I think I may be awesome but I'll have to make calls to check. Only I'm afraid of making phone calls. So I'll do it but not for like 2 weeks tell I feel bad for procrastinating. Of course if some one else wanted to call.... PLEASSSE
Well Ok so What I've found is this. You can get pay as you go insurance plans "Individual Plan's" for a fairy low cost; That would be perfect for SRS/GRS. The way they work is that you have a deductible of say $3000. That normally alot, but it works for us. Ok so you pay $3k and then you have this thing "Coinsurance" and it's 0%-%20. What that is is how much you pay of the costs in a percent. SO!!!!
Out of pocket
Cost $20,000
Pay $20,000
Insured
Cost $20,000
Pay $6,400
(lets say it's 20%)
{20,000-3,000deductable=17,000}
{17,000x20%=3,400} Coinsurance is then $3.4k so
$3000 deductable + $3,400 coinsurance = $6,400
T=((P-D) x C%)+D
T=Total cost to you
P=Price before insurance
C=Coinsurance precentage
D=Deductable
See below for an explanation of terms
ANYHOW Cigna Does pay for SRS/GRS and they have a plan for about $100 a month. I figure if I get the coverage awhile before I go in like more then a year. It would save something like $11,000 for me. And well if it works for me it will work for you girls to :
What do you think? Am I the good kind of crazy here or the bad kind. Would any one be willing to call them and check. I know it a stupid Phobia I jsut. Gah the more important the call the skicker I feel I got al my infor form the web and I don't trust it tell I've called some one and asked.
You must meet the fullowing criteria for Cigna to pay for your SRS/GRS
CIGNA covers gender reassignment surgery as medically necessary when ALL of the following criteria
are met:
• age 18 or older.
• diagnosis of gender identity disorder (GID), including a diagnosis of transsexualism with ALL of the
following criteria:
• demonstrated desire to live and be accepted as a member of the opposite sex,
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Coverage Policy Number: 0266¾ expressed desire to make his/her body as congruent as possible with the preferred sex through
surgery and hormone replacement.
• transsexual identity has been present consistently for at least two years.
• GID is not secondary to another mental disorder or chromosome abnormality.
• The individual is an active participant in a recognized gender identity treatment program and
demonstrates ALL of the following conditions:
• the individual has successfully lived and worked within the desired gender role full-time for at least
12 months (real life experience) without returning to the original gender
• initiation of hormonal therapy or breast surgery recommended by a qualified health professional with
written documentation submitted to the physician responsible for the medical treatment
• documentation of at least 12 months of continuous hormonal sex reassignment therapy, unless
medically contraindicated (May be simultaneous with real life experience.)
• recommendation for sex reassignment surgery by two qualified mental health professionals
recommend sex reassignment surgery with written documentation submitted to the physician
performing the genital surgery (At least one letter should be a comprehensive report. Two separate
letters or one letter with two signatures is acceptable. One letter from a Master's degree mental
health professional is acceptable if the second letter is from a psychiatrist or Ph.D. clinical
psychologist.)
• separate evaluation by the physician performing the genital surgery
CIGNA covers ANY of the following surgeries when performed as part of a med
• male to female reassignment:
- vaginoplasty
- colovaginoplasty
- orchiectomy
- penectomy
- clitoroplasty
- labiaplasty
• female to male reassignment:
- initial mastectomy/breast reduction
- hysterectomy
- salpingo-oophorectomy
- colpectomy/vaginectomy
- urethroplasty
- metoidioplasty combined with initial phalloplasty
Pre-existing Conditions[/b]
This is the boogiman when it comes to SRS/GRS and insurance. You should always call the insurance provider and ask them what would qualify as pre-existing. If your concerned you can beat it one of several ways. The simplest is to get diagnosed after you start the insurance. Go to a shrink and a Doctor. After you start the plan.
But in most cases if you meet all the criteria, they won't turn you down. Pre-Exsisting is the get out of jail card insurers use when some one is trying to lie to them. Some one gets sick, THEN signs up for insurance. GID is more like diabetes. Yes you had it before but they won't try say they won't cover it. To be safe you should start your insurance plan at least a full year before you plan to go in for SRS/GRS. For 2 reasons. The first is that being on HRT and RLE are requirements to be covered for SRS/GRS. If your using the plan to see your endo they know your not faking. And the second is that starting a policy right before the Big Day. Is kind of a slap in the face to the insurer. Remember how I said they don't like you trying to pull a fast one, Hence the Pre-Existing clause? Show the company some respect an thing go much easier.
Finally There's good new on the Legal front. We can thank Obama for this one. Part of the heath care bill he pushed was a bit that said "Pre-existing" will become illegal. In 2014 and 2019 depending on your age. If you are under 18 in 2014, you will not be able to be exclude for PE. For everyone over 18 you have to wait untill 2019. But come that day PE will be gone forever.
Terms
-Deductible[/b]:
This is the amount you have to pay out of pocket before the insurance kicks in. Say you have a bill for $2200, and you have a $2500 deductible. You will have to pay all $2200 out of your own pocket. On the other hand if you have a $3000 bill or even a $30,000 bill and a $2500 deducible you pay $2500 plus a % of the remainder. the percentage is called the Coinsurance
-Coinsurance[/b]:
This term refers to a Percentage you have to pay. It can be 0%, 10% 20% or 30%. You may also see it written as 0/100, 20/80. Insurance does not pay all of the hospital cost. So just remember that the Coinsurance is your share of the bill and you want it low.
A big thank you to Malachite!
