I have BlueCross through my wife's work and it "specifically excludes" anything to do with TS.

Sometimes your doctor can send it in as hormonal problems and not explain too much.


Sarah L.

That's because of your wife's employer, not Blue Cross.  BC is a provider option in my benefit plan and they cover TS surgical procedure, including SRS, up to $75,000.  My employer pays for it.

QuoteThat's because of your wife's employer, not Blue Cross.  BC is a provider option in my benefit plan and they cover TS surgical procedure, including SRS, up to $75,000.  My employer pays for it.

That is helpful information Claire. I have had contact with our GLBT folk in our national office and they were confident that the HRT would be covered and that they would investigate if SRS would also be covered. My denomination is fairly progressive so I will try to be optimistic about crossing that bridge (if I ever get to that point).

Dee

Quote from: debbiej on April 29, 2008, 09:48:54 PM

QuoteThat's because of your wife's employer, not Blue Cross.  BC is a provider option in my benefit plan and they cover TS surgical procedure, including SRS, up to $75,000.  My employer pays for it.

That is helpful information Claire. I have had contact with our GLBT folk in our national office and they were confident that the HRT would be covered and that they would investigate if SRS would also be covered. My denomination is fairly progressive so I will try to be optimistic about crossing that bridge (if I ever get to that point).

Dee

Most insurance cos. don't require a diagnosis to cover a drug that's in the formulary.  Spironolactone and generic estradiols are Tier 1 drugs in most formularies.  They may be relativly expensive for you and I to buy out of pocket but the insurance companies only pay a few dollars for them.  My experience is they don't get fussy until you get into expensive drugs (Tier 3) or off-label uses.  Never accept a denial of coverage.  Always contest it.  I've alway managed to get what I need covered if I perceviered.   

Quote from: Claire de Lune on April 29, 2008, 09:09:38 PM
That's because of your wife's employer, not Blue Cross.  BC is a provider option in my benefit plan and they cover TS surgical procedure, including SRS, up to $75,000.  My employer pays for it.

And that is not true for every BC/BS. It must be true in California because that's a state mandate there, but not in NJ or PA or TN of IA or ND and most other states.

Nichole

In some cases BC/BS is only employed as the administrator. In my case my company is self insured and makes the rules. BC/BS processes the claims.

You may want to read your specific policy to see if there are restrictions on "sex change" treatments or surgery. Please proceed with caution. The insurance company may see a red flag with, let's say, estrogen, and refuse to pay for the office treatment as well as the meds. I'm not saying that there will be a problem, I have no idea, but a diagnosis from the doctor that refers to sex change treatment is not the same as a diagnosis code of HRT. Men CAN, of course, have a hormonal imbalance.

Spiro is routinely prescribed for high blood pressure, I don't know if estrogens are prescribed for men. At the dosages that we use estrogens, probably not. Personally, I pay for my estrogen out of pocket. There is no need to put that information in the hands of my insurance company.

Quote from: Nichole on April 30, 2008, 12:32:53 PM

Quote from: Claire de Lune on April 29, 2008, 09:09:38 PM
That's because of your wife's employer, not Blue Cross.  BC is a provider option in my benefit plan and they cover TS surgical procedure, including SRS, up to $75,000. My employer pays for it.

And that is not true for every BC/BS. It must be true in California because that's a state mandate there, but not in NJ or PA or TN of IA or ND and most other states.

Nichole

I didn't make myself clear.  Sorry.  BC is the carrier that provides the coverage that my employer purchases from them.  My employer pays additional premium to provide coverage for transgender surgeries.  The point I was making in my OP was that it is not BC that doesn't cover TG services but the employer that declines to provide it.

Yeah, I thought (in fact I know because I work on the health care section of my union contract) that BC is sort of a cafeteria deal.  You get what you pay for.  If your coverage wants to pay for SRS, its covered, if not, then no.