New job - negotiating health insurance and when/if to disclose about having surgery

[Audrey]

Hi all, I am negotiating a new job offer which I am very excited about! It is a major promotion and career advancement opportunity. But there is a pitfall I am wrestling with about my upcoming vaginoplasty.

 

I am reluctant to change jobs a year away from surgery. My existing health insurance does cover the surgery with a somewhat reasonable deductible. It is possible that the new insurance will have lesser coverage or even no coverage for this, which is a negotiating point for me in the offer to be sure I keep the coverage (through COBRA or otherwise). I am also very hesitant to give any details about my intent to have surgery for fear of discrimination on that basis or my status as a trans person. Not that they can outright say that, but I know that reality can be harsh here.

 

Thank you in advance for your thoughts about how to navigate this delicate issue!

 

Love,

~Audrey.

[emeraldmountain2]

Hi. I don't have experience with this particular situation, but I hope this link is helpful: https://www.dfs.ny.gov/consumers/health_insurance/transgender_healthcare

 

If you fall under the NY protections outlined on that site then it states "your health insurance policy can’t exclude medically necessary gender-affirming treatment as a category of treatment."

[Audrey]

@emeraldmountain2 Thank you for sharing the link! I do know about these protections, but I have learned that my surgeon is not a provider in many insurance plan networks, so the exclusion seems to be happening a different way. She has a sterling reputation and long wait lists of many years for consultations and surgery dates. So I feel I definitely need to keep or go to a plan she works with. Another flaw of the employer driven health insurance system in the U.S. unfortunately.

 

Love,

~Audrey.

[KatieSC]

Audrey,

 

The fact that your surgeon is not a provider in insurance networks is somewhat concerning. I have had experience with going to a surgeon who was not taking insurance, and I thought I would be covered by the out-of-network clauses. I was shocked when I found out that I was not going to get the percentage of coverage quoted as out-of-network. You will get what the insurance company deems is reasonable for reimbursement and not what the surgeon actually charges. I cringe when I see this stuff going on. I know there are some surgeons offering vaginoplasty, and other gender affirming care, that do not accept any insurance. That leaves us vulnerable. Some of the surgeons have a cash only, and too bad if you cannot pay the fee attitude. Fortunately, there are not many of them, but you need to be cautious.

 

There are a number of really good transgender health programs that are in the network of many of the major known insurance plans. Be careful with how you proceed. If you can, ask your prospective employer to share with you the insurance company's name and plan. Then you can call and inquire about coverage. You do not have to disclose your name when you call.

 

New York has some great laws that protect us, but you have to watch the fine print with the surgeons who are not participating in the insurance plans. I am not sure if the insurance commission can help if it is an issue outside of what the insurance company does with in-network resources.

[Audrey]

Thank you Katie. I would share your worry about the insurance issue and the surgeon not having as extensive a network. But she does work with several big players (though only one on the exchange, I noticed). I do know the prospective employer's plan and it is trash. The surgeon is perhaps among the most respected in the field (Drs. Bluebond-Langner and Zhao with NYU Langone), and have been on the schedule for surgery for a year now after my consult at the start of 2023. So I am feeling quite married to my insurance policy or at least one that will work with these doctors and this hospital. COBRA will be my saving grace if I accept the job since I can keep my existing plan, but I hate to turn down a lifetime career opportunity over health insurance. Such is the reality of our system in the U.S.

 

Love,

~Audrey.