oh the joys of wrangling with insurance--UPDATE!

[Ravin]

So, my gyno health care is being denied coverage because of my legal gender change. The doctor suggested changing it back until after my upcoming procedure. I'm like, um...no. I'm appealing it, because it's ridiculous.

[Ravin]

I also filed a complaint with the HHS Office of Civil Rights.

[Carolyn Marie]

I think the appeal route is the way to go, Ravin. I wish you luck.

HUGS

Carolyn Marie

[tracy_j]

Good luck Ravin

Tracy

[Ravin]

Just followed up with doctor's office. Got clarification that they are also refusing to pay for normally covered other stuff done already, in addition to refusing to do the preauthorization on the surgery.

They are going to try to do a verbal appeal tomorrow from the doctor's office side of it.

I'm raring to go on this now. They messed with the wrong guy.

[Charlize]

I'm glad your on this. As you push forward the road will be opened to others. Best of luck with your appeal and efforts.

Hugs,

Charlize

[Guest]

I think they denied the wrong person.

Good luck to you, Ravin.

Stick with the appeal and complaint.

Huggs,

Joann

[Guest Deenah]

Yeah those insurance companies are a pain to deal with. I'm in the same situation, they have no idea how persistent I am. I had to call them today because for some reason they now have a problem with paying for my finasteride. I don't get these people at all.

[Ravin]

So I got a call today from someone in appeals at the insurance co. I was away from my phone so got a message to call back, which I attempted like 5 times today, including twice when I left messages.

I'll keep y'all posted of new developments.

[Guest sydney]

Because of Affordable Health Care for America Act (i.e. Obamacare), it's illegal for health insurance companies to deny based on gender change (previous conditions fall under that clause.) This was discussed at the Trans Health Conference in Philly last year. Many procedures (like gyno exam) is coded for a specific gender. There is a workaround as there is usually an alternative code to use when the procedure doesn't match the typical gender for the procedure. The doctor needs to contact the insurance company and ask for that code. If they provide one, they are breaking federal law. Tell them that and your appeal will get answered and taken care of real quick.

[Ravin]

Well, the surgery got approved yesterday (scheduled for tomorrow morning) and the ultrasounds I can't be billed for, and doctor can appeal. Insurance throwing up extra hoops which might deter doctors from treating us because of the hassle bites though.

The ob/gyn I'm working with is awesome though. She makes working with trans men part of her practice and they are sensitive and considerate and generally awesome. Hopefully in future they'll know not to take the "switch the gender back" bs from insurance!

[Carolyn Marie]

Outstanding news, Ravin. Persistence pays dividends. I hope all goes perfectly with your surgery.

HUGS

Carolyn Marie

[Guest alexaz]

Hi Ravin

Uggggggh insurance.

Im on Medicaid in Oregon and I cant believe the red tape and excuses they come up with.

Oh Ok got me there its the government.

First hoop: Want to see a therapist that accepts my insurance. Insurance CO sez, OK NO PROB.

call back from therapist office 2 days later, ummm we cant take your insurance program call them.

Call insur. co. OH. you need to change your policy program for that. (didnt even tell them they said it was ok the way it was ) OK lets do that....Oh you cant do that here you need to call ............. ugggggh ok

Call ............ need to change to my program.....WHY ? my therapist said I needed to to be paid......OH OK.

Talk to these people those people then these people again uggggggh finaly got it ok'd and done. 2 weeks later.

Next hoop: Now I want to see a nature path for HRT.....cool insurance pays for that. BUT....

You need a referral from your therapist.....uggggh ok

Get the referral and fax it to them......get the ok to see the nature path from insurance. COOL BEANS !!!!

NOPE. You need a referral from your regular DR. BUT BUT you said........ If you want it you need a referral from your DR.....uuuuuggggghhhhhhh

OK got an appointment with my DR saw him got the referral. Well not really it was a order for a referral but the worker in the office was really nice and is going to do the paper work and send it in...Will take a day or 2 and you can see your nature path........cool beans its done. NOT.

4 days later called insurance to find out what the status was.,,,,,, Oh it can take up to 2 to 3 weeks.......Wait you said it would only take a day or 2.

Oh NO thats if your DR sent it in URGENT...........................UGGGGGGGGGH

​Back to the DR office Please if its not to inconvenient. URGENT !!!!!!......Sure no prob, have to call them for the codes but will get on it

I swear the people in the GOV and insurance co's sit at the water cooler and laugh their heads off telling what they did that day to hurt people.

I keep really good records of who, when and why I talk to someone and I have talked to the same person at SSI. Oregon health care. and other GOV. offices. several times and they change what they say each time.

​Im so grateful that Im not a violent person BUT......

Love, peace and tranquility to all.

Alexa

[Ravin]

So, over a year ago now, I ran into problems with the AHCCCS (Arizona Medicaid) contracted insurance company Mercy Care not doing prior authorizations for and paying necessary gyno procedures, including a routine exam and ablation surgery, because those things were coded for "F" and my documents and everything with insurance said "M".

After getting the runaround from Mercy Care, I filed a complaint with the Federal Department of Health and Human Services Office of Civil Rights for violation of ACA section 1557, which is the nondiscrimination part of Obamacare.

Well, up through September I continued to get bills from the doctor's office informing me that I owed them money for all those procedures and the follow up exams, to the tune of over $6K.

I had had contact and a couple of conversations with the OCR, but as far as I could tell, nothing had come of it.

I was going through some old paperwork, came across that bill, and the letter I had received from DHHS OCR, and called them to follow up. The person assigned to my case had evidently been tied up in D.C. helping work out the new regs that are going to clarify, among other things, application of section 1557 to transgender care, including transition procedures.

Cool beans. Good excuse for taking a while getting back to me. Anyway, she told me that the complaint had been about prior authorization not going through, and that they had inquired and been told that it had been--which it had, the day before the surgery, which was scheduled and prior authorization asked for almost two weeks in advance. Then I told her about the outstanding bill, and she had some more questions, so I followed up with my doctor's billing person.

Turns out, Mercy Care finally paid for those outstanding bills in November and December. The doctor's office just hadn't bothered sending me statements for $0 owing.

The delay was stress-making--Paying out in November and December for procedures done in January-March. But...they DID finally pay. I have let the OCR person know this.

Some states may have grievance procedures at the state level as well--in my case, I was told that any problems had to be worked out by the doctor's office, not by the patient. I know there are doctor's offices who will use barriers like this as an excuse to not provide care, so that didn't sit well with me.

So, here's the victory lap. Medicaid is supposed to pay for appropriate care for your current anatomy regardless of whether it jives in their coding system with your gender. If they give you grief about this, file a complaint here: http://www.hhs.gov/ocr/filing-with-ocr/index.html .

[Jani]

Thanks for the update Ravin.

Jani

[Charlize]

Thank you for your efforts but i'm sorry you had to go through that stress. We often are under so much pressure as it is when we are facing or recovering medical procedures. No-one needs this kind of runaround. Hopefully you have helped not only yourself but others who would otherwise be denied care by the system.

Hugs,

Charlize

[Oceans3]

Thank you for the information. I hadn't thought health care coverage would apply to me since I'm not having hormones/surgery in regards to being genderqueer. But if a gyno check up can only be coded F and my docs say X....does anyone have experience heading this off in advance? My list of who to notify about my transition keeps getting longer.