A Federal Directive went into effect on 01/01/2017 directing ALL health insurance companies nationwide to remove all denials to gender reassignment surgeries.
I know this because I have my insurance through Cigna. This is not a directive just to Cigna, it is to every insurance company nationwide that sells on the Federal exchanges (HealthCare.gov).
This directive removed all the final legal loopholes that insurance companies were exploiting in order to refuse authorizing and paying for gender reassignment surgery.
The one problem I have is I can NOT find out what piece of legislation this directive is covered under because the memo makes no reference to the official US Govt legislation that it was addressed in.
I was initially denied at the first of the year, but I was working with a Customer Care Manager through Cigna. She oversaw everything from that point forward. On 01/24/2017 I was approved for GRS.
So my suggestion is to be persistent, and I dont know how Humana does things, but I know they are covering these surgeries as we speak because I've heard of other transwomen locally going through Humana. See if you can get a Customer Care Manager or equivalent appointed to you and have him/her push things through to the appropriate departments and personnel. Sometimes things just need to be elevated up the chain of command. The review nurse who got my initial file, was not briefed on the new Federal Directive. Her manager was brief on it and so my CCM escalated it to her and it got approved. Sometimes the right people are just not in the know and this is unfortunately one of the many what I call "ignorance tactics" these insurance companies use to weasel out of their responsibilities and obligations.
To corroborate what I'm saying here's the internal memo that my CCM at Cigna sent me.
Now for the bad news...
with the almost certain repeal of the ACA...if you arent scheduled and booked with a surgeon to have GRS by December 31, 2017...you may be out of luck.
All insurance contracts (Wisconsin excluded as they cancelled all trans-inclusive healthcare policies effective 01/01/2017) are guaranteed through the end of the year.
After 12/31/2017 all bets are off. Why? We simply do NOT know what the new AHCA legislation being proposed will have in it. We dont know if it will include all current protections for transgender people, if it will retain transgender anti-discrimination policies and mandates that insurance companies must provide coverage for GRS.
We are hopeful, but with the actions of Sessions, the DoJ on pending transgender and EEOC cases, it looks very grim that trans protections in healthcare will remain in place.
I feel very fortunate that I slipped through a tiny window and was able to get my GRS done. I feel for those of you who may not be able to have the same success that I did, I can't even begin to imagine to be so close and then have it taken from you. [emoji20]
If I can be of any assistance, dont hesitate to pm me.
