Thursday, October 30, 2014

Insurance

This is going to be a short blog. I have been trying to figure out how to send an email from a form on a website that I manage. It works on one website that I manage but when I copy it to another website it doesn’t work so sent in a help ticket. Grrr… Just the way I wanted to spend my Thursday morning.

Now that we have insurance everyone thought this will be an answer to all our prays… Wrong!

In the Hartford Courant they had an article about healthcare coverage, “Sex Change Insurance Coverage Increasingly Common,” don’t you just love the title, as if that is the only thing that the insurance covers.

The article is terrible misinformed; they say nothing about Medicare coverage,
"There is an evolving professional consensus that treatment is considered medically necessary for certain individuals who meet established … criteria for a diagnosis of Gender Identity Disorder/Gender Dysphoria," John O'Brien, director of Healthcare and Insurance at the U.S. Office of Personnel Management, wrote in a June 13 bulletin to health insurers.

O'Brien's advisory was sent to health insurers that sell policies on the Federal Employee Health Program, a sort of insurance exchange serving nearly 9 million federal employees, retirees and family members. Coverage for federal employees is largely funded by U.S. taxpayer dollars, though employees also pay a portion of premiums.
 The article sound like Connecticut just passed the anti-discrimination law last year instead of 2011…
Within the past year, the legislature amended Connecticut's anti-discrimination laws to prohibit discrimination based on "gender identity or expression." As a result, HMOs and health insurance companies writing individual, large and small group plans cannot discriminate for coverage of treatment for gender dysphoria — the condition in which a person identifies with a gender different from that person's biological sex — when deemed medically necessary, said Connecticut Insurance Department spokeswoman Donna Tommelleo.
Then the article says, “This change is in accordance with guidance from the Connecticut Department of Insurance, Bulletin HC 34, and effective December 19, 2013.” Umm… no, it was the Insurance Commission bulletin IC 37 that did that not HC 34.

The problem now is that insurance coverage is so new that no one really knows what is covered and what isn't. From what I have heard it depends on who answers the phone at the insurance company, one person might tell you the medical procedure is covered while another operator might tell you that it isn't. It also depends upon how the question is asked or how the doctor codes the procedure.

In addition, if insurance does cover Gender Confirming Surgery it will only cover a fraction of the cost. Many of the doctors are out-of-network and they want the cash up front so there is a large out-of-pocket expense that many trans-people cannot afford.

What we must do now is to take the imitative to define what should be covered and not let the insurance companies dictate to us what is covered. 

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