Hrt And Your Health Insurance Coverage

[Guest Jinny M]

Hi Everyone , I'm new to this forum.

This topic may have been up before, if it has been I appoligize.

I was wondering for those of you on HRT , does your Health Insurance cover it ?

I've been seeing a Theraphyst since August , My wife ,My Wife and I have discussed me going on Hormones.

We all feel it's the right path for me to go, Suprisingly my wife is all for it. She wants to see me happy. She supports me fully .. I'm so lucky to have her in my life. She laughed about it and said it's going to be nice seeing me go through this tansition.

She said It'll be nice for me to see things from her (the female) perspective . The sore breasts, the emotions , the lower sex drive , putting in time and effort to look nice all the time. I was taken back by her when she said that,, I was like WOW ! you are the greatest, I figured she would have been put off by me wanting HRT and to transition. She is truly my best friend.

OK , SORRY to get off topic.

My theraphyst said she's going to write me a Refferal Letter . She said the insurance should cover it , she said she already sent her diagnosis in to the insurance Co. that I'm transgendered . She said other diagnosis are covered for treatment , why shouldn't what a Transgender person needs be covered.

I would like to do my transition using my Health Insurance . I can't see why they wouldn't pay for the doctors visits and the blood work and prescriptions. I have Harvard Pilgram ?

Anyone run into thier Insurance denying them for it ? from a legal perspective isn't that discriminating ?

Very curious as I'll be getting my letter soon and would like to know what to expect in advance.

Thanks Jinny

[Guest Colm]

Hi Jinny, and welcome to the forums!

Since your question is particularly specific, I'm leaving it here, but you ought to go over to the Introductions Forum and make a thread there so that more people will see that you're new and say hello.

My insurance does cover the hormones but not surgery, but that's also new this year. You should check the exclusions for your particular company/policy to see whether your insurance covers hormone treatment. I've had trouble getting the blood tests covered, sometimes, which are necessary for hormone treatment. I haven't got your particular heath insurance though, mine's through my uni.

I'm so glad to hear your wife is so supportive!

Best,

Colm

[Carolyn Marie]

First of all Jinny, you are absolutely lucky to have a wonderful woman like that in your life. It is rare indeed to find someone who can

adapt to all the changes that a transitioning spouse will bring. I should know, too, as mine is just as supportive. Never forget

to tell her how much it means to you ( I know you do, but I had to say it anyway).

Insurance runs the gamut, hon. I have heard of companies whose plans include everything up to surgery. But I think its still fairly rare.

I am in the public sector, where you might think things were good. But alas, my coverage specifically excludes anything having to do with

transition.

Some therapists and doctors do get around some of the restrictions by creatively coding the diagnosis. I'm not saying its right or wrong,

just that I know its done.

Carolyn Marie

[Guest Jinny M]

Thank You Colm and Carolyn .

They do pay for my gender theraphyst visits , I pay a co pay.

I'm hoping they cover the doctors, blood tests and hormones I need . My theraphyst told me about Fenway Health it's a LGBT Clinic in Boston , they have a Transgender Clinical Team there. I'm just waiting on my theraphyst to send the refferal letter to them , then once they recieve it , it'll reviewed by the clinical team at there next meeting which is every Thursday. Once they approve the letter , then I make an appointment with one of there physicians and get a refferal from my primary care doctor and have him foward a copy of my latest physical to them .

Now the Transgender Clinical Team Coodinator , told me I shouldn't have a problem with Harvard Pilgram , so I'm going to keep my fingers crossed. All my life , I've been hiding my true self , my wife and theraphyst have helped me to accept and embrace that this is who I truley am .

I am so looking foward to transition. I only wish I would have done this alot earlier in my life , like when I was in my teens or 20's.

Thanks again ,

Jinny

[Guest sarah f]

Jinny mine covers my hormones and blood tests. All I have to do is pay a co-pay. I would call you insurance company and ask them so that you will know ahead of time. You don't want the suprise later if they don't. Hormones you can get a wal-mart pretty cheap but blood tests can be very expensive.

I also want to say how happy I am that your wife is so accepting of you. That is just wonderful to have her in your corner.

Good Luck and I hope everything works out for you with your insurance.

[Guest Jinny M]

Hi Everyone thanks for your replies.

I emailed a LGBT Clinic That has a Transgender Clinical Team , which my Theraphyst and I have dicussed for my HRT , I got a quick reply back from them that they accept and don't haven't had any problems with my Health Insurance Company . They said that they simply bill it as a hormone imbalance . I just need my refferal letter sent to them , which my theraphyst is working on and going to send them. They also need a copy of my latest physical and a complete set of labs sent to them. when I told my Primary he sent me for base line blood work to see where my hormone levels are at. So they want that also. I also need a refferal from my primary as well .

Now I also sent my Insurance Company an inquiry message through there website asking them if they cover HRT for transgendered patients.

This was the reply I got from them ;

Dear Mr. ----- , Hormone therapy is not covered for transgender. I'm sorry about that. Let me know if you have any other questions.

So I know the Clininc said the simply diagnose and bill for a hormone imbablance , but I'm wondering since I asked the Insurance Company already ,will a red flag go up (So to Speak) if they get a bill for me ,from the clinic for treatment for a hormone imbalance ..

Hmmm ! real grey area . My therephyst said they should cover it, she said it should be no different then treating any other diagnosis. I'm hoping to just pay my co pays for everything. She said she sent in my diagnosis to the insurance company already for GID and transgendered.

I'm kinda bummed ,I hope everything works out , I'm so looking foward to starting out this new year with transition.

The end of the month I have an appointment to get My face neck and brows waxed again on one day and a full body wax another day .

Jinny

[Guest Jinny M]

Hi Everyone ,

Just an update , I've been contacted back from the LGBT Health Care Clinic , here is there reply to my grey area snag .

Hi Jinny,

Thank you for sending me the string of emails so I could understand a little more of the things that have been happening. Unfortunately, now that your insurance knows you are transgender, they may deny coverage for gender transition treatments

Unfortunately, now that your insurance knows you are transgender, they may deny coverage for gender transition treatments. I can tell you that hormones are pretty inexpensive (usually around $20 a month on average) if you end up paying for them out of pocket. Most insurance companies have no idea whom to refer people to who specialize in or even know about transgender patients. Most policies also deny coverage for anything that is related to gender identity disorders as well.

While I cannot make any guarantees, I would encourage you to make an appointment with a primary care provider here and have them try to help negotiate this with you and the insurance company. It may not be negotiable, so there is no promise Often, insurance companies will cover hormones, but not for the purpose of gender transition. Each policy will vary in its exclusions. There are no federal or even state protections against being denied coverage because one is transgender. I would recommend you contact GLAD with this string of emails and ask them for advice. GLAD helps with legal cases of discrimination against LGBT peoples and they may have an idea what is possible to get coverage for you. Jennifer Levi is the lawyer who is in charge of the Transgender Legal Clinic at GLAD. Here is their phone number to contact them: 1-800-455-4523. You may also want to contact Gunner Scott, Executive Director of Massachusetts Transgender Political Coalition (MassTPC). He may have additional information or resources to assist you in this concern about the insurance coverage and denials of coverage. The office number for MassTPC is 617-778-0519.

So I'm still waiting on my Theraphyt do my refferal letter ,, Hopefully for the next time I see her on the 19th. Once I get it I'll make the appointment with theier Primary Care Provider and see what happens.

I did send out detailed emails with all coversations attached to GLAD and the MASSTPC ,I'm waiting for replies and keeping my fingers crossed.

Jinny

[Guest Colm]

Thanks for the info, Jinny, I'm sure our Massachusetts members will find this all very useful.

Good luck!

[Guest Jinny M]

Your Welcome Colm,

I contacted both Orginizations. GLAD contacted me back Positivly on this matter , I'm still waiting on my Theraphyst for the letter . I'll see her on the 19th , since the appointment on the 12th was resqueduled do to a snow storm.

Once I have the letter , I can make my appointments and see if my Insurance approves or denies me and we can go from there. I'll keep everyone posted.

Jinny