Insurance with surgeries

[Raven1981]

Been in contact with my insurance and figuring out what they will cover and how much they will cover and my insurance with Cigna will cover the Gender Reassignment Surgery fully for me minus my deductible where if I go in-network it will be 2500 and if out of network then it is 13000.  So That is one reason why I want to make sure to have a doctor that takes my insurance and I have the packet that tells me the requirements that my insurance requires for bottom surgery.  But I am happy that I will be able to have my insurance cover my bottom surgery.

 

Male to female reconstructive genital surgery, which may
include any of the following:
Vaginoplasty**, (e.g, construction of vagina with/without
graft, colovaginoplasty)
Penectomy
Vulvoplasty, (e.g., labiaplasty, clitoroplasty, penile skin
inversion)
Repair of introitus
Coloproctostomy

 

My insurance does not cover breast Augmentation as to it is considered to be cosmetic along with part of FFS like the forhead and brow lift and hair line.  It will not cover VFS or nose, but it will cover the Chin and jawline.

 

So my insurance that I have through my work will only cover 1 item on my face which is fine cause I really want my chin and jawline to me more feminine but wish I had better insurance to cover more on FFS.  Then I am really glad that my insurance will cover the full bottom surgery.

 

[Jani]

Very good Amy.  Look carefully for a surgeon!  

 

Jani

[lauraincolumbia]

You are lucky!  My insurance really doesn't cover anything.  

[Kirsten]

That’s really great! As far as what’s not covered, you should still try to get everything covered. Because anything that is “medically necessary” and that is covered for some other issue (eg breast reconstruction for a cancer patient) means they can not just deny a claim for the same thing because of a different diagnosis. 

 

Basically no matter if it says covered or not, you can still try to get it covered. You never know. And it’s worth the effort of trying just in case I think. 

[Raven1981]

2 hours ago, Kirsten said:

That’s really great! As far as what’s not covered, you should still try to get everything covered. Because anything that is “medically necessary” and that is covered for some other issue (eg breast reconstruction for a cancer patient) means they can not just deny a claim for the same thing because of a different diagnosis. 

 

Basically no matter if it says covered or not, you can still try to get it covered. You never know. And it’s worth the effort of trying just in case I think. 

Thank you Kirsten.  I know through my insurance, bottom is medically necessary.  Also since I am a Cancer survivor from Testicular cancer and have had one of them already taken which is why my T was already low and my cancer spread up to my chest area.  So no matter what, I know that I can get my bottom covered.  Wonder if since I have my medical records and how far my cancer has spread if I can get breast covered as well.

[Kirsten]

having had cancer in the past will not help you. I only mentioned the cancer thing because so many women do have to deal with it.  And because insurance covers reconstruction, by law they can’t deny that surgery completely to anyone.If you can show it to be “medically necessary” you’ll have a chance at having it covered. 

 But having a cancer diagnosis in the past won’t help you with it now. 

[Carolyn Marie]

That is very good news, Amy.  If you can find an in-network surgeon(s) (don't forget the anesthesiologist, etc.) who has experience, that would be awesome.  If not, your insurance company may be willing to let you go out-of-network) for the smaller co-pay, because its not your fault that there's no one in-network who is qualified.  Best of luck to you!

 

HUGS

 

Carolyn Marie

[Kylie]

Amy,

I have Cigna as well. Their coverage is pretty phenomenal.  I suggest you discuss with them about the things that are not 'covered' as I have known others that have managed to get a lot from the insurance. 

 

 

[Raven1981]

3 hours ago, Kylie said:

Amy,

I have Cigna as well. Their coverage is pretty phenomenal.  I suggest you discuss with them about the things that are not 'covered' as I have known others that have managed to get a lot from the insurance. 

 

 

Hello Kylie

 

I know in Cigna there are different plans.  The plan in Cigna I have through my work that they offer is only Cigna HSA High deductible plan.  That does not cover too much.

[KymmieL]

Amy, one thing to make sure you look for is that your whole medical team takes your insurance. I have been seeing stories from the Denver area about people going for surgeries, thinking everything was covered by insurance. yet to get a huge bill from one team member who was out of network. Anesthesiologist mostly.

 

So make sure you research every member of your team.

 

  Kymmie

[Jani]

This is very important!  My wife had this situation recently for a routine test that needed to be evaluated by a non-affiliated doctor.  Ouch! 

Jani