Good insurance that covers MtF HRT? And a question about sugaring?

[flyinhawaiian16]

I was recently given false information that I qualify for insurance through my workplace, so now I'm kinda scrambling to find something I can afford that will cover my impending/needed HRT. Does anyone have an advice/insight, or at least know how to look into it further/narrow down a company?

And another question, while I'm here. I recently learned about sugaring, a home-diy version of waxing, and it seems inexpensive, easy, and as effective/long lasting as waxing. Anyone have any advice on that?

Thanks for your time <3

[Carolyn Marie]

The insurance question is a tough one, hon.  It depends on the insurance regulations in your state for starters.  Maine does not mandate TG health insurance coverage, unfortunately.  You can try the Affordable Care Act marketplace, but if Trump hasn't had the regulations changed already, they likely will be in the near future.  The ACA mandated such coverage for insurers in that program.

Outside of that, I suggest checking with an insurance broker to see if there are any insurers that are covering TG care on their own initiative.

I have no advice or information about sugaring.

HUGS

Carolyn Marie

[Briana]

I can speak to the sugaring!  Don't waste your money.  Conceptually it seems like it would work.  We've tried many versions of it and none of them worked as advertised.  Sticky mess...good for the ants and bees.

Insurance is soooo tricky.  Even what seems straight forward many times isn't.  I've found that much legwork up front pays in the end.  Many times it's identifying plans that are available and calling them and explaining your particular needs or concerns.  From there most times you can get straight info on what they will and won't cover and if it's the insurance for you. 

[Cecilia]

I hope this helps - this is Blue Cross Blue Shield.

 

Medical Policy
Transgender Services

Policy Number: 189
BCBSA Reference Number: N/A
NCD/LCD: N/A

Policy
Commercial Members: Managed Care (HMO and POS), PPO, and Indemnity
Medicare HMO BlueSM and Medicare PPO BlueSM Members
Please Note: According to the American Psychiatric Association, the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) defines gender dysphoria as a condition where a person’s gender at birth is contrary to the one they identify with. This definition replaces the criteria for gender identity disorder which will no longer be used in DSM-5. However, ICD-9 and ICD-10 codes continue to use the term gender identity disorder, and providers will need to submit claims for coverage using this diagnosis.

Breast augmentation in male to female patients may be considered MEDICALLY NECESSARY when ALL of the following candidate criteria are met:
 The candidate is at least 18 years of age,
o If the candidate is less than 18 years of age, then treating clinician must submit information indicating why it would be clinically inappropriate to require the candidate to meet this criterion.
 The candidate has been diagnosed with gender dysphoria (ICD-9 code 302.85 gender identity disorder), including meeting ALL of the following indications:
o The desire to live and be accepted as a member of another sex other than one’s assigned sex, typically accompanied by the desire to make the physical body as congruent as possible with the identified sex through surgery and hormone treatment
o The new gender identity has been present for at least 12 months
o The gender dysphoria (ICD-9 code 302.85 gender identity disorder) is not a symptom of another mental disorder.
 For those candidates without a medical contraindication, the candidate has undergone a minimum of 12 months of continuous hormonal therapy that is provided under the supervision of a licensed clinician.
 The candidate has completed a minimum of 12 months of successful continuous full time real-life experience in their new gender, with no returning to their original gender
o If the candidate does not meet the 12 month time frame criteria of 12 months of successful continuous full time real-life experience in their new gender noted above, then the treating clinician must submit information indicating why it would be clinically inappropriate to require the candidate to meet these criteria. When submitted, the criteria of 12 months of successful continuous full time real-life experience in their new gender may be waived.
Genital surgery in male to female or female to male patients may be considered MEDICALLY NECESSARY when ALL of the following candidate criteria are met as documented by two treating clinicians:
 The candidate is at least 18 years of age,
o If the candidate is less than 18 years of age, then treating clinicians must submit information indicating why it would be clinically inappropriate to require the candidate to meet this criterion.
 The candidate has been diagnosed with gender dysphoria (ICD-9 code 302.85 gender identity disorder), including meeting ALL of the following indications:
o The desire to live and be accepted as a member of another sex other than one’s assigned sex, typically accompanied by the desire to make the physical body as congruent as possible with the identified sex through surgery and hormone treatment
o The new gender identity has been present for at least 12 months
o The gender dysphoria (ICD-9 code 302.85 gender identity disorder) is not a symptom of another mental disorder.
 For those candidates without a medical contraindication, the candidate has undergone a minimum of 12 months of continuous hormonal therapy that is provided under the supervision of a licensed clinician.
 The candidate has completed a minimum of 12 months of successful continuous full time real-life experience in their new gender, with no returning to their original gender
o If the candidate does not meet the 12 month time frame criteria of 12 months of successful continuous full time real-life experience in their new gender noted above, then the treating clinician must submit information indicating why it would be clinically inappropriate to require
3
the candidate to meet these criteria. When submitted, the criteria of 12 months of successful continuous full time real-life experience in their new gender may be waived.
Facial Feminization (typical components of facial feminization) or Masculinization may be considered MEDICALLY NECESSARY when ALL of the following candidate criteria are met:
 The candidate is at least 18 years of age,
o If the candidate is less than 18 years of age, then the treating clinician must submit information indicating why it would be clinically inappropriate to require the candidate to meet this criterion.
 The candidate has been diagnosed with gender dysphoria (ICD-9 code 302.85 gender identity disorder), including meeting ALL of the following indications:
o The desire to live and be accepted as a member of another sex other than one’s assigned sex, typically accompanied by the desire to make the physical body as congruent as possible with the identified sex through surgery and hormone treatment
o The new gender identity has been present for at least 12 months
o The gender dysphoria (ICD-9 code 302.85 gender identity disorder) is not a symptom of another mental disorder.
 The candidate has completed a minimum of 12 months of successful continuous full time real-life experience in their new gender, with no returning to their original gender
o If the candidate does not meet the 12 month time frame criteria of 12 months of successful continuous full time real-life experience in their new gender noted above, then the treating clinician must submit information indicating why it would be clinically inappropriate to require the candidate to meet these criteria. When submitted, the criteria of 12 months of successful continuous full time real-life experience in their new gender may be waived.
Electrolysis performed by a licensed dermatologist may be considered MEDICALLY NECESSARY for the removal of hair on a skin graft donor site prior to its use in genital sex reassignment surgery.