GRS and Insurance

[michelle666]

There are actually a few. Dr. Melissa Johnson in Springfield MA did my surgery and I was covered 100% under MassHealth. There's also Dr. Richard Bartlett, Dr. Paul Costas, and Dr. Simpone Topal, all in Massachusetts. There are probably others I am forgetting.

I was just looking at Dr Johnson's site and cant find anything about GRS on there, just breast augmentation and I'm doing fine on my own with that. If you dont mind me asking, how were your results if it was grs that you had. If you dont want to share publicly, please send me a pm.

[veritatemfurto]

I'm insured through CareFirst BlueChoice HSA Bronze, when asking them about GRS they said that I would need the procedure codes and diagnosis codes to determine whether or not I'm covered.  My doctor then informed me that I would need to speak to the surgeon I choose to get those.  Is there a better way to figure this garglemesh out, or should I start looking for surgeons who preform this work in my area?

55970 is the cpt code I had for my GRS with Bowers... it should be the same code regardless of doctors. I have the diagnosis code too somewhere but that is the important one for the cost of surgery... but that doesn't include hospital or anesthesia cost.

[veritatemfurto]

BTW from the AMA Website: https://ocm.ama-assn.org/OCM/CPTRelativeValueSearchResults.do?locality=8&keyword=intersex

The figures presented below are based on 2015 CPT codes and Medicare payment information.

55970   Intersex surgery; male to female

55980   Intersex surgery; female to male

56805   Clitoroplasty for intersex state

57335   Vaginoplasty for intersex state

There is also this little tidbit. ICD coding is set to supplement (if not replace) CPT coding, but unfortunately the ICD coding still references the DSM-IV, including typing transvestism as a fetish   

http://www.icd10data.com/ICD10CM/Codes/Z00-Z99/Z77-Z99/Z87-/Z87.890

Specific code icon 2015 ICD-10-CM Diagnosis Code Z87.890 

Personal history of sex reassignment

2015 Billable Code POA Exempt
Z87.890 is a billable ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes.
On October 1, 2015 ICD-10-CM will replace ICD-9-CM in the United States, therefore, Z87.890 - and all other ICD-10-CM codes - should only be used for training or planning purposes until then.
This is the American ICD-10-CM version of Z87.890. Other international ICD-10 versions may differ.
Description Synonyms
History of intersex surgery
History of intersex surgery (situation)
History of sexual reassignment surgery
Hx of sexual reassignment surgery
Present On Admission
Z87.890 is considered exempt from POA reporting.
ICD-10-CM Z87.890 is grouped within Diagnostic Related Group (MS-DRG v30.0):
887 Other mental disorder diagnoses

F64.1  Gender identity disorder in adolescence and adulthood
F64.2  Gender identity disorder of childhood
F64.8  Other gender identity disorders
F64.9  Gender identity disorder, unspecified
F65.1  Transvestic fetishism

[Jaelithe]

Thanks muchly, I've sent those back to my insurance company. Now we play the waiting game...


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[michelle666]

I had a consultation with Dr Rumer today. After being initially told that she accepts insurance, it turns out that she takes cash up from and then gives you a paper for reimbursement from you insurance company.

[Jaelithe]

Finally got word back from my insurance.  It turns out that in-network they absolutely cover GRS.  I've requested a list of in-network surgeons who preform that procedure, but they don't have the best track record of responding in a timely fashion.  Would any of you lovely people be able to provide me with people who accept Carefirst Blue Cross Blue Shield, so I can further put together my plans?

[Jaelithe]

Okay, disregard last request.  Got all that worked out.  At this point I think I'm set aside from making sure I have everything that Carefirst Blue Cross Blue Shield might want to approve coverage.  Going in, I'm expecting to bring letters from 2 therapists, my medical history records for general health and hormone therapy reports, and a form from my electrologist about the clearage there.  Is there anything else I should be doing before my consultation to make sure I have everything set to go? 

[AncientMyth]

I had a consultation with Dr Rumer today. After being initially told that she accepts insurance, it turns out that she takes cash up from and then gives you a paper for reimbursement from you insurance company.

That's what i'm finding; the surgeons are more than happy to give you codes and hope it works out for you, but don't work with insurance at all and expect lots of monies up front.

[Mariah]

Hi AncientMyth, welcome to Susan's. I look forward to seeing you around the forums. Good luck and Hugs
Mariah

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[Myers]

Is there any insurance (in California) that covers doctors overseas?
I'm looking at dr Miro, but not sure which insurance to switch to get it covered

[michelle666]

Is there any insurance (in California) that covers doctors overseas?
I'm looking at dr Miro, but not sure which insurance to switch to get it covered

I dont think you'll find any american insurance company that will cover overseas.

[KristinaM]

The company I work for just switched to United Healtcare, does anyone know if the cover SRS?

United Healthcare seems to be like every other company so far this year anyways.  They have coverage available, but only if it hasn't been excluded from your plan.

My employer is signed up through United Healthcare, and I had to go back and forth with my HR Department to get them to add coverage for even basic diagnosis and treatment of GID.  As of July 1st of this year (enacted retroactively), they cover the diagnosis, therapy, and hormones at least, so I just pay copays for office visits and prescriptions.

I'm hoping with the new legislation coming through this year or next that by July 1, 2016, GRS will be added to that list at least, maybe BA or FFS too.  I'm the only trans person at my company it seems, so I'll be fighting every step of the way.  I will be specifically saying I want to have McGinn's services covered, lol.  No surprises!

[Dodie]

And just think, me managing insurance claims....I would often sit there and think "what in the world would this do for me in the future other than typical medical procedures?"

Those years in the field became more valuable to me now more than ever.

Annah,
Right now I have BCBS of Oklahoma.. which denies coverage of course specifically for SRS.  I have a great uncle begging me to move to Colorado.. He is 87 and needs help.
Anyway they have anthem BCBS Bronze plans only in the Colorado Springs area.. and no one can tell me if they would cover a surgery in California or if the DR. is in network.. and its a PPO..
I have basically given up on getting coverage.. and will have to pay out of pocket.
I thought about paying out of pocket in Oklahoma then getting an attorney to go after BCBS especially if the  new HHS laws pass.. What do you think
Keri AKA Dodie

[SarahJ]

Open Season for Federal Employees is upon us again, does anyone know whether more plans are covering the surgery this year?  I've personally looked at Blue Cross Blue Shield and it looks to me that they are continuing to not cover reassignment surgery.  As I am presently scheduled with Dr. Bowers in May of 2016, I think I'm willing to change plans for a year to get my surgery covered.

Sarah

[Wynternight]

Open Season for Federal Employees is upon us again, does anyone know whether more plans are covering the surgery this year?  I've personally looked at Blue Cross Blue Shield and it looks to me that they are continuing to not cover reassignment surgery.  As I am presently scheduled with Dr. Bowers in May of 2016, I think I'm willing to change plans for a year to get my surgery covered.

Sarah

I was hoping BCBS would actually decide to follow the law this year so I could change back to them but I guess they think they're above it. Looks like I have to stick with Aetna.

[Keri]

I got so frustrated I gave up and am going to Thailand..
One day every insurer with have to pay.. we deserve to be treated like anyone else
Urrrrrrrrr and that is a polite way to say it.
Keri

[SarahJ]

Found out today that BCBS has denied my pre-authorization request for surgery.     Their excuse was that 55970 is a non covered code.  So I've broken out pen and paper and am going to appeal their decision.  I'll keep everyone apprised as it to how it is going.  I just wish there was a way to appeal directly to OPM without all the games first!

Sarah

[Jaiden2.50]

I need to find an insurance that fits me. I'm FTM 19 and live in Cali. I also go too college so I'm practically broke all the time.

[Wynternight]

Found out today that BCBS has denied my pre-authorization request for surgery.     Their excuse was that 55970 is a non covered code.  So I've broken out pen and paper and am going to appeal their decision.  I'll keep everyone apprised as it to how it is going.  I just wish there was a way to appeal directly to OPM without all the games first!

Sarah

Any news, Sarah?

[marctravis]

Here is a list I compiled last July. I know there's about 15 more companies added in the next quarter so I haven't been able to add them in yet:

Coca Cola
Campbells Soup
Walt Disney
State of Conn. Teacher Association
The Government of Louisana
HRC
Johnson and Johnson
Aetna Insurance (private plan)
AmeriHealth
Anthem Blue Cross Blue Shield
Blue Cross Blue Shield for:
Massachusetts
Minnesota
Michigan

Ameriprise Financial Inc
Avaya Inc.
Barclays Capital
Bingham McCutchen LLP
Booz Allen Hamilton Inc.
Cardinal Health Inc.
Chrysler LLC
Cisco Systems Inc.
Clifford Chance US LLP
Covington & Burling LLP
Cummins Inc.Deloitte LLP
Deutsche Bank
Diageo North America
DLA Piper
E. I. du Pont de Nemours and Co. (DuPont)
Eastman Kodak Co.
Ernst & Young LLP
Exelon Corp.
Faegre & Benson LLP
Food Lion LLC
Ford Motor Co.
Fried, Frank, Haris, Shriver & Jacobson LLP
Genentech Inc.
General Motors Corp.
Google Inc.
Herman Miller Inc.
Intel Cigna
International Business Machines Corp. (IBM)
Katten Muchin Rosenman LLP
Kimpton Hotel & Restaurant Group Inc.
Kirkland & Ellis LLP
KPMG LLP
Kraft Foods Inc.
Latham & Watkins LLP
Littler Mendelson PC
Marsh & McLennan Companies Inc.
McGraw-Hill Companies Inc., The
Microsoft Corp.
Morrison & Foerster LLP
Nike Inc.
Northern Trust Corp.
PG&E Corp.
Pillsbury Winthrop Shaw Pittman LLP
Replacements Ltd.
Robins, Kaplan, Miller & Ciresi LLP
Shearman & Sterling LLP
Sonnenschein, Nath & Rosenthal LLP
Sun Microsystems Inc.
Sutherland Asbill & Brennan LLP
White & Case LLP
Yahoo! Inc.

Cigna Private plan
Emblem Health
HealthNet
Health Partners (Minnesota)
Medica

University of Pennsylvania
Penn State
Goldman Sachs
Bank of America

City and County of San Francisco
IBM
AmEx
AT&T
Wells Fargo
Eastman Kodak
Sears
Morgan Stanley
Price Waterhouse
State Farm

New York Life Insurance
Angell Palmer and Dodge Law Firm
City of Berkley

All of these have GRS/GCS/SRS included in their policies.

However, getting disability insurance (i.e., paychecks while you are out recuperating) is at the discretion of your specific company's individual Disability Carrier Contract Guidelines.

Are you sure about 'Government of Louisiana'? Where did you get this information if you don't mind me asking. If this is true, it's great news for me and my spouse, but I was unaware of this coverage.