Current Events > If she checked male on health insurance forms because she is a transgender

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Medz2017
07/13/17 6:47:51 PM
#1:


and later on needs a hysterectomy does the insurance company have the right to deny coverage?
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Nikra
07/13/17 7:10:22 PM
#2:


Health Insurance. Only in the US. LMFAO
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Medz2017
07/14/17 8:46:22 PM
#3:


Nikra posted...
Health Insurance. Only in the US. LMFAO

What do they have in third world countries?
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s0nicfan
07/14/17 8:47:59 PM
#4:


Medz2017 posted...
Nikra posted...
Health Insurance. Only in the US. LMFAO

What do they have in third world countries?


Early death.
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Medz2017
07/14/17 8:49:32 PM
#5:


s0nicfan posted...
Medz2017 posted...
Nikra posted...
Health Insurance. Only in the US. LMFAO

What do they have in third world countries?


Early death.

Well that is horrible
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omega cookie
07/14/17 8:51:18 PM
#6:


That... is an interesting question. Hmm.

Like, obviously they'll most likely TRY to deny coverage because money, but I don't know whether they can or not legally. I don't think there is a precedent for it, or if there is I haven't seen it.

10/10 topic TC, seriously. I'm really thinking about it.
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s0nicfan
07/14/17 8:52:26 PM
#7:


omega cookie posted...
That... is an interesting question. Hmm.

Like, obviously they'll most likely TRY to deny coverage because money, but I don't know whether they can or not legally. I don't think there is a precedent for it, or if there is I haven't seen it.

10/10 topic TC, seriously. I'm really thinking about it.


I assume by default it'll be denied because that treatment isn't covered for males. At the very least, their automated processing of claims will reject it. The question then becomes... what happens on appeal?
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Mikablu
07/14/17 8:55:08 PM
#8:


I think at the point that a trans female needs a hysterectomy, she's essentially medically female and would have her insurance forms changed to reflect that far ahead of actually needing the surgery.
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Medz2017
07/14/17 9:01:58 PM
#9:


Mikablu posted...
I think at the point that a trans female needs a hysterectomy, she's essentially medically female and would have her insurance forms changed to reflect that far ahead of actually needing the surgery.

Can you change legal forms that has been signed without the insurance company asking questions?
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Mikablu
07/14/17 9:03:07 PM
#10:


Medz2017 posted...
Mikablu posted...
I think at the point that a trans female needs a hysterectomy, she's essentially medically female and would have her insurance forms changed to reflect that far ahead of actually needing the surgery.

Can you change legal forms that has been signed without the insurance company asking questions?

I'm sure the insurance company would look into medical records at the very least to prove that someone was actually transitioning before approving it.
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Medz2017
07/14/17 9:05:05 PM
#11:


Mikablu posted...
Medz2017 posted...
Mikablu posted...
I think at the point that a trans female needs a hysterectomy, she's essentially medically female and would have her insurance forms changed to reflect that far ahead of actually needing the surgery.

Can you change legal forms that has been signed without the insurance company asking questions?

I'm sure the insurance company would look into medical records at the very least to prove that someone was actually transitioning before approving it.

I do not think the insurance company would allow people to dick them around like that.
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KogaSteelfang
07/14/17 9:05:27 PM
#12:


I think on medical forms it asks for sex, not gender, and should probably be answered based on the current equipment you've got to avoid situations like this and to receive proper check ups/tests.
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Mikablu
07/14/17 9:05:54 PM
#13:


/facepalm
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Medz2017
07/14/17 9:09:59 PM
#14:


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omega cookie
07/14/17 9:12:14 PM
#15:


s0nicfan posted...
omega cookie posted...
That... is an interesting question. Hmm.

Like, obviously they'll most likely TRY to deny coverage because money, but I don't know whether they can or not legally. I don't think there is a precedent for it, or if there is I haven't seen it.

10/10 topic TC, seriously. I'm really thinking about it.


I assume by default it'll be denied because that treatment isn't covered for males. At the very least, their automated processing of claims will reject it. The question then becomes... what happens on appeal?

Okay, so I'm gonna take this straight to the end game, i.e. having to sue the insurance company. I believe that it would come down to whether the court decides to legally view you as your biological sex(female), or your chosen sex(male). If they view you based on your biological sex, you would just have to prove that any other female in your circumstances with your plan would be covered and the court would rule in your favor.

If they go based on your chosen sex, however, things get weird. They could argue it's elective and therefore not covered, but it's not really elective. Like, men don't have a uterus, so covering that for a normal male would be insane, but on the flip side women can get testicular cancer(through some medical clown shit that I don't fully understand), and that would absolutely get covered despite women not having testes.

This isn't easy...

Mikablu posted...
I think at the point that a trans female needs a hysterectomy, she's essentially medically female and would have her insurance forms changed to reflect that far ahead of actually needing the surgery.

That would be a really, really bad idea. Not only does it stink of insurance fraud, but it runs the risk of the insurance company claiming that they were insuring a male, and when you went back to female it's technically a new plan, and the hysterectomy that you need is now a pre-existing condition and will absolutely not be covered no matter what you are.
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MemeDaddy
07/14/17 9:12:18 PM
#16:


s0nicfan posted...
Medz2017 posted...
Nikra posted...
Health Insurance. Only in the US. LMFAO

What do they have in third world countries?


Early death.

Lots of 3rd world countries in Asia have extremely competitive privately-owned health care. Pricing and service is quite reasonable but on a typical 3rd world wage it can break the bank.

I'm talking like...India, Thailand, Vietnam, Philippines
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Mikablu
07/14/17 9:14:19 PM
#17:


omega cookie posted...
That would be a really, really bad idea. Not only does it stink of insurance fraud, but it runs the risk of the insurance company claiming that they were insuring a male, and when you went back to female it's technically a new plan, and the hysterectomy that you need is now a pre-existing condition and will absolutely not be covered no matter what you are.

I actually misunderstood the topic title and assumed a MtF transperson.
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Medz2017
07/14/17 9:15:27 PM
#18:


omega cookie posted...
s0nicfan posted...
omega cookie posted...
That... is an interesting question. Hmm.

Like, obviously they'll most likely TRY to deny coverage because money, but I don't know whether they can or not legally. I don't think there is a precedent for it, or if there is I haven't seen it.

10/10 topic TC, seriously. I'm really thinking about it.


I assume by default it'll be denied because that treatment isn't covered for males. At the very least, their automated processing of claims will reject it. The question then becomes... what happens on appeal?

Okay, so I'm gonna take this straight to the end game, i.e. having to sue the insurance company. I believe that it would come down to whether the court decides to legally view you as your biological sex(female), or your chosen sex(male). If they view you based on your biological sex, you would just have to prove that any other female in your circumstances with your plan would be covered and the court would rule in your favor.

If they go based on your chosen sex, however, things get weird. They could argue it's elective and therefore not covered, but it's not really elective. Like, men don't have a uterus, so covering that for a normal male would be insane, but on the flip side women can get testicular cancer(through some medical clown shit that I don't fully understand), and that would absolutely get covered despite women not having testes.

This isn't easy...

Mikablu posted...
I think at the point that a trans female needs a hysterectomy, she's essentially medically female and would have her insurance forms changed to reflect that far ahead of actually needing the surgery.

That would be a really, really bad idea. Not only does it stink of insurance fraud, but it runs the risk of the insurance company claiming that they were insuring a male, and when you went back to female it's technically a new plan, and the hysterectomy that you need is now a pre-existing condition and will absolutely not be covered no matter what you are.

Wouldn't her marking male in the first place be insurance fraud?
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Capn Circus
07/14/17 9:15:55 PM
#19:


Why would they need a hysterectomy if they're truly a man?
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DocileOrangeCup
07/14/17 9:16:29 PM
#20:


they should deny because it's a medical thing and dont be a dumbass when you fill those out, put your actual sex.
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Medz2017
07/14/17 9:17:37 PM
#21:


Capn Circus posted...
Why would they need a hysterectomy if they're truly a man?

One more argument the insurance company has
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omega cookie
07/14/17 9:21:41 PM
#22:


Mikablu posted...
omega cookie posted...
That would be a really, really bad idea. Not only does it stink of insurance fraud, but it runs the risk of the insurance company claiming that they were insuring a male, and when you went back to female it's technically a new plan, and the hysterectomy that you need is now a pre-existing condition and will absolutely not be covered no matter what you are.

I actually misunderstood the topic title and assumed a MtF transperson.

Ah, fair enough. Yeah, the last thing you'd ever want to do with health care is try to pull a fast one. Once something gets marked as pre-existing, you are utterly fucked. No company will ever cover that.

A friend of my mother's has... Some lung and back thing, stuck in a wheelchair, life expectancy of 40 tops. I'm not sure exactly what he did, but he tried to play the system and they killed his insurance plan because of it, and now he has to shell out 80k a month for medical bills because it's marked as pre-existing and no insurance company will touch him. Kind of sad, but at the same time he shouldn't have done whatever he did.
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spikethedevil
07/14/17 9:24:25 PM
#23:


Medz2017 posted...
Nikra posted...
Health Insurance. Only in the US. LMFAO

What do they have in third world countries?


Health care that doesn't send you into a life of debt. Here in the UK we have the NHS.
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Mikablu
07/14/17 9:24:41 PM
#24:


omega cookie posted...
Ah, fair enough. Yeah, the last thing you'd ever want to do with health care is try to pull a fast one. Once something gets marked as pre-existing, you are utterly fucked. No company will ever cover that.

Yeah, that's one thing as a transperson that I would never do.

A friend of my mother's has... Some lung and back thing, stuck in a wheelchair, life expectancy of 40 tops. I'm not sure exactly what he did, but he tried to play the system and they killed his insurance plan because of it, and now he has to shell out 80k a month for medical bills because it's marked as pre-existing and no insurance company will touch him. Kind of sad, but at the same time he shouldn't have done whatever he did.

They really, REALLY crack down on insurance fraud, so that's not surprising.
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s0nicfan
07/14/17 9:25:33 PM
#25:


spikethedevil posted...
Medz2017 posted...
Nikra posted...
Health Insurance. Only in the US. LMFAO

What do they have in third world countries?


Health care that doesn't send you into a life of debt. Here in the UK we have the NHS.


And all for the low, low cost of... most of your income.
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spikethedevil
07/14/17 9:27:48 PM
#26:


s0nicfan posted...
spikethedevil posted...
Medz2017 posted...
Nikra posted...
Health Insurance. Only in the US. LMFAO

What do they have in third world countries?


Health care that doesn't send you into a life of debt. Here in the UK we have the NHS.


And all for the low, low cost of... most of your income.


Not how it works at all, do some research before you spout "most of your income". At least I won't go into debt if I break my leg.
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s0nicfan
07/14/17 9:28:16 PM
#27:


spikethedevil posted...
s0nicfan posted...
spikethedevil posted...
Medz2017 posted...
Nikra posted...
Health Insurance. Only in the US. LMFAO

What do they have in third world countries?


Health care that doesn't send you into a life of debt. Here in the UK we have the NHS.


And all for the low, low cost of... most of your income.


Not how it works at all, do some research before you spout "most of your income". At least I won't go into debt if I break my leg.


Okay then, what's your effective tax rate?

because from what I can tell, it's near 50% in the UK, and around 30% in the US.
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spikethedevil
07/14/17 9:30:34 PM
#28:


The more you earn the more income tax you pay the lowest beeing 20% the highest beeing 45% iirc but your tax goes to everything not just the NHS.
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s0nicfan
07/14/17 9:32:58 PM
#29:


spikethedevil posted...
The more you earn the more income tax you pay the lowest beeing 20% the highest beeing 45% iirc but your tax goes to everything not just the NHS.


Right, but that's kind of my point... your taxes (in part) are covering your health insurance. Claiming it's lower based on the per-visit cost is a bit disingenuous, because you're paying into it constantly. Someone in the US could theoretically take the extra 20% they're saving in taxes and put it into a savings account and end up in the same place, if not better in the long run when combined with their existing insurance.
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omega cookie
07/14/17 9:33:19 PM
#30:


Medz2017 posted...
Wouldn't her marking male in the first place be insurance fraud?

See, that's where things get weird. This transgender thing is relatively new, so the law(which already moves slowly out of necessity) has very little on the subject. If you are legally your chosen sex, then it wouldn't be fraud, but if you are legally your biological sex it would be fraud unless your health care provider has some type of provision allowing for transgender people to mark their chosen gender.

It's a big legal grey area, with very little precedent on both sides. The law tends to take a "cross that bridge when we come to it" approach with narrow circumstances like this.
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Medz2017
07/14/17 9:34:53 PM
#31:


omega cookie posted...
Medz2017 posted...
Wouldn't her marking male in the first place be insurance fraud?

See, that's where things get weird. This transgender thing is relatively new, so the law(which already moves slowly out of necessity) has very little on the subject. If you are legally your chosen sex, then it wouldn't be fraud, but if you are legally your biological sex it would be fraud unless your health care provider has some type of provision allowing for transgender people to mark their chosen gender.

It's a big legal grey area, with very little precedent on both sides. The law tends to take a "cross that bridge when we come to it" approach with narrow circumstances like this.

Should just rule on the issue now to prevent situations
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spikethedevil
07/14/17 9:35:48 PM
#32:


s0nicfan posted...
spikethedevil posted...
The more you earn the more income tax you pay the lowest beeing 20% the highest beeing 45% iirc but your tax goes to everything not just the NHS.


Right, but that's kind of my point... your taxes (in part) are covering your health insurance. Claiming it's lower based on the per-visit cost is a bit disingenuous, because you're paying into it constantly. Someone in the US could theoretically take the extra 20% they're saving in taxes and put it into a savings account and end up in the same place, if not better in the long run when combined with their existing insurance.


Assuming they don't have a family history of practically any condition that blocks you from getting it/ makes it stupidly expensive.
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s0nicfan
07/14/17 9:39:09 PM
#33:


spikethedevil posted...
s0nicfan posted...
spikethedevil posted...
The more you earn the more income tax you pay the lowest beeing 20% the highest beeing 45% iirc but your tax goes to everything not just the NHS.


Right, but that's kind of my point... your taxes (in part) are covering your health insurance. Claiming it's lower based on the per-visit cost is a bit disingenuous, because you're paying into it constantly. Someone in the US could theoretically take the extra 20% they're saving in taxes and put it into a savings account and end up in the same place, if not better in the long run when combined with their existing insurance.


Assuming they don't have a family history of practically any condition that blocks you from getting it/ makes it stupidly expensive.


Well sure, but generally you get seen immediately. I could equally point out that the NHS waitlist for surgery is something like 1 to 3 years, meaning a lot of people will die before they can even get their "affordable coverage".... it's all relative.
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nexigrams
07/14/17 9:40:48 PM
#34:


For profit health insurance will always take any opportunity they can get to deny coverage. In their perfect world, you pay their premiums and get 0 benefit from it.

Can they deny it? I don't know. Will they? Absolutely. It's up to you to hire lawers etc. and fight for the service you paid for, unfortunately.

'murica lol
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spikethedevil
07/14/17 9:41:13 PM
#35:


If your condition is life threatening you get seen instantly, priority cases come first.
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Medz2017
07/14/17 9:43:35 PM
#37:


nexigrams posted...
For profit health insurance will always take any opportunity they can get to deny coverage. In their perfect world, you pay their premiums and get 0 benefit from it.

Can they deny it? I don't know. Will they? Absolutely. It's up to you to hire lawers etc. and fight for the service you paid for, unfortunately.

'murica lol

We are not talking about a hair cut. This is about dishonesty and fraud.
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spikethedevil
07/14/17 9:46:11 PM
#38:


The UK also has the issue of our government doing everything it can to destroy the NHS by cutting it's budget and the amount of medical staff we have unfortunately.
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Sylph
07/15/17 6:00:59 AM
#39:


Luckily I live in Massachusetts the non-asshole of the US world. We've already solved these issues insurance-wise. Blue Cross Blue Shield of MA covers all of these things if pre-approved by your physician properly before surgery. Which little box you checked is not an issue because it is just another thing that you get changed along the road towards clearing your paperwork trail when you transition.

Honestly, do you know what gave me the hardest time to change? I had zero trouble changing over my e-trade account with over $100k in it. My useless paypal account was the biggest pain in the ass to change account details for. They wanted everything, new ID, proof of name change through a court AND it took weeks.
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spikethedevil
07/15/17 7:45:36 AM
#40:


Yea I can definitely see it depending where in the US you live.

http://www.bbc.co.uk/news/health-40608253
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Sonic Cannon
07/15/17 8:04:35 AM
#41:


s0nicfan posted...
spikethedevil posted...
s0nicfan posted...
spikethedevil posted...
The more you earn the more income tax you pay the lowest beeing 20% the highest beeing 45% iirc but your tax goes to everything not just the NHS.


Right, but that's kind of my point... your taxes (in part) are covering your health insurance. Claiming it's lower based on the per-visit cost is a bit disingenuous, because you're paying into it constantly. Someone in the US could theoretically take the extra 20% they're saving in taxes and put it into a savings account and end up in the same place, if not better in the long run when combined with their existing insurance.


Assuming they don't have a family history of practically any condition that blocks you from getting it/ makes it stupidly expensive.


Well sure, but generally you get seen immediately. I could equally point out that the NHS waitlist for surgery is something like 1 to 3 years, meaning a lot of people will die before they can even get their "affordable coverage".... it's all relative.


I feel like your understanding of the NHS comes from incorrect information.

You comment about it being cheaper under the US system isn't true at all. USA health spending per person is literally double what the UK spends, including all private and public spending.

Im not sure about surgery waitlist times in UK, but we have a similar system here in NZ and the waitlists for elective surgeries don't extent past around 4 months. If it's for cancer, it's usually within 2 weeks.
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thelovefist
07/15/17 9:40:58 AM
#42:


@gunplagirl
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Callixtus
07/15/17 10:16:07 AM
#43:


Just another needless complication that wouldn't exist if we didnt indulge in fantasies.
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Medz2017
07/15/17 2:25:35 PM
#44:


Sylph posted...
Luckily I live in Massachusetts the non-asshole of the US world. We've already solved these issues insurance-wise. Blue Cross Blue Shield of MA covers all of these things if pre-approved by your physician properly before surgery. Which little box you checked is not an issue because it is just another thing that you get changed along the road towards clearing your paperwork trail when you transition.

Honestly, do you know what gave me the hardest time to change? I had zero trouble changing over my e-trade account with over $100k in it. My useless paypal account was the biggest pain in the ass to change account details for. They wanted everything, new ID, proof of name change through a court AND it took weeks.

Is it harder to change your gender or race in Massachusetts?
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Sylph
07/15/17 5:20:12 PM
#45:


I don't know anything about changing race at all. Changing gender requires a doctor's note signing off on the permanence of the new gender identity.
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ChrisHanson24
07/15/17 5:31:14 PM
#46:


Yes I do not think the insurance company would allow people to dick them around like that.
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gunplagirl
07/15/17 7:22:09 PM
#47:


The wording in the OP is off, I'm assuming they mean a trans man. Yes, if it's medically necessary (and as part of trans health it would be), they'd have to provide it. However, insurance can be very annoying in how they try to make you go through hell to provide coverage they're legally (like, ACA levels of reach) required to provide.

For instance, trans women need spironolactone and estradiol. Spiro is typically assigned to older men for blood pressure reasons, and estradiol for women... so if the trans woman is legally a man in the insurance system, the insurance company might not cover estradiol until you message them and appeal it. Meaning you're paying out of pocket until they can reimburse you through the appeals process. Whereas if a trans woman is legally a woman in the insurance system, they might need to pay for spiro out of pocket. It makes life that much more annoying because insurance company programs for coverage tend to be very simplistic. If they're a woman, anything that's typically for men (even things that can help people for their diuretic purposes) will be denied by default. And vice versa.

Don't even get me started on all my friends and my own collections of "family planning" emails and letters from our insurance companies and hospitals because we've not had a (insert medical exam here) performed recently.
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Nepsy
07/15/17 7:22:57 PM
#48:


s0nicfan posted...
Medz2017 posted...
Nikra posted...
Health Insurance. Only in the US. LMFAO

What do they have in third world countries?


Early death.


Fucking rekt
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Sylph
07/15/17 7:48:16 PM
#49:


Negi, part of why BCBS MA is so nice is because it has solved those billing issues, it has separate codes for transgender requirements that are authorized and skip that sort of hassle. Which isn't to say I haven't gotten any fun questionnaires though.
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gunplagirl
07/15/17 7:54:38 PM
#50:


Sylph posted...
Negi, part of why BCBS MA is so nice is because it has solved those billing issues, it has separate codes for transgender requirements that are authorized and skip that sort of hassle. Which isn't to say I haven't gotten any fun questionnaires though.

I know all about bcbs... Billing and coding specialist certification will fall off in the next few weeks or else that time next year. :l

Do you at least get those annoying adverts on Facebook? "Click here to buy stuff for your future baby that you're going to have?"
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Sonic Cannon
07/15/17 9:12:08 PM
#51:


gunplagirl posted...
Whereas if a trans woman is legally a woman in the insurance system, they might need to pay for spiro out of pocket. It makes life that much more annoying because insurance company programs for coverage tend to be very simplistic. If they're a woman, anything that's typically for men (even things that can help people for their diuretic purposes) will be denied by default. And vice versa.


I would be quite surprised if spironolactone was declined on the basis of someone's gender. It's used pretty often for heart failure, in women as well as men.
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