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Thread: Insurance

  1. #1
    Member CD Rachel's Avatar
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    Insurance

    I have switched to a new therapist so that i would be able to use my current health insurance, provided through my wife's work. So after speaking with the insurance rep I was assured that mental health coverage would cover an unlimited number of visits and up to 80% until i meet my out of pocket maximum. This was great news until i got the letter from the insurance company rejecting my claim for my first visit to the new therapist.

    Turns out that the school district my wife works for that provides the insurance included specific diagnosis that they would not provide any coverage for. So the following diagnosis are not covered at all under my insurance
    Transsexualism, Dual role transvestism, Gender identity disorder of childhood, Other gender identity disorders, Gender identity disorde. They also will not cover anything to do with transitioning such as HRT, BA, FFS etc.

    I would say that the school is not very trans friendly.

    I make too much money to qualify for reduced rates with the therapist but I see no way that i can afford more then 2 visits a month. This has not helped with my depression. I am feeling trapped.

    Rachel

  2. #2
    Silver Member Aunt Kelly's Avatar
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    Those diagnoses are taken straight out of the ICD10 (insurance codes), specifically F64.0.
    Assholes...

    FWIW, and IANAL, if this is a governmental body we're talking about, those exclusions may be illegal. The place to start is the "diversity" policy of the district, and then of any governmental entity with whose policies the district must comply. Might be worth a shot
    Calling bigotry an "opinion" is like calling arsenic a "flavor".

  3. #3
    Aspiring Member
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    Makes me really angry reading the exclusions. A word of caution - you listed HRT, BA, FFS as not being covered. Don't lump them up. For example I have a good plan with Aetna that covers therapy, HRT, GRS, but not BA or FFS. So it is not all or nothing.

  4. #4
    Little Mrs. Snarky! Nadine Spirit's Avatar
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    Sorry to read that. I work for a school in CA that also refuses to pay for any and all trans care. All insurance in CA is supposed to provide trans care, however, they can avoid that regulation if they are self insured. If they are self insured, they typically fall under ERISA a 1974 federal regulation that defines minimum acceptable health and welfare benefits. However my employer insists that they are not even bound by ERISA as they provide health care as a 401C or some such BS. My point is simply to say I am sorry and to say that if an employer can figure out how they do not have to pay for trans care, they wont.

    Oh an yeah I did challenge this. I charged them with discrimination at the EEOC. We went to mediation, we agreed on a settlement, they will pay for my therapy for the rest of my life if I want it, but they will not pay for anything else and I will never be able to bring a charge of discrimination again. The EEOC was looking at this as a violation of the ACA, and Title XII of the Civil Rights Act. It could possibly be proven, however someone will need to take their employer to federal court over this and be granted a ruling in their favor.

  5. #5
    Silver Member Devi SM's Avatar
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    Some words come to my mind, 2 monthly visits would be enough if you focus on the really important issues and take notes to discuss with the therapist and take the most advantage of the time in therapy.
    Second, there're some Acts, laws that what your insurance is doing would be discrimination, when talking with some companies that I feel being discriminated, immediately change the way we're talking with me. If that doesn't work it would need to hire a versed attorney on these cases and suit the insurance company, it would probably be a long run but in the way, the attorney could find other trans discriminated people as you and make a class suit action...you know? We need to change the world....

    Third, I would read guidelines of the insurance company regarding approved treatments. I had an issue with my insurance company regarding voice feminization therapy treatment rejected but going around I got speech therapist and she's very experienced working with transwomen so the insurance approved 26 weekly sessions of 45 minutes...

    Not to say that electrolysis was another battle so keep looking and pushing....if not,ok for another health insurance....government help?

    My penny
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  6. #6
    Member CD Rachel's Avatar
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    Thank you everyone for the advice. I just do not know if this is the hill that i want to die on. Because the insurance is through my wife's work I may not have this insurance for much longer. My wife and I have yet to discuss divorce but I am fairly certain that I will no longer be able to be covered under her plan after a divorce. My next option should I lose her coverage is the insurance provided by my work. I have no idea what they have but I will be reaching out to HR over the next couple of weeks to learn what options I will have as a federal employee under the DOD.

    Rachel

  7. #7
    Member Robin-in-TX's Avatar
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    Rachel,

    I'm a federal employee myself and federal regulations prohibit a general exclusion for transgender care. Please take a look at OPM's website or send me a pm and I'l send you the link.

    Robin
    I'm just trying to find a decent melody
    A song that I can sing in my own company

    U2

  8. #8
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    i would not mention your trans issues when inquiring about the insurance, see what they offer,, and kind of feel out what their trans policy are with out outing yourself

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