Fighting my insurance company

[ChickenLittle]

I have a hysterectomy scheduled for next Wednesday. Two days ago, we were informed that coverage was denied by Blue Shield California, but they wouldn't tell us or my surgeon why. They refused to have a peer-to-peer call with my surgeon to explain what was going on, and told us on the phone that all they could say was that it was "not a covered benefit." I'm so lucky that my partner works in the medical field and knows the right questions and pathways to find info, because after HOURS on the phone he finally got somebody to admit to him that they denied coverage due to my gender. Mind you, I never changed my gender from F to M with my insurance for just this reason. And the representatives we spoke with called me "miss." 

 

We finally reached somebody who basically told us "I can't tell you anything you don't already know because you know what's going on here. I'll try to advocate for you as best as I can." Between that and my partner being able to get his employer on board (great, now I'm out to them, which I've really been working to avoid), I think it's going to be covered. 

 

But I can't stop thinking, what would have happened if I didn't have a partner who knows how to fight this? Or if he didn't find an ally in his company to fight for us? My surgeon's office told me Blue Shield has been sending them more rejections than average, and that they've been told they can't appeal on the patients' behalf. Most of these patients don't file appeals for themselves, and after the phone calls I've had I imagine it's because they were told by the insurance company that they're not allowed to. 

 

Are there any organizations that exist to help us navigate insurance denials like this, with volunteers or staff who work in the medical or insurance industry and know what to do? I'm glad it's looking like I'll get my surgery but I'm so so angry about what happened and the fact that it's happening to others too.   

[VickySGV]

You are flying the California State flag there, so go to the State Insurance Commissioner's office.  Under California law they are must cover Trans medical procedures. Their investigators love to get involved in this stuff.  BS/BC makes too much money here to get their licenses revoked.

[ChickenLittle]

@VickySGV Perfect, thank you so much! We just got word that it's covered for me (waiting on them to contact the doc today), but I want to make sure it doesn't happen to anybody else.