So I contacted the two trans-friendly health clinics in my area (Chase-Brexton in Baltimore and Whitman-Walker in DC) looking to get a T prescription and neither take my insurance. Instead I set up an appointment with an ob/gyn who has supposedly prescribed T before and takes my insurance, but the receptionist said my insurance might not cover everything. Right after I made the appointment I felt okay about it, but now I don't know what to do. I really don't want to go to an ob/gyn sit in the waiting room, get misgendered etc. because I know it will make me feel like ->-bleeped-<- and want to have an anxiety attack. plus my insurance might not cover all of the costs so it could end up costing me a buttload of money anyway.

I'm thinking about making an appointment with Whitman-Walker and paying for most of it out of pocket. Whitman-Walker is specifically an lgbt clinic, so I'd feel safer going there. My therapist would also be more comfortable with me going there, and I have some savings so I won't be completely broke  if I do that, but I don't know if that's a stupid idea or not.

Has anyone else had to pay out of pocket to get bloodwork/labs done? Was it expensive? I just feel really frustrated and confused about what to do.

In my experience, out of pocket labs tend to be around 400 bucks....depends on what they're checking for though

My doctor asked for a ridiculous amount of bloodwork. I'm still waiting to see how much insurance covers, but without it they'd cost close to $1000. It might just have been my doctor being thorough. Some of the tests seemed completely unrelated to hormones or their effects, and from what I've heard it's unusual to get that many done to get T. So maybe that's worst case scenario.

So the way insurance companies work is they look at diagnosis codes to determine if something is covered.   Most insurances won't cover GID related expenses.   However it's important to know that most of the time insurance companies look at the primary Diagnosis Code and any secondary codes are generally ignored. 

Drug coverage usually has nothing to do with those diagnosis codes.  Where the risk comes into play is the Lab and Doctor's visits.   I'm pretty sure as long as your OB/GYN doesn't put Transgendered codes as your primary diagnosis, you'll be ok.

My insurance very explicitly says all of this isn't covered, but they don't actually care.  They've been paying with no problem for awhile.   They do, however, take issue with surgeries.

Hey man I don't have insurance but am a college student with no job. I contacted my local hospitals lab. Explained to them that I was diagnosed with gender identity disorder, I made sure to emphasize disorder, and they said that I can get discounts as well as having the hospital work with me on payment plans. Maybe somewhere in your area could do something similar?

Quote from: Epigania on December 11, 2010, 08:49:30 PMMy insurance very explicitly says all of this isn't covered, but they don't actually care.  They've been paying with no problem for awhile.   They do, however, take issue with surgeries.

Same here. Some guys have said that their insurance covers all trans expenses. I'm curious what companies those are.

Its really dependent on the policy.  I have Aetna and while it explicitly says it doesn't cover GID/Sexual Therapy expenses, they still pay for the drugs and doctor's bills so far.   I've read that Aetna employees have all their GID expenses paid for including surgery.

@Epigania: Would this also count for children of Aetna employees? My dad works for Aetna, so that would be great. And so by the drugs, that's hormones, right? I'm sorry for asking, but my mom and I are having trouble figuring out if anything is covered (my dad is in charge of this stuff and is reluctant about my transition, so he's also reluctant to look it up).

I should have added that my insurance might not cover everything at the obgyn because it's called a 'limited benefit plan' or some bs like that, not because of GID.

so if you go to a pharmacy that is included in your insurance to get hormones, it shouldn't matter that GID isn't covered right? the prescription will still get covered no matter what it is?

thanks for the help, all of this is super confusing. it's the first time I've ever tried to use an insurance plan that's not my parents.

If you are covered under your father's insurance, then yes it would apply to you, Noah.  They don't discriminate between dependents and the policy holder.

My company has a web portal we can go in through the Aetna.com website and posted on that site is everything that's covered and not covered.   I'm pretty sure if my company, as a customer, has that info on the benefit site that Aetna employee plans have a similar site.

Quote from: lostradio on December 12, 2010, 08:14:14 PM
I should have added that my insurance might not cover everything at the obgyn because it's called a 'limited benefit plan' or some bs like that, not because of GID.

so if you go to a pharmacy that is included in your insurance to get hormones, it shouldn't matter that GID isn't covered right? the prescription will still get covered no matter what it is?

thanks for the help, all of this is super confusing. it's the first time I've ever tried to use an insurance plan that's not my parents.

Insurance companies will categorically cover or not cover a drug.   For example, mine won't cover Propecia (1mg Finesteride) but they will cover Proscar (5mg Finesteride).   

Just make sure you look up the limitations on if it requires generics or not.   That's the only thing that will catch you, I think.

As for the OB/GYN, I think you're safe as long as it covers doctor visits and labs.   That's really all your doctor is doing.  You're doctor will work the system as much as they are comfortable working it, because they want to be paid as much as you want them to be paid.

Quote from: Espenoah on December 12, 2010, 07:54:58 PM
@Epigania: Would this also count for children of Aetna employees? My dad works for Aetna, so that would be great. And so by the drugs, that's hormones, right? I'm sorry for asking, but my mom and I are having trouble figuring out if anything is covered (my dad is in charge of this stuff and is reluctant about my transition, so he's also reluctant to look it up).

So my interest got piqued ...

Here's an article on what Aetna uses to consider GRS Medically Necessary.  (My plan, for example covers it if it's considered medical necessary, which seems like good news looking at this article.)  http://www.aetna.com/cpb/medical/data/600_699/0615.html

EDIT:  here's an article that lists companies that include transgendered in their policies:

http://www.hrc.org/issues/7644.htm

Wow, that's really helpful! Me and my mom don't know our way around this insurance business very well, so I'm very grateful for your help! Sadly, my phone won't load those websites right, so I can't look at them now, but I will be sure to have a look at them later. Thank you!

Pesky phones.  

According to the HRC Site, Aetna Employee insurance covers everything, surgery included.  However, the caveat is that it may  have limitations.  For example, I've heard through the grapevine that Microsoft's insurance covers GRS Surgery, but only part of it.  Something like 75% of it.

Well that's great news! Sounds like I'll have to look into it more...