stardraigh wrote:
beneficii wrote:
OK, y'all, I've got a conundrum. Last year, I called the insurance company and asked about the exclusions on my employer's self-funded group plan (which I'm a part of) and they said all transition-related care from therapy through hormones to surgery was excluded. Now, I found out from my endocrinologist that all this time I've been doing hormones, he's been billing my insurance company for both office visits and lab work (to include checking the T and the E) using the ICD-9 CM code 302.85, which is "Gender identity disorder in adolescents or adults." According to my Explanations of Benefits, those office visits and lab work have all been covered except for the specialist co-pay. In addition, my estradiol prescriptions and (previously) my spironolactone prescriptions have all been covered by our prescription drug plan, except for the co-pay for generics.
Does anyone have an explanation for this discrepancy? It's not like my endocrinologist hasn't been open about what these hormones are being used for, LOL.
Should I move forward, like HR originally recommended, and try to get preauthorization for SRS or would that come back to bite me?
When I started HRT with my previous doc, He said that he would bill my insurance a different way than how he would normally do so in order for them to not immediately refuse it. I didn't understand the explanation so I don't have details. Needless to say, they've been covering everything so far with checkup visits and the prescriptions except for one drug which they only cover under 1 specific circumstance and I don't fit that.
My local LGBT community center recommended to a support group I occasionally attend there, that we should bill our insurance anyway for everything. If they refuse, appeal it. If they refuse again, appeal again, and keep on and eventually they would cave. They mentioned two others mtf trans who were known to several in the room at the time had experienced this and upon several appeals finally had their insurance cover SRS among other things. This isn't to say it will always work out like that, but it can happen.
For myself, I'm trying to get all my ducks in a row. I'm literally typing this right now as I'm doing an allergy test. I get surgery on my knee in a week. I just did hair transplant surgery a month ago. I'm trying to get everything taken care of both for transitioning and otherwise. I'm having a hard time saving up anything because I spend it on my few hobbies to stay sane and paying off my hair transplant. I don't expect Aetna to cover anything, and will at some point save up what I can and finance the rest. Ideally, Aetna will cover it and I can spend what I saved up on either the copay, and/or additional surgeries like FFS.
Ja. That's why I'm pressing my therapist to write the letter and to get another therapist in a purely evaluative role to write teh letter, too, and then to apply and press on both ends, the insurance company end and the HR end. I think that as we move forward in time, with the way Obamacare is set up, with the resolutions by the major psychiatric organizations, a whole lot of the recent court rulings on SRS, some states and many employers and schools covering SRS on their health plans (without running into major cost problems), and being more likely to be backed up by doctors, this process will become more and more likely to succeed until universal coverage for SRS is won. Of course, the downside is that my company is based in the South.
I have that same issue with saving; however, I see that my retirement accounts are slowly building up, so that option remains and I should be able to use it in the next 5 years, assuming no major economic collapse because of like peak oil in 2015 or something. I think our issues with saving are more executive functioning issues. It makes things more frustrating.
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"You have a responsibility to consider all sides of a problem and a responsibility to make a judgment and a responsibility to care for all involved." --Ian Danskin
26 Nov 2013, 4:09 pm
