HRT Insurance

[somestuffp]

I hope it is ok to continue to ask questions like this.

I am curious if going on hrt affected your medical insurance at all in one way or another? Did they cover any of it?

Thanks again for all the assistance.

[JohnH]

My endocrinologist and lab tests are covered by insurance as is the antiandrogen (Spironolactone) but the injectable estradiol is not. However, the estradiol is inexpensive - 5 months including needles and syringes is only about $60 including shipping (from a compounding pharmacy).

Johanna

[Angela Campbell]

So far it has covered the Dr visit bloodwork,and the spiro but not the estrogen, but it is only about $15 anyway. I don't know why it would effect the insurance. Either they pay or they will not.

[Ariamythe]

Johanna and Ellen, do you know if your doctors are submitting the covered items (bloodwork, Spiro, etc.) with a fake code / coded for a purpose other than HRT? My understanding was that insurance companies won't cover anything put to HRT as it's considered "off-label" use of the drugs / not a health-related use of the tests.

If that's the case, if doctors have to false code ... my fear would always be that the insurance company somehow finds out the "true" purpose and uses it as an excuse to drop my coverage.

[mikiSJ]

I believe the ACA (otherwise known as Obamacare) means you can not be dropped from any insurance coverage for simply having a new issue, AND you cannot be denied coverage because of any preexisting condition. I do not know if an insurer is required to cover all conditions, but they cannot simply deny you coverage!

[Angela Campbell]

I really do not know. I go to the Dr. and they tell me how much I owe and I pay them. The codes....?? I cannot say. I have BCBS and I make the co pay and if the insurance does not pay the Dr. will send me a bill. So far so good. I really have no control over what the Dr's office does. I take my prescription in to the pharmacy and they tell me the Spiro will be covered and the estrogen will not.

Then again I would kind of think the Dr used a claim for the office visit being an examination and bloodwork is common and actually expected at any Dr visit at my age. There is likely not even a code for MtF HRT. (but who knows)

If you have coverage under the employer they cannot just drop you so easily. They can refuse to pay or even make the DR pay back any claims that they false billed, but that isn't our fault. You did not falsify any claims, the Dr did. We cannot control what the Dr does. If the insurance does just drop you because of a diagnosis of GD and you seeking treatment, keep in mind that the treatments have been deemed "medically necessary" and although this does not make them cover it if there are exclusions it is not justification for dropping coverage. That would be a good reason for a lawsuit.

[linda allen]

I think coverage varies based on the company. Why not call or write them and ask your questions? That's the only way you will get reliable answers.

[sandra-leigh]

We would be able to provide more accurate and relevant information if you indicated which country you are in.

[LeaP]

I wouldn't worry about having coverage dropped entirely, and I agree that coding is the doctor's issue. A more realistic risk is being denied of unrelated treatment because the insurance company links it falsely to something trans. Coverage of, say, an orchiectomy denied because it is deemed "transition-related" - even if required because of another condition.

[StephanieC]

I believe they are covering it the same as any other treatment...exams, blood, scripts.

-stephani

[Stephanie-L]

Thus far my insurance has covered my endocrinologist, and all of my meds, including the estrogen. If they didn't cover the estrogen, it would not be a big deal as I can get the same patches for only slightly more than my co-pay. My endocrinologist codes the bill for two things, gender dysphoria, and testicular hyperfunction, which is true, they do produce more than what I want. I have not had any problem from the insurance company, but they may have been distracted by my wife's bills, which usually run in the hundreds of thousands every year......................Stephanie

[tanyalynn51]

My insurance company didn't cover the estrogen as they said they wouldn't cover anything to do with sex changes (probably not the literal wording, but this was a while back). I was going to an endocrinologist who also specialized in thyroid issues, so that was covered. I did find that my pharmacy does have a program to help with medicine not covered by insurance, and it knocked down the cost considerably. some pharmacies have that program, so I would check into it.

[Cheyenne Skye]

I started therapy two and a half years ago and they billed the insurance for depression. When I started hormones last year, the doctor coded it as an "endocrine disorder". As of this year though, my insurance covers trans benefits including therapy, hormones, and surgeries (incl BA). All I need to pay are the co-pays and my annual deductible. This is with BC/BS through a Fortune 500 company though. Contact your benefits administrator and find out what coverages are specifically denied under your plan.

[Nicole Brown]

Being over 65 years old, I have found that my insurance company relates everything back to medicare. If medicare doesn't cover it, they won't. So I just don't directly tell them what my treatments are for, it is really none of their business anyway.

Since my endocrinologist does not participate in my insurance plan, I simply submit her bills as out of network, and after my annual deductible I get 65% of her charges refunded to me. They do pay for all of my blood work and other diagnostic tests as well as my Spiro. As others have indicated, my estradiol is inexpensive - 6 months including needles and syringes is only $56 including shipping.

[somestuffp]

Thanks everyone for the responses. I would have assumed that there would have been little coverage. this is great news!

[natasha]

Old insurance company covered it no problems, new one...............the pharmacist says.............."the insurance company is saying they are denying coverage because the prescription is gender inappropriate"