GRS and Insurance

[Guest suden]

HI all, My insurance has started to cover GRS. I have spoken with them and inquired about my out of pocket costs. (I,m trying not to get too excited)  I have found a surgeon that is out of state put still in my plan. It all sounds to good to be true! I,m looking down the road a year hoping its still covered then. I was wondering if others have had Insurance pay for GRS and if so What are the pit falls  and hidden trap doors to look out for? Thanks Eden

 

[Carolyn Marie]

I had an orchi done under my insurance plan.  I had no real problems, especially with my GP certifying that the operation was "medically necessary."  The insurance company didn't squawk at all.  I had a good doctor, who, while never having performed on a trans woman, had plenty of experience with men needing the procedure.

The only thing I was upset about was the cost that the insurance company absorbed.  The surgeon charged them what I considered to be a ridiculous amount.  The doctor justified it by telling them she did extra "cosmetic" enhancements.  If I had known in advance what she was planning to charge, I would have questioned it.  

Carolyn Marie

[Guest]

1 hour ago, Carolyn Marie said:

I had an orchi done under my insurance plan.  I had no real problems, especially with my GP certifying that the operation was "medically necessary."  The insurance company didn't squawk at all.  I had a good doctor, who, while never having performed on a trans woman, had plenty of experience with men needing the procedure.

The only thing I was upset about was the cost that the insurance company absorbed.  The surgeon charged them what I considered to be a ridiculous amount.  The doctor justified it by telling them she did extra "cosmetic" enhancements.  If I had known in advance what she was planning to charge, I would have questioned it.  

Carolyn Marie

That is the problem. Medical providers have two different fees. Insured and un-insured. It's horrible and I can't believe the insurance companies let them get away with it.

[VickySGV]

There is also the deal in this that insurance companies do not pay the doctors what they are billed.  Both sides know this and it is part of the medical insurance game. My doctor was happy with the $23 grand I paid her out of pocket, but she billed a friend's insurance company 3 times that, and then settled with them for about a 10% difference in her favor.  Here in Southern California, Kaiser Health  Plan just did their first three in house  GCS operations with only small co-pays to the patients.  I spoke to one of Kaiser's upper management physicians and it boiled down to costing them less than hospitalization costs for suicide attempts that are too close for comfort. 

[MarcieMarie12]

I've heard that too, which is why Kaiser decided to roll it out to all their plans not just policies in localities that require it.

[Guest]

14 hours ago, VickySGV said:

Here in Southern California, Kaiser Health  Plan just did their first three in house  GCS operations with only small co-pays to the patients.  I spoke to one of Kaiser's upper management physicians and it boiled down to costing them less than hospitalization costs for suicide attempts that are too close for comfort. 

Well I'm glad to see that some insurance companies actually understand this isn't vanity or cosmetic.