Ban lifted on trans-related health care for fed’l employees

[Guest Carla_Davis]

Ban lifted on trans-related health care for fed’l employees

http://www.washingtonblade.com/2014/06/13/opm-lifts-ban-transgender-related-health-care-fedl-employees/

Hugs,

Carla

[Carolyn Marie]

I suppose its a step forward, but reading the Memo, it seems to have it both ways. Why leave the option of exclusion open to the carriers, if the intent is to allow GD-related health care? Does the Memo allow for coverage of surgery, or not? It doesn't give a clue. The White House's comments seem pretty timid, too.

It's an election year. I guess this is all we can expect

Carolyn Marie.

[Guest CassieX]

That answers easy Carolyn Marie, because OPM likes to be inscrutable when giving answers. I've been petitioning on this since last year, particulary since last October as some FY14 healthcare plans in california removed the exclusion. The way I look at it is this: Several of the insurance providers do have Surgical Plans and other transition related stuff on the books (easily googled), but because of the OPM exclusion did not include them on their federal healthcare policies. Even if for some bizarre reason a provider decided not to remove the exclusion in their FY15 policy, in My opinion there would still be a very strong case for someone who has satisfied the medical neccesity criteria, got their letters, etc to be able to get treatment approved, as them being denied would technically violate OPM's original letter to FEHB carriers from 2011 and by definition medical necessity is a pretty compelling arguement, legally.

Subject:Gender Reassignment. One of the sections in it states: 'Enrollees should also be provided appropriate benefits in accordance with their individual medical status. For example, an individual who undergoes reassignment from female to male, but who still needs routine mammograms and pap smears, should be provided benefits for those services. The same rule applies to the medical needs and benefits of male-to-female transitioners.'

But it's all apples and oranges at the moment, we'll just have to wait and see. Personally, I'm moving forward with the intent that it will be approved so will be getting my letters from my doctors soon.

Another thing that is very related to this story is that the new diagnostic manual codes will become active October 1st and this will change a lot of ways doctors code their patients treatment plans and insurance providers process stuff. From what I've heard, this will be a plus.

Cassie