Having GRS since the new healthcare laws

[Guest Lizzie McTrucker]

I'm wondering since the health care reforms have begun, are insurance companies more likely now to cover GRS or is it the same as before where many don't and just a select few do? I have Anthem BCBS of Indiana and reading their website I'm kind of unclear if it's covered or not. I'm kind of hoping with the health care reform that more insurance companies now cover it but I'm just as confused now reading their website as I was about a year or two ago when I first tried searching for information. It might just boil down to what coverage my employer is paying for but who knows.

Granted, yes, I could call the # on the back of my card but I figured I'd ask here first. (also I hate talking on the phone with my voice)

[Charlize]

I can only say i hate the medical situation here and especially the insurance "industry" whose goal is to make money and not provide care. Denials even if not justified often seem to be constant with the commercial policies i've had. Medicare is at least seemingly honest in it's approach.

Lizzy if you do call to get their approval make sure to keep notes, times and the names of the people with whom you speak. Even better get them to send you a note or point out where in the policy you are covered.

Hugs,

Charlize

[Guest Ky_Ki]

I think it more depends on your state and if they require it. I'm in Georgia wuth Cigna and it explicitly covers NOTHING to do with transgender issues. But pretty sure the same kind of plan would in California for instance.

[Carolyn Marie]

As I understand it, he new Federal rules "allow" insurers to cover GD-related health care, but don't mandate it. A few states mandate that insurers cover GD care, and some include it under Medicaid. In short, its a hodgepodge (first time I've used that word I think ) and you'll need to do some research, Lizzie. Sorry I couldn't be more helpful.

Carolyn Marie

[Guest]

As I understand it, he new Federal rules "allow" insurers to cover GD-related health care, but don't mandate it. A few states mandate that insurers cover GD care, and some include it under Medicaid. In short, its a hodgepodge (first time I've used that word I think ) and you'll need to do some research, Lizzie. Sorry I couldn't be more helpful.

Carolyn Marie

It is my understanding and I could be wrong but, Federal is working more towards not allowing carriers to forbid gender care. It does not have to be a blanket coverage in the policies. That is up to the carriers discretion. Where does that leave us? Insurance companies are able to do procedures on a case by case basis if one files for an Organizational Determination. That would give carriers more control than a blanket open door coverage that could leave them with a landslide of claims. As we all get a handle on healthcare reform, I suspect that coverage will become more common and accessible.

OK how does one get one? By having all your doctors on board, with all the letters and supporting documentation ready, all I's dotted, all Tee's crossed before filing the request. The GT says it is vitally medically necessary and you are in suitable mental health to receive it. Your medical doctor(s) also supports a vital medical need. Also the issue of health and quality of life. Then it is submitted and you wait. If the answer is favorable, very good. If no, you have to appeal. It may be covered completely or with the co-pay of the carrier's choice. It is worth a shot, but you have to be ready. Don't do any tire kicking inquiries.

This comes with my usual JodyAnn disclaimer: I am not an insurance agent or carrier, nor have I ever played on on TV or DVD. This is the information I have gathered to use for myself. Your mileage may very. I am working to get all the steps in place and I will be one of the OD pioneers to get my new motor and help others in the future. "I want to trade in my old Hot Rod for a new Sports Car... I don't think I will let any men drive it though???" Giggle. That's my $.02, I'm sure others could possibly find fault with my findings. Please do your own research, this is just a clue where to look. Hug. JodyAnn

[KathrynJulia]

Hi Lizzie

It's still a mess out there. Each state and insurance carrier is a yes - no - maybe? Many large employers self insure and hire aninsurance company to manage their employee health care which can really make it a nightmare. I was employed by the University of Missouri which uses Coventry Healthcare to manage their health plan. They have the usual we don't cover Sex Reassignment Surgery clause.

I went to my HR with letters from my Gender Therapist, Clinical PhD Psychologist, and a letter from my HRT prescribing physician who all were on board that in my case, GRS was a medical necessity. I had all of the policy letters from the AMA, Psychiatry and Psychology, Society of family Practice, you get the idea, all the Professional associations that have come out and stated that surgery is a medical necessity and ought to be covered. Put it all in a 3 ring binder. I even wrote my doctors letter and my Gender Therapist used my letter as a template to write her letter. I'm pretty good at writing a very professional medical letters of recommendation. This all was sent into Coventry for evaluation. I was called by two of the insurance companies doctors and had a phone consultation that lasted over an hour. These two doctors both wrote letters recommending that Coventry cover my procedure.

On top of that, the University Board of Curators added Gender Identity and Gender expression to their non-discrimination policy. In the end it was denied because of the exclusion in the policy. At my age and Dysphoria was really kicking my butt, I went to Thailand and paid for myself. I weenied out. I could have fought this and won based on medical necessity, I just didn't have the time to fight it.

What I've learned is even when their is a non-discrimination policy, doesn't mean squat. When the company is more into appearances, hey look how wonderful we are and how enlightened we are because we have this cutsy policy on paper. We just don't enforce our own policy unless somebody embarrasses us big time by suing us. It's still a crappy world for us TS people who as the Vice-President acknowledged, Transgender people are the last group of people in the United States to be afforded Human Rights. It's coming, sometime in the next decade. In short, at 59 years old, I just didn't have the luxury of time to push this through.

And even playing nice and taking it through the employers own procedures, it still cost me my job. I stilled retired early from the University and I may still write a book about my experiences. Lizzy, it's still a crap shoot on whether or not insurance will cover your surgery. I spent 31 days in Thailand. Had world class healthcare over their. Enjoyed a heck of a trip and saw a nice piece of the world for around 14 thousand dollars which covered everything. Or you can have your surgery here in the U.S. For approximately 20 to 30 thousand dollars depending on the surgeon. There's no guarantee on insurance coverage out there yet except for a half dozen states that mandate coverage. Good luck getting coverage. Kathy

[Guest ToriLynn]

One thing to remember is that since Medicare will be covering GRS and because of that you will more than likely see a slow shift to everyone covering. It will take time but normally medicare, at least when i was dealing with insurance companies, sets the minimum standard for what is covered by other companies. That said, it may not apply in this case due to the feeling many have toward the the community depending on where you live.

Hugs,

Tori

[Guest Ky_Ki]

The Medicare thing is a double edged sword. Dr. Bowers was apparently just talking about it. Apparently Medicare won't pay anywhere near what the top surgeons charge and since the Drs can't ask for more money on top of Medicare they're essentially left in a position of not being able to accept it -which might hurt their elgibity with other insurers as well.

[Guest ToriLynn]

The Medicare thing is a double edged sword. Dr. Bowers was apparently just talking about it. Apparently Medicare won't pay anywhere near what the top surgeons charge and since the Drs can't ask for more money on top of Medicare they're essentially left in a position of not being able to accept it -which might hurt their elgibity with other insurers as well.

This is very true and medicare covering something is normally a double edged sword no matter what you are talking about due to the fact that what medicare pays is the standard for all insurance companies. However, there are still companies that will cover more than what medicare covers and i was speaking solely on the coverage. As with anything if you want better coverage you buy high end policies. But, since medicare does cover it you will see other companies start to. The amount they will cover will be dependent on the company and the policy.

Hugs

Tori

[Guest]

I want to go the overseas route too, talking to other people who have convince me that there are far more successes than the failures of the past. Hug. JodyAnn

[Guest Deenah]

Here in Wisconsin, United health care will cover up to $75,000 lifetime for anything transgender related. Now that's if you can afford the $728 a month premium. They also told me that there is no waiting period to use such insurance.

I know I can't afford it anymore since I changed my job.

Keep praying girls