So, I went to my first therapy session today. I've been on hormones about three months, but my primary care physician hasn't cared for me primarily (she doesn't want to see me and won't refer me to anyone else). The therapist, who has had transgendered patients before, referred me to a doctor that has had TG patients before too. I looked the doctor up on my healthcare provider list and I'm covered if I want to go with him as my primary care physician. I call his office to set an appointment, said that I was referred by my therapist to this doctor and asked if I could make an appointment. They told me that if I wanted to come see the doctor for TG issues, I would have to pay $150 up front and that my insurance wouldn't cover a basic checkup and blood work. I informed her that I had insurance and they were in my provider network and they said my insurance would cover me for a normal visit, but not a TG-related one. Has this happened to anyone else before?? I'd never heard of this happening.

It seems to me it's all going to depend on how they code the visit.  If they code the visit as Transgender related, then the claim will likely be denied and they will need to be paid out of pocket by you.  Though, if they code it as "endocrine disorder", then it could very well pass through your insurance.  That is how mine currently works anyway.

Wow... and some wonder why others self medicate.

Gypsy,

  I know that my ideas may be radical to you... BUT...

  You need to contact your local Trans community and try to  find a new doctor that's really trans-friendly. Please, do not accept the discrimination you've faced.

  Fight, girl....

  Don't you dare tell me that you "don't want to make waves" or that you're willing to accept how you're being treated... STAND UP and FIGHT! You have the right to be treated with dignity and the right to be who you are. Fight!!

but my primary care physician hasn't cared for me primarily (she doesn't want to see me and won't refer me to anyone else).

In this situation she is only a doctor, you are the patient, channel your inner Trump and fire her.

Quote from: JessicaR on April 19, 2011, 11:20:15 PM
Gypsy,

  I know that my ideas may be radical to you... BUT...

  You need to contact your local Trans community and try to  find a new doctor that's really trans-friendly. Please, do not accept the discrimination you've faced.

  Fight, girl....

  Don't you dare tell me that you "don't want to make waves" or that you're willing to accept how you're being treated... STAND UP and FIGHT! You have the right to be treated with dignity and the right to be who you are. Fight!!

In matters like these, I am proactive. I called damn near every doctor on my PCP list in my area to find one doctor that had had transgender patients before. Out of maybe 25 calls, I got several people (including the physician themselves) who tried to preach to me, several who had no idea what transgender was, most who said they knew the term and had moral issues with dealing with it, and none who had actually treated TG patients before.

After my minor meltdown a couple of weeks ago, I tried to do the same thing with psychiatrists and while looking for someone else, found a psychologist (apparently only one of two in Nashville) who specialized in treatment and care. It was he who suggested the doctor I called, and he got the name from the TVals website (http://www.tvals.org/). I'm not sure what other options are available to me. The only other medical doctor on the website has the specific note that he's strict and makes you jump through a lot of hoops before you can even get hormones.

I'm not really a drama queen, but I've been kinda feeling the "world is against me" vibe the last few weeks. I mentioned my troubles from the doctor call to my friend yesterday and her response was that it was perfectly reasonable they required it, because if they didn't, she'd want to go get a boob job and a tummy tuck and have her insurance cover it. Needless to say, that comment stung.

Ugh. I'll probably just pay the $150 in a few weeks when I get the money to do it because I don't see how I can fight the medical community, the insurance company, and peoples' prejudices all at the same time. And Bismarck was only worried about a war on two fronts...

Contact a local college and they will have a list for you. as far as ins they know the work around.

G luck

Most health insurance will not cover trans related treatments. Depends on your coverage. Most doctors who are savvy will know how to code things so insurance will pay. I had gynecomastia which was a legitimate reason for having my hormone levels tested. You may have a similar condition that requires your hormone levels to be tested. Whose to say?

FYI, your therapist should also be using generic codes for your treatment or it may also be denied by your insurance.

Quote from: Melody Maia on April 25, 2011, 02:54:34 PM
Most health insurance will not cover trans related treatments. Depends on your coverage. Most doctors who are savvy will know how to code things so insurance will pay. I had gynecomastia which was a legitimate reason for having my hormone levels tested. You may have a similar condition that requires your hormone levels to be tested. Whose to say?

FYI, your therapist should also be using generic codes for your treatment or it may also be denied by your insurance.

God, I hope so... I mean, he's had gender patients before and they checked to make sure that I was covered. I really don't want to find out I'm not covered.

The thing that gets me is that it's blatant discrimination no matter how you look at it. Whether TG is viewed as a "choice" or not to go through HRT, there are a multitude of other services that are all covered that result from choices. If you have a whole lot of sex, no problem. They'll test you out the wazoo for diseases. If you happen to have a baby, no biggie. Covered up to a very reasonable degree (considering the massive costs of having a baby). If you're morbidly obese because you eat a LOT and don't exercise, that's not a problem either. Anything obesity-related is covered. But, if you have the gall and tenacity to sit across from a medical professional or an insurance company exec or what have you and tell them that you were born the wrong gender, good golly, watch out! That's going to cost money and it's completely elective to fix, so good luck, honey! Don't let the door hit ya where ya wish God woulda split ya!

Just so frustrating and infuriating at the same time.

Today was a crying day...

Gypsy,

I just read this thread, and have to say that you are NO "drama queen", your situation is unfair, and not right.  I am sorry that you are fighting such an outrageous battle when you are just trying to get services.

I am sure you have already tried this, but do you have local trans friends?  Have they had similar problems?

Andy

I had the same problems until my doctor began to code it as an endocrine disorder.  If the doctor won't do it directly, maybe the doctor's office manager will take care of it for you.  Don't put up with having to pay $150 for something that should be far less. 

I had a similar experience when I approached my PCP and I too live in Mid-TN. I have not yet selected another PCP but will need to soon so I can start documentation again for my hrt. I for one would like to know who you choose and why.

I was a DIYer but am now ready to move forward with the established protocols.


Randi

You may want to check these providers to see if they are in your plan or how much your plan covers if you go outside of plan to see them.

Good Luck!
Stacy

Gender Therapists in Tennessee

George R. Brown, M.D.
Department of Psychiatry
Mountain Home VAMC
Johnson City, TN. 37684
Phone : (423) 926-1171 ext. 7709
Psychiatric/medical practice devoted to gender and sexuality concerns. SRS evaluation, hormone treatment. Uses Harry Benjamin Standards. Presently Dr Brown only deals with Veterans. That may change in the near future.


Saroj Chand
Alternative Counseling Center
3105 Essary Drive,
Knoxville TN. 37918
Phone: (865) 687-8990
Fax : (865) 687-1190
Therapist. Ms. Chand offers her services on a sliding scale, and usually does not turn people away due to lack of funds.
Accepting new clients..

Dr. Terry Edwards
1007 Murfreesboro Road
Murfreesboro Road Office Park
Nashville, TN. 37217
Phone : (615) 791-3449
Email : terryedwardstoo@hotmail.com

ACC in Knoxville (licensed GID counseling with sliding scale, free supervised support groups, referrals for HRT and surgery, etc.)


Tennessee Trans Friendly Endocrinologist

Dr. Martin V. Acree, MD
1325 Eastmoreland Avenue
Memphis, TN. 38104-3519
Phone : (901) 725-0648

Typically medical providers are supposed to take insurance if they know you have it. It's a part of the contract they have with the insurance companies that they are credentialed with to provider services. Many forward-thinking clinics/offices will get creative with their medical billing and use of CPT diagnosis codes used for insurance billing. For example, many transpeople could be seen as having hormone imbalances, right? It's why you need HRT, to set it right. That might be considered not 302.85 (TS-NOS) but Endocrine Disorder NOS. Sometimes by changing the medical code to be something that you technically HAVE while not coding you as having the disorder of transsexualism (their diagnosis code, not mine!) will result in an insurance company getting paid.

This isn't a medical doctor being prejudiced against trans people, this is them trying to run a profitable business, although they probably won't think outside of the box AT ALL when it comes to diagnosis codes. If you can find ONE decent doctor and suggest coding you for something else you have, they can get paid (a win for them AND you!) and you can get treated (a win for both of you, again).

I like the ideas that people suggested to you though...go to a university, LGBT place, etc. I know people that travel five hours to get HRT but it's because once you get the first few visits out of the way, you are only going like two or three times a year. From a monetary standpoint, it might not break the bank. Keep up the searching, stay diligent Meghan