So much for health insurence

[Niya W]

I applied for Kaiser and I was denied. Want to guess why ?? Drum roll please. G.I.D. Thank you very much for playing. Please dont come back again Kaiser dont want your type.





Thank you for submitting your request for reconsideration of our denial of your application for Kaiser Permanente for Individuals and Families Plan (KPIF). After careful consideration of all information available to us during this process, we remain unable to approve your application. This decision is based on the following reason(s):
You do not meet the medical underwriting criteria for this plan because you are receiving treatment for gender identity disorder. Our KPIF enrollment criteria require that this treatment be completed and you be released from care for this condition prior to considering you for enrollment. Additionally the prescription medication Spirolactone does not meet our KPIF enrollment criteria.
We recommend considering enrollment in one of the following options, if applicable:
• COBRA and /or Cal-COBRA continuation coverage
• If your latest form of health care coverage was through an employer group, you may qualify for our Heath Insurance Portability and Accountability Act (HIPAA) plan, Kaiser Permanente HIPAA. Your Kaiser Permanente HIPAA enrollment request is being processed and should be completed within 10 days if you:
• Completed the HIPAA eligibility information section on your Kaiser Permanente for Individuals and Families application.
• Qualify as HIPAA eligible.
• Accepted the offer of guaranteed enrollment in Kaiser Permanente HIPAA.
• Provided Proof of credible coverage.
• If you did not complete this section on your KPIF application but would like more information about KP HIPAA please call our Member Service Call Center at 1-800-634-4579.

[sailcruisn]

It is sad how it is. I have been carefull about it. But I am prepared mentally for it. I figured flags may go up as I filed the therapist on it. I don't know how my insurance company is going to take it but I am hoping for the best as they haven't shelled out a dollar yet since I have to meet my deductible for the year first. So far from what I have read they are pretty good but I will see. I am not going to count on them for anything though.

I will get a job if finances get too much to bear. I know though that if I am near death or have something super urgent I know that I have some one in my very close family to count on that has the money to help but I haven't come out to her yet.

I have my fingers crossed though in hopes of you finding a company and in my company staying with me.

[DeeInGeorgia]

I think you fall under the "Pre-Existing Conditions" clause. The only way around it is by having been in a previous healthcare plan, which I guess you do not qualify for.

It's a bummer that this is an insurance business thing. From what I understand, Kaiser is one of the few companies that cover GRS and hormones for transitioning employees.

Deanna

[Niya W]

I was with Kaiser for two years. Lost my Job and health care.

[Suzy Harrison]

I don't have any private health cover here in Australia as it's so expensive. You can get everything you need on the public system if you're prepared to wait. Or you can pay for individual treatment (as your own private patient) if you want something in a hurry.

I've been here 15 years and have saved a fortune in insurance over that time.

[MELISSA2U]

i do have limited health coverage.fortunately the federal government pays for my hrt.i basically slid under the fence prior to the federal laws about gender were changed.

[Priss]

I applied for Kaiser and I was denied. Want to guess why ?? Drum roll please. G.I.D. Thank you very much for playing. Please dont come back again Kaiser dont want your type.





Thank you for submitting your request for reconsideration of our denial of your application for Kaiser Permanente for Individuals and Families Plan (KPIF). After careful consideration of all information available to us during this process, we remain unable to approve your application. This decision is based on the following reason(s):
You do not meet the medical underwriting criteria for this plan because you are receiving treatment for gender identity disorder. Our KPIF enrollment criteria require that this treatment be completed and you be released from care for this condition prior to considering you for enrollment. Additionally the prescription medication Spirolactone does not meet our KPIF enrollment criteria.
We recommend considering enrollment in one of the following options, if applicable:
• COBRA and /or Cal-COBRA continuation coverage
• If your latest form of health care coverage was through an employer group, you may qualify for our Heath Insurance Portability and Accountability Act (HIPAA) plan, Kaiser Permanente HIPAA. Your Kaiser Permanente HIPAA enrollment request is being processed and should be completed within 10 days if you:
• Completed the HIPAA eligibility information section on your Kaiser Permanente for Individuals and Families application.
• Qualify as HIPAA eligible.
• Accepted the offer of guaranteed enrollment in Kaiser Permanente HIPAA.
• Provided Proof of credible coverage.
• If you did not complete this section on your KPIF application but would like more information about KP HIPAA please call our Member Service Call Center at 1-800-634-4579.

Personally, I was somewhat concerned when I first got coverage. By the time I did, I already had a therapist and MD... Apart from getting meds on coverage, and no one to my knowledge has ever informed them for what purpose Iam taking those particular meds, I have never told the insurance company squat... I kept the therapist off of the insurance, and the MD has no obligation to disclose that information, especially if they've made an agreement to such with you up front. When it came to SRS, why I got prescriptions filled, but that's it. The rest was on my dime. The point of it is that the insurance companies treat me as female, and that's all they've ever known from the get go.

Seeing as most insurance companies, have those anti GID clauses, it makes sense to not disclose it. I find it highly disturbing however that Kaiser is not taking you on, just refusing to pay for those particular items. There's something wrong with that if you ask me...

[Niya W]

Few things .Kaiser only says they wont pay for SRS. Were every one else says we wont pay for any thing.


I only disclosed it after I was initially denied do to spiro.

Additionally the prescription medication Spirolactone does not meet our KPIF enrollment criteria[/COLOR]

I had my doctor write a letter saying that I' m healthy and the reason why I was taking sprio.

[denise413]

That is a real shame. Hopefully you can find some other options. It is a shame that the "land of the free" is not free for everybody. Most of the girls I know have had to pay for surgeries out of pocket, some have even taken HRT on the black market, while others even left the country for operations at a lower cost. I wish you good luck and I'm sure you will find a way. :hugs:

[Niya W]

I did do hormones for a year off the net. I Decided to do it right and this is what happens . You read of all the dangers of taking hormones off the net. I never had a problem. Now my very real problem is do I disclose this to my current heath provider and risk losing my health coverage, or do I go back to the net.

[MELISSA2U]

niya ;yes , you are right ....diy meds isnt a good way to go. i myself state this, and for a while , i diy....from a pharmacy that was shut down for selling prescription meds without having scripts.this pharmacy was in new zealand.
the funny part is my gp started to notice changes....and asked me if there was something i needed to talk about...i looked around the room,as i replied nope.then about 8 months after this,i went back to him after the pharmacy was shut down,and showed him my receipts,
he continued them.
then when that gp retired,my medical file was split...part to a gp,the other to a ob-gyn....i gave her all the history....including when i was a bit naughty...SHE GOES: IF I AM WILLING TO PRESCRIBE THESE MEDICATIONS FOR YOU ...DO YOU PLAN TO BUY THEM THAT WAY AGAIN...?I REPLIED,NOPE.SHE GOES..GOOD, YOU HAVE AN OB-GYN DOCTOR.

[DeeInGeorgia]

Today at CNNhealth dot com, there is an article titled "Tips for getting insurance when you have a pre-existing condition" which has a couple of tips for getting health coverage with pre-existing conditions. One is creating a group of one.

Anyway, the article may give you some ideas to get around your situation.

Deanna