->[[EInsuranceStory|E's Insurance Story]]
>><<

!!! Understanding your plan

!!!! Key terms

->''Case Manager'' - Usually a doctor or nurse assigned to you by your insurance company to help you understand your plan, as well as advise you in health care decisions.
->''Co-insurance'' - Percent of the medical costs you are required to pay.
->''Copay'' - Fixed cost of medical services, varies from service to service.
->''Deductible'' - Amount one must pay before insurance will start to cover medical services.
->''Network'' - Group of healthcare providers who have signed a contract with an insurance company(s).
->''HMO'' - Health Maintenance Organizations, a single network based healthcare plan managed by a PCP.
->''PCP'' - Primary Care Provider, your primary doctor. Required by most HMO insurance plans.
->''PPO'' - Preferred Provider Organizations, a multi-network based healthcare plan.
->''Provider'' - Any doctor, or specialist who provides healthcare.
->''Specialist'' - Healthcare provider who provides a special service that your normal doctor cannot.

!!!! Checking for TG/TS related coverage

!!!! More About Insurance Plans

!!!!! HMO - Health Maintenance Organizations

An HMO plan is when your insurance company 

* You are required to have a Primary Care Provider ('''PCP''')

!!!!! PPO - Preferred Provider Organizations

* You do not need to select a Primary Care Provider ('''PCP''').

!! Insurance Requirements

!!! [[Glossary#GCS|GCS]]/[[Glossary#SRS|SRS]] Coverage

* [[http://www.aetna.com/cpb/medical/data/600_699/0615.html|Aetna]]
* [[https://medicalpolicies.amerigroup.com/medicalpolicies/guidelines/gl_pw_a051166.htm|Amerigroup]]
* [[http://www.anthem.com/ca/medicalpolicies/guidelines/gl_pw_a051166.htm|Anthem Blue Cross Blue Shield]]
* [[http://www.bcbsil.com/PDF/providermanual/hmo_scope_of_benefits.pdf|Blue Cross Blue Shield of Illinois (HMO)]]
* [[http://www.bluecrossma.com/common/en_US/medical_policies/189%20Transgender%20Services%20prn.pdf|Blue Cross Blue Shield of Massachusetts]]
* [[http://secure.bcbsm.com/mprApp/MedicalPolicyDocument?fileId=2067929|Blue Cross Blue Shield of Michigan]]
* [[https://www.bcbsnc.com/assets/services/public/pdfs/medicalpolicy/gender_reassignment_surgery.pdf|Blue Cross Blue Shield of North Carolina]]
* [[https://bb.thor.org/Bulletins/Blue_Cross_Blue_Shield_ND_Medical_Policy/Gender_Reassignment_.htm|Blue Cross Blue Shield of North Dakota]]
* [[https://www.bcbsri.com/sites/default/files/polices/Gender_Reassignment_Surgery.pdf|Blue Cross Blue Shield of Rhode Island]]
* [[http://www.bcbst.com/mpmanual/!SSL!/WebHelp/mpmprov.htm|Blue Cross Blue Shield of Tennessee]]
* [[http://www.bcbsvt.com/wps/wcm/connect/ff21090c-2d6a-41f5-91d6-164b7aa6f81b/med-policy-gender-reasignment-surgery-uvm-2013.pdf?MOD=AJPERES|Blue Cross Blue Shield of Vermont]]
* [[https://www.blueshieldca.com/provider/content_assets/documents/download/public/bscpolicy/Gender_RA_Surg.pdf|Blue Shield of California]]
* [[http://notesnet.carefirst.com/Ecommerce/medicalpolicy.nsf/vwWebTableX/393CF5B396A7884685257CDE006C25B6?OpenDocument|Care First]]
* [[https://cignaforhcp.cigna.com/public/content/pdf/coveragePolicies/medical/mm_0266_coveragepositioncriteria_gender_reassignment_surgery.pdf|Cigna]]
* [[http://www.emblemhealth.com/~/media/Files/PDF/_med_guidelines/MG_Gender_Reassignment_Surgery_C.pdf|Emblem Health]]
* [[https://www.excellusbcbs.com/wps/wcm/connect/3bdf3fa6-609d-487d-9e5c-dfa6a89fb1d4/mp+sex_+reassign+mpc3+13.pdf?MOD=AJPERES&CACHEID=3bdf3fa6-609d-487d-9e5c-dfa6a89fb1d4|Excellus Blue Cross Blue Shield]]
* [[https://www.healthnet.com/portal/provider/content/iwc/provider/unprotected/working_with_HN/content/medical_policies.action#G|Health Net]]
* [[https://www.healthpartners.com/public/coverage-criteria/gender-reassignment/|HealthPartners]]
* [[https://secure.highmark.com/ldap/medicalpolicy/wpa-highmark/S-184-004.html|Highmark]]
* [[http://medpolicy.ibx.com/policies/mpi.nsf/6eeddf656d983ec98525695e0068df68/85256aa800623d7a85257aa8004a9867!OpenDocument&Highlight=0,sex,reassignment|Independence Blue Cross]]
* [[https://www.nhp.org/provider/medicalpolicies/Gender_Reassignment_Surgery_024.pdf|Neighborhood Health Plan]]
* [[https://www.unitedhealthcareonline.com/ccmcontent/ProviderII/UHC/en-US/Assets/ProviderStaticFiles/ProviderStaticFilesPdf/Tools%20and%20Resources/Policies%20and%20Protocols/Medical%20Policies/Medical%20Policies/Gender_Identity_Disorder_CD.pdf|UnitedHealthcare]]
* [[http://www.wellmark.com/Provider/MedpoliciesAndAuthorizations/MedicalPolicies/policies/Gender_Reassignment.aspx|Wellmark Blue Cross Blue Shield]]

!!!! TG/TS Service Coverage

* [[http://www.unicare.com/medicalpolicies/guidelines/gl_pw_a051166.htm|WellPoint - UniCare]]
* [[https://www1.ghc.org/html/public/services/transgender|Group Health Cooperative]]
* [[https://www.harvardpilgrim.org/pls/portal/docs/PAGE/PROVIDERS/MEDMGMT/MEDICAL_REVIEW_CRITERIA/FULLY_INSURED_TRANSGENDER_CRITERIA_0714.PDF|Harvard Pilgrim Health Care]]

Source(s): [[http://www.hrc.org/resources/entry/finding-insurance-for-transgender-related-healthcare|HRC.org - Finding Insurance for Transgender-Related Healthcare]]

Tags: (:tags srs, gcs, trans health, insurance, ppo, hmo:)

%rframe% '''Categories:''' [[!Surgery]]

[[E's Insurance Story -> Main.EInsuranceStory]]

!!!Understanding your plan

!!!!Key terms

''Case Manager'' - Usually a doctor or nurse assigned to you by your insurance company to help you understand your plan, as well as advise you in health care decisions. ''Co-insurance'' - Percent of the medical costs you are required to pay. ''Copay'' - Fixed cost of medical services, varies from service to service. ''Deductible'' - Amount one must pay before insurance will start to cover medical services. ''Network'' - Group of healthcare providers who have signed a contract with an insurance company(s). ''HMO'' - Health Maintenance Organizations, a single network based healthcare plan managed by a PCP. ''PCP'' - Primary Care Provider, your primary doctor. Required by most HMO insurance plans. ''PPO'' - Preferred Provider Organizations, a multi-network based healthcare plan. ''Provider'' - Any doctor, or specialist who provides healthcare. ''Specialist'' - Healthcare provider who provides a special service that your normal doctor cannot.

!!!!Checking for TG/TS related coverage

!!!!More About Insurance Plans

!!!!!HMO - Health Maintenance Organizations

An HMO plan is when your insurance company

* You are required to have a Primary Care Provider (PCP)

!!!!!PPO - Preferred Provider Organizations

* You do not need to select a Primary Care Provider (PCP).

!!Insurance Requirements

!!! [[GCS -> Main.Glossary#GCS]]/ [[SRS -> Main.Glossary#SRS]] Coverage

* [[Aetna -> http://www.aetna.com/cpb/medical/data/600_699/0615.html]]
* [[Amerigroup -> https://medicalpolicies.amerigroup.com/medicalpolicies/guidelines/gl_pw_a051166.htm]]
* [[Anthem Blue Cross Blue Shield -> http://www.anthem.com/ca/medicalpolicies/guidelines/gl_pw_a051166.htm]]
* [[Blue Cross Blue Shield of Illinois (HMO) -> http://www.bcbsil.com/PDF/providermanual/hmo_scope_of_benefits.pdf]]
* [[Blue Cross Blue Shield of Massachusetts -> http://www.bluecrossma.com/common/en_US/medical_policies/189%20Transgender%20Services%20prn.pdf]]
* [[Blue Cross Blue Shield of Michigan -> http://secure.bcbsm.com/mprApp/MedicalPolicyDocument?fileId=2067929]]
* [[Blue Cross Blue Shield of North Carolina -> https://www.bcbsnc.com/assets/services/public/pdfs/medicalpolicy/gender_reassignment_surgery.pdf]]
* [[Blue Cross Blue Shield of North Dakota -> https://bb.thor.org/Bulletins/Blue_Cross_Blue_Shield_ND_Medical_Policy/Gender_Reassignment_.htm]]
* [[Blue Cross Blue Shield of Rhode Island -> https://www.bcbsri.com/sites/default/files/polices/Gender_Reassignment_Surgery.pdf]]
* [[Blue Cross Blue Shield of Tennessee -> http://www.bcbst.com/mpmanual/!SSL!/WebHelp/mpmprov.htm]]
* [[Blue Cross Blue Shield of Vermont -> http://www.bcbsvt.com/wps/wcm/connect/ff21090c-2d6a-41f5-91d6-164b7aa6f81b/med-policy-gender-reasignment-surgery-uvm-2013.pdf?MOD=AJPERES]]
* [[Blue Shield of California -> https://www.blueshieldca.com/provider/content_assets/documents/download/public/bscpolicy/Gender_RA_Surg.pdf]]
* [[Care First -> http://notesnet.carefirst.com/Ecommerce/medicalpolicy.nsf/vwWebTableX/393CF5B396A7884685257CDE006C25B6?OpenDocument]]
* [[Cigna -> https://cignaforhcp.cigna.com/public/content/pdf/coveragePolicies/medical/mm_0266_coveragepositioncriteria_gender_reassignment_surgery.pdf]]
* [[Emblem Health -> http://www.emblemhealth.com/~/media/Files/PDF/_med_guidelines/MG_Gender_Reassignment_Surgery_C.pdf]]
* [[Excellus Blue Cross Blue Shield -> https://www.excellusbcbs.com/wps/wcm/connect/3bdf3fa6-609d-487d-9e5c-dfa6a89fb1d4/mp+sex_+reassign+mpc3+13.pdf?MOD=AJPERES&CACHEID=3bdf3fa6-609d-487d-9e5c-dfa6a89fb1d4]]
* [[Health Net -> https://www.healthnet.com/portal/provider/content/iwc/provider/unprotected/working_with_HN/content/medical_policies.action#G]]
* [[HealthPartners -> https://www.healthpartners.com/public/coverage-criteria/gender-reassignment/]]
* [[Highmark -> https://secure.highmark.com/ldap/medicalpolicy/wpa-highmark/S-184-004.html]]
* [[Independence Blue Cross -> http://medpolicy.ibx.com/policies/mpi.nsf/6eeddf656d983ec98525695e0068df68/85256aa800623d7a85257aa8004a9867!OpenDocument&Highlight=0,sex,reassignment]]
* [[Neighborhood Health Plan -> https://www.nhp.org/provider/medicalpolicies/Gender_Reassignment_Surgery_024.pdf]]
* [[UnitedHealthcare -> https://www.unitedhealthcareonline.com/ccmcontent/ProviderII/UHC/en-US/Assets/ProviderStaticFiles/ProviderStaticFilesPdf/Tools%20and%20Resources/Policies%20and%20Protocols/Medical%20Policies/Medical%20Policies/Gender_Identity_Disorder_CD.pdf]]
* [[Wellmark Blue Cross Blue Shield -> http://www.wellmark.com/Provider/MedpoliciesAndAuthorizations/MedicalPolicies/policies/Gender_Reassignment.aspx]]

!!!!TG/TS Service Coverage

* [[WellPoint - UniCare -> http://www.unicare.com/medicalpolicies/guidelines/gl_pw_a051166.htm]]
* [[Group Health Cooperative -> https://www1.ghc.org/html/public/services/transgender]]
* [[Harvard Pilgrim Health Care -> https://www.harvardpilgrim.org/pls/portal/docs/PAGE/PROVIDERS/MEDMGMT/MEDICAL_REVIEW_CRITERIA/FULLY_INSURED_TRANSGENDER_CRITERIA_0714.PDF]]

Source(s): [[HRC.org - Finding Insurance for Transgender-Related Healthcare -> http://www.hrc.org/resources/entry/finding-insurance-for-transgender-related-healthcare]]

Tags: [[srs -> ?action=tags&tag=srs]], [[gcs -> ?action=tags&tag=gcs]], [[trans health -> ?action=tags&tag=trans health]], [[insurance -> ?action=tags&tag=insurance]], [[ppo -> ?action=tags&tag=ppo]], [[hmo -> ?action=tags&tag=hmo]]

Metadata -- keep at end of page Summary:Basics on insurance transsexuals Tags: stories

 '''Categories:''' [[Category/Surgery]] |

  [[Register -> https://transadvice.org/user/register]] - [[Edit -> Main.Insurance]] - [[History -> Main.Insurance]] - [[Print -> Main.Insurance]] - [[Recent Changes]] - [[Site/Search]]Page last modified on April 03, 2016, at 07:35 PM

If you do find TG/TS services specifically listed in the ''limitations and exclusions'' of your plan do not give up! These days an increasing number of plans have the ability so simply add TG/TS services such as SRS/GCS to an existing or new plan for little or no extra cost. If you get your health care though an employer you will have to talk to your Human Resources Department to ask if they can add it to your plan. In general it may only take a single phone call for them to add it to your plan if they are willing to do it.

If you do not find Transgender/Transsexual Services such as sexual reassignment surgery, therapy, or hormone replacement therapy in the ''limitations and exclusions'' section of your plan, this means those services are covered. The next step is to read your plan, or call your insurance provider to confirm what services are covered and what the copay/co-insurance cost would be.

If you do not find Transgender/Transsexual Services such as sexual reassignment surgery, therapy, or hormone replacement therapy in the ''limitations and exclusions'' section of your plan. The next step is to read your plan, or call your insurance provider to confirm what services are covered and what the copay/co-insurance cost would be.

The first thing to do when checking a plan for coverage is to check the ''limitations and exclusions'' list. This list can be obtained from your current or potential healthcare provider, and can be found on your instance providers website when you log in. If you need an updated copy of it due to a policy change it can be requested as needed. It is recommended that if you get your insurance through your employer, that you get this list from the insurance company itself as the copy they have on file may be out of date.

More and more insurance companies are starting to cover TG/TS services, such as but not limited to: Hormone Replacement Therapy (HRT), Behavior Health (therapist), and transition related surgeries.

Here are some people experience getting their health care to cover TG/TS Services:

->[[EInsuranceStory|E's Insurance Story]]

!!! [[Glossary#GCS|GCS]]/[[Glossary#SRS|SRS]] Coverage

!!!! TG/TS Service Coverage

!!!! More About Insurance Plans

Here is a quick summery about different types popular healthcare plans.

!!!!! HMO - Health Maintenance Organizations

!!!!! PPO - Preferred Provider Organizations

If you do find TG/TS services specifically listed in the ''limitations and exclusions'' of your plan do not give up! These days an increasing number of plans have the ability so simply add TG/TS services such as SRS/GCS to an existing or new plan for little or no extra cost. If you get your health care though an employee you will have to talk to your Human Resources Department to ask if they can add it to your plan. In general it may only take a single phone call for them to add it to your plan if they are willing to do it.

->''Co-insurance'' - Percent of the medical costs you are required to pay.
->''Copay'' - Fixed cost of medical services, varies from service to service.
->''Deductible'' - Amount one must pay before insurance will start to cover medical services.
->''Network'' - Group of healthcare providers who have signed a contract with an insurance company(s).
->''HMO'' - Health Maintenance Organizations, a single network based healthcare plan managed by a PCP.
->''PCP'' - Primary Care Provider, your primary doctor. Required by most HMO insurance plans.
->''PPO'' - Preferred Provider Organizations, a multi-network based healthcare plan.
->''Provider'' - Any doctor, or specialist who provides healthcare.
->''Specialist'' - Healthcare provider who provides a special service that your normal doctor cannot.

->Co-insurance - Percent of the medical costs you are required to pay.
->Copay - Fixed cost of medical services, varies from service to service.
->Deductible - Amount one must pay before insurance will start to cover medical services.
->Network - Group of healthcare providers who have signed a contract with an insurance company(s).
->HMO - Health Maintenance Organizations, a single network based healthcare plan managed by a PCP.
->PCP - Primary Care Provider, your primary doctor. Required by most HMO insurance plans.
->PPO - Preferred Provider Organizations, a multi-network based healthcare plan.
->Provider - Any doctor, or specialist who provides healthcare.
->Specialist - Healthcare provider who provides a special service that your normal doctor cannot.

* Specialist - Healthcare provider who provides a special service that your normal doctor cannot.

If you do not fine Transgender/Transsexual Services such as sexual reassignment surgery, therapy, or hormone replacement therapy in the ''limitations and exclusions'' section of your plan. The next step is to read your plan, or call your insurance provider to confirm what services are covered and what the copay/co-insurance cost would be.

If you do find TG/TS services specifically listed in the ''limitations and exclusions'' of your plan do not give up! These days an increasing number of plans have the ability so simply add TG/TS services such as SRS/GCS to an existing or new plan for little or no extra cost. If you get your health care though an employee you will have to talk to your Human Resources Department

The first thing to do when checking a plan for coverage is to check the ''limitations and exclusions'' list. This list can be obtained from your current or potential healthcare provider, and can be requested as needed. It is recommended that if you get your insurance through your employer, that you get this list from the insurance company itself as the copy they have on file may be out of date.

Once you check the

When selecting a plan, there are a few things that are key too look for to see if TG/TS related care will be available. The following sections will attempt to outline the following items:

* The differences between HMO and PPO plans.
* How to identify what TG/TS related services are covered.
* What steps to take, to get TG/TS related services covered if they are not.

!! Insurance coverage for Transgender/Transsexual (TG/TS) related services

* Your '''PCP''' will '''refer''' you to a '''specialist''' in the HMO's network if required.
* If a '''specialist''' can not be found in your network, you can be '''referred''' to an out-of-network provider (this may or may not cost extra).
* A lower a copay/deductible compared to a PPO plan.

!! Insurance Requirements

!!! [[Glossary#GCS|GCS]]/[[Glossary#SRS|SRS]]

* [[http://www.bluecrossma.com/common/en_US/medical_policies/189%20Transgender%20Services%20prn.pdf|Blue Cross Blue Shield of Massachusetts]]

* [[https://cignaforhcp.cigna.com/public/content/pdf/coveragePolicies/medical/mm_0266_coveragepositioncriteria_gender_reassignment_surgery.pdf|Cigna]]
* [[http://www.emblemhealth.com/~/media/Files/PDF/_med_guidelines/MG_Gender_Reassignment_Surgery_C.pdf|Emblem Health]]

Tags: (:tags srs, gcs, trans health, insurance, ppo, hmo:)