Does Your Health Insurance (us Only For This One)

[Guest Joanna Phipps]

I am wondering if I have an odd ball for an insurance co. My Dr tried to code a set of labs as HRT V07.4 and the insurance co denied the claim because they were miscoded. Anything to do with my GID has to be coded that way or its rejected. Does anyone else have this problem?

[Guest Donna Jean]

I am wondering if I have an odd ball for an insurance co. My Dr tried to code a set of labs as HRT V07.4 and the insurance co denied the claim because they were miscoded. Anything to do with my GID has to be coded that way or its rejected. Does anyone else have this problem?

I'm not familiar with that code, Hon...

But, I DID find this...

V07.4 is a billable ICD-9-CM medical code that can be used to specify a diagnosis on a reimbursement claim.

And this one (second one down....)

http://health-information.advanceweb.com/E...l.aspx?CC=24593

Good luck, Honey...

Donna Jean

[Guest sarah f]

It will be next month before I start. I was just wondering who you have ins through. I have united healthcare and don't know if they cover it yet.

Love,

Sarah F

[Guest Donna Jean]

It will be next month before I start. I was just wondering who you have ins through. I have united healthcare and don't know if they cover it yet.

Love,

Sarah F

Sarah......

Do NOT call and ask them! That will only make them aware of your intentions...

What you need to do is read the insurer's manual and see what they say about SRS, HRT or like mine "Sex Change"....

It it doesn't pay for you on HRT, for instance, you'll need to ask your doctor to code it "Hormone imbalance" or it won't be paid...

I've been doing it that way for a year as have many others here...

See how it's handled on your insurance, but don't play your hold card!

HUGGS!

Donna Jean

[Guest Joanna Phipps]

I'm not familiar with that code, Hon...

But, I DID find this...

V07.4 is a billable ICD-9-CM medical code that can be used to specify a diagnosis on a reimbursement claim.

And this one (second one down....)

http://health-information.advanceweb.com/E...l.aspx?CC=24593

Good luck, Honey...

Donna Jean

Its the code for HRT as used by peri and post menopausal women and women who've had complete histos. Its not applicable to us

[Guest Kaitlyn88]

Aren't we categorized as that after SRS though? I would hate to be considered a man taking estrogen for the rest of my life....

[Guest Joanna Phipps]

Aren't we categorized as that after SRS though? I would hate to be considered a man taking estrogen for the rest of my life....

I dont know what code they would use then, but this is right now while we are preop and may not have all the records changed.

[Guest TracieV3]

This is not meant as a political statement, it is just meant as a question.

Does the new Health Care Bill passed passed by the U.S. Federal Government provide any coverage for the needs of transgender and transsexuals? HRT? SRS?

[Guest Donna Jean]

This is not meant as a political statement, it is just meant as a question.

Does the new Health Care Bill passed passed by the U.S. Federal Government provide any coverage for the needs of transgender and transsexuals? HRT? SRS?

Traci.....

No it won't, to the best of my understanding....

We're still out in the cold, for the most part...

There are isolated cases wher an insurance carrier will provide HRT and SRS, but it would be a Rolls Royce plan!

Donna Jean

[Guest Jewel]

I am wondering if I have an odd ball for an insurance co. My Dr tried to code a set of labs as HRT V07.4 and the insurance co denied the claim because they were miscoded. Anything to do with my GID has to be coded that way or its rejected. Does anyone else have this problem?

V07.4 is the ICD code for Postmenopausal Hormone Replacement.

Of note is that many, if not most, insurers will automatically reject procedures marked with this diagnosis if the gender of the insured, according to their records, is not female. Cross checking diagnosis and procedure codes with the gender on file is standard practice among US insurers. As is cross checking CPTs (procedure codes) with ICDs (diagnosis codes). Individual insurers will often publish lists of ICDs and CPTs that are associated strictly with one gender or the other, as well as CPTs that must have an associated ICD within a certain set.

So my best guess would be that the insurance company currently has your gender listed as male.

Source: I've been developing billing software for the medical industry for 15+ years.

[Guest TracieV3]

Traci.....

No it won't, to the best of my understanding....

We're still out in the cold, for the most part...

There are isolated cases wher an insurance carrier will provide HRT and SRS, but it would be a Rolls Royce plan!

Donna Jean

Thank you for answering my questions.

Taking that into account, I hope the states when the legal battle, because if not, then it is just another tax that we cannot afford that only hurts us.

[Guest Kay_Donohue]

I'd say that it's odd for any insurance company to cover anything related to HRT (unless your company is really accepting, and has already had it included in their policy).

.

All of my HRT meds are out of pocket, except for the Fin, because it can be coded for 'enlarged prostate.'

.

I'm actually surprised to hear that some get it covered by 'hormonal imbalance.'

I'd think the insurance company would look into a male (from their view) patient getting E and Progesterone, or Spiro in such high dosages prescribed without some sort of heart or other condition.