Insurance Denied Coverage For My SRS

[Guest Angelgrlsue]

I have received the most devastating news any woman want to hear who was completely ready for SRS. My insurance denied to pay for my SRS. I receive Medicare/Medicaid and the doctor's office put in a letter of authorization to my insurance with a return reply of DENIED!! I do not know the full reason behind the reason why they denied to cover my surgery but will find out soon, I asked the doctor's office to send me a written copy of the letter they received from my insurance. The other concern is that if they did accept to pay for the surgery they would only pay $2,000.00 and no more. I would have to come up with the remaining amount to cover the surgery, which as you know the current price for SRS in the states is close to $30,000.00. I do not have that kind of money, I'm living on a very low fixed income.

Susan

[Guest Sarah Faith]

I have received the most devastating news any woman want to hear who was completely ready for SRS. My insurance denied to pay for my SRS. I receive Medicare/Medicaid and the doctor's office put in a letter of authorization to my insurance with a return reply of DENIED!! I do not know the full reason behind the reason why they denied to cover my surgery but will find out soon, I asked the doctor's office to send me a written copy of the letter they received from my insurance. The other concern is that if they did accept to pay for the surgery they would only pay $2,000.00 and no more. I would have to come up with the remaining amount to cover the surgery, which as you know the current price for SRS in the states is close to $30,000.00. I do not have that kind of money, I'm living on a very low fixed income.

Susan

Well based on conversations I've had with a friend who runs a practice in Cosmetic and Plastic Surgery.. Medicaid and care are both extremely difficult to work with and will often kick out a rejected automatically with little or no reasoning. Really depends on the representitive your Doctor is forced to deal with.. I know that my friend had a rep that was really understanding of the trans care they were providing and would accept it as long as all the paperwork was in order.. Then they got one who really just rejected nearly everything they requested. Unfortunately that's the nature of the giant bureaucracy that is Federal Health Care.

[MarcieMarie12]

Isn't there an appeals process? You might want to check with Lambada Legal or the Transgender Law Center for help navigating this.

[Carolyn Marie]

Isn't there an appeals process? You might want to check with Lambada Legal or the Transgender Law Center for help navigating this.

I agree with Marcie on this. There definitely is an appeal process, and you need to work with your doctor to find out what it is and start an appeal. You should also be aware that it is illegal in California to deny medical coverage for TG health care, and that includes HMO coverage and Medicaid. Medicaid is a state run program and I know for a fact that they cover TG health care in California. So please do start asking questions, because that denial is not the final answer, I promise you.

Carolyn Marie