insurance

[Guest aadenr]

Hi,

So I recently got CIGNA and I know that they cover gender reassignment, but does anyone know how can I figure out if its covered under my specific plan or is it covered by all plans? I'm a little hesitant to call and ask...

All I found was this:

http://www.cigna.com/sites/careallies/pdf/CA0266_gender_reassignment_surgery.pdf

[Guest Theosphir]

I don't see that anything that tells me what plan types are included in this, but it should be noted that it does appear only to cover treatment, and specifically surgery. Unless you have a part of your plan that covers mental health and therapy and includes therapy sessions, you'll be paying on your own to see someone and get the diagnosis. It doesn't appear to cover hormones from what I can tell, either, just the surgeries themselves.

If you aren't sure if your specific plan covers it, I would call and ask. If you're nervous, try asking "what does my plan cover?" and see what they list, and if they skip it ask if it covers that and maybe a few other things, that way they just assume you're seeing what you have in your plan (if you're nervous about that sort of thing). It's better to be sure that they will cover it then to submit a claim and have it denied.

[Charlize]

I wish i knew an expert on insurance but i know several thing that may help. If you know the medical code for the procedure you are thinking off that will help. With that information you can look at what codes they cover. Reassignment can take several courses. The best way however is to ask. Even then knowing the specific procedure will help. Oddly the insurance companies seem to say no one day and when bothered some more they end up saying yes. My insurance seems to enjoy denying claims until you show them they are wrong. I would be amazed if i didn't know it is in part a way to pay slower or hope that they don't have to pay at all. It is frustrating and while we have "the best healthcare system in the world", some improvements need to be made. Sorry i can't help more.

Hugs,

Charlie

[Guest Carla_Davis]

Hi,

You need to contact your employer who is covering you.

Many employers "Opt Out" of TG care as it is cheaper for them.

Hugs,

Carla

[Guest KimberlyF]

Depending on the size of your company, they may have HR info posted online. I found the specific insurance rider from my employer and BCBS online. That lists specific exclusions and coverages.

[Cyndee]

302.85 is the diagnostic code typically used, having the diagnosis from your Dr certainly one of the steps neccessary for insurance coverage, they tend to like to see those things.

http://www.hrc.org/corporate-equality-index#.Ui3b7oGDGBM

You may possibly find your company listed in the "Corprate equality index" compiled by HRC. I found mine in there, and an encouraging answer for me.

C -

[VickySGV]

Who is the principal insurance contract purchased by? If your employer, then you need to get a "benefits" pamphlet from HR, or giving your MedID # to Cigna will let send you a terms of coverage letter. Most insurance is renewed or has open enrollment / plan change time in October - November and you will get a copy of your contract in the mail. My insurance was through my retirement plan, and they had a downloadable copy of the contract. I know that with a couple of insurance carriers, you can get a "super plan" above what your contract holder provides for only a little extra, which your employer can withhold and remit for you. A friend of mine is paying $9.00 per month extra for the added coverage of SRS, which she can use after a year of enrollment.

[Guest Billie De]

Many Times is not really a question of will they cover it vs will they not..You should have an outline of covered and not covered procedures....If you see no Trans Exclusion in the not covered column then I bet your in good shape. Insurance is VERY GOOD at letting you know what they WON'T do but always vague on what they will.

As for the mental side.. Yes it will be covered... It is required by The Affordable Care Act..

Now Hormones..Hit and Miss depending on your prescription plan and what state you're in.. For me in CO.. Yes they are covered as they can not deny any service or Care that is offered by to any other person Male or Female..ex...So cis woman are covered for HRT and Mammograms they cannot deny HRT or Mammograms no mater what Gender you are is....

That's what I am Battling with now with my insurance as they are denying my SrS as SrS is not used outside for anything else. Orchy yes..It's also a treatment for Testicular Cancer so they can't deny that. So now we will be filing a Discrimination Lawsuit Against them along with the Unlawful Denial Suit....(We're going to try and use the Medical Necessity Clause and that they cover Hysterectomies stating that a Post-Op Trans is no different then a Post OP Cis after a Hysterectomy...(It's a reach but we'll see...)

Also to Add..Even if your insurance covers your meds..depending on your deductible you may be better off buying them outright so you need to check around..Prime example...I can buy Estrogen at Walmart for $8 as it is on their $4 list of meds...(I take 4mg a day and the largest they make are 2mg Tablets so it's doubled.) Go online and they have a list of what's on the $4 script list...But my co-pay on my Insurance is $10 for Generics and $20 for name brand but they are raising it to $20 for Generics and $50 for name brand so I am better off switching Pharmacies and not using my Insurance on my Basic Meds.. Estrogen,Spiro,Pravistatin.. ETC... and I will have my Doctor change me off the name brands...

Hope this Helps.