So Now You Have Insurance… Now What?

Have insurance coverage for trans people is one thing, getting them to pay for trans related procedures is another thing.

Health insurance for transgender people exists. Good luck understanding it.
America claims “Liberty and justice for all,” yet it continues to ignore its transgender citizens' medical struggles.
LGBTQ Nation
By Fei Lu
January 14, 2020

Coming to terms with being transgender is difficult, but getting trans-inclusive insurance is worse.

Socially and legally, cis people are debating whether insurance companies are obligated to cover transition-related costs. Many trans people are now turning to dangerously unregulated transition methods, just to save money.
[…]
Yet depending on the state, insurance companies and Medicaid can discriminate against trans people. Medicaid only covers transition-related costs in 23 states, while states like Alaska can legally deny trans coverage. With 1 in 5 Americans on Medicaid, low-income trans people face two choices: either move to a trans-affirming state or switch to private insurance. 

Here in Connecticut the Insurance Commissioner said that any coverage for cisgender people must also cover trans people and that covers a lot! Gender Confirming Surgery isn’t just one procedure but is make up of something like seven different surgeries and all of them are covered for cisgender people so  therefore they should be covered for us.

There are a few expectations. For example, Blue Cross/Blue Shield Massachusetts (each state differs) considers GCS and facial feminization surgery necessary only when certain criteria are met. 

Here in Connecticut facial feminization surgery should also be covered because once again the surgery is made up of covered surgical procedures.

For my annual physical the insurance company balks at my prostate exam for a woman and I have to fight with them for months to get it covered

Some tips for getting insurance coverage for trans-affirming procedures;

• Don’t take no for an answer, “No” is the favorite answer of the insurance companies because most people do not appeal. If you get a no from an insurance representative hang up, wait a minute or two and call back again so you get a different operator. Sometimes that is all it takes, the original operator might not have been properly trained or was a bigot. 
• Many procedures are gender specific… for example electrolysis. For women hirsutism (L68. 0) is covered so if you want to have it covered you have to be “female” on the insurance policy. So check to see what is covered under what gender before you change your gender markers on your policy.
• Remember the important phrase… “medically necessary.” Otherwise the insurance companies say it is comedic surgery, breast reductions or enlargement are always considered comedic surgery unless the doctor says it is “medically necessary” for your well being.
• There is an insurance code that prevents the claim from automatically rejected and forces a medical override. (Code 45 for Medicare and Code KX for non-Medicare claims)
• If nothing else works it is time to bring out the heavy weights… contact the insurance commissioner‘s office.

Good luck!