Insurance? Transitioning? Agender? What?

[-Lex-]

So is there any way insurance will pay for top surgery or T if I'm not *technically* a *normal* transgender person.  So I don't know if it would be considered sex-reassignment surgery if it was not to change to the *other* sex but to just get rid of my female parts and look more... gender nuetral I guess?  (I'm trying to think of how insurance companies would word stuff like this.)  I'm a broke college student and I'm going to be in school for seven more years, but I don't know if I can live much longer feeling like my body is wrong and gross.

 

Does anyone know anything about any of this?  Like at all?  I'm currently in the US and I have QualChoice paid for by Medicaid.

[Gentle Giant]

If you have insurance you should call their customer service line and ask about it.

[Mezzo Forte]

If your insurance covers transition, then all you need is a diagnosis of gender dysphoria and a therapist letter explicitly saying that top surgery is medically necessary for the treatment of said dysphoria. You will definitely need to talk directly with your insurance providers to figure out what transition care they cover though.

 

That said, not all top surgeons take insurance, and the red tape surrounding the reimbursement process can be quite frustrating to sort through. I'm 7 months post op and still haven't gotten properly reimbursed for my surgery even though I had approved pre-clearance for insurance coverage. (Granted, this is partly because of complications of being double insured, but be warned that this process can get rather frustrating.)

 

One thing that might help save you money is to check and see if your university's counseling center is equipped to write therapist letters for transition. If so, your counseling sessions should be free, and that saves you the cost of finding/paying for a therapist. I started transition in grad school, and my counseling center wrote my therapist letters for free. My alma mater's medical center also offers HRT/trans care, and my student health insurance included in my assistantship covered all my doctor's visits and my testosterone prescriptions. Check your school's resources, as you never know what they might offer.

[Irelandaz]

I’m also a broke college student who will be in school for 6-7 more years. I am on my school’s student insurance (which is Aetna) and my school’s plan covered trans related health care costs (HRT, surgery). So I suppose first step is to find out if your specific insurance plan covered trans specific health care at all (many don’t unfortunately).

 

After that, the steps for me to have top surgery covered were that I needed a letter from a therapist saying that surgery was necessary for me. For 100% coverage I needed a referral from my school’s heath clinic, and I went to see their doctor who deals with trans students and he kinda said he didn’t know where to send me as a referral for surgery because he mostly did HRT referrals. He gave me a bunch of information for NB/trans people in the city my college is in though, he was trying to help me. I went to my school’s counseling center and a therapist there met with me for a little while and then wrote me a letter.

 

I picked out an NB friendly surgeon near-ish to me (Dr. Cori Agarwal in Salt Lake City, Utah, one state away) and basically filled out paperwork they needed and gave them my letter. Then the surgeons office submitted to the insurance for me, it was approved for 50% coverage (but it hit my deductible so I only paid up to my deductible which was $2,000, so basically every penny I had saved for a few years for this). They also mentioned to me in my pre-op appointment that I was (to their knowledge) their first agender patient covered by insurance (most pay out of pocket).

 

So yeah, first step would be to see if your plan covered it. Call them or somehow get a copy of all the benefit of coverage. If you dont see it under you covered expenses look in the section that explicitly outline what is not covered because many insurance put it there because they dont want to cover it and if its there you cant get around it . If it does cover it, look at the requirements for coverage. To my knowledge they don’t normally specify you must be binary trans, usually just that you need a letter or diagnosis of gender dysphoria. If you’re worried doctors or therapists won’t treat you the same for being enby, bring a copy of the newest WPATH standards of care (2011) wich most follow if they work with trans people, and highlight the areas which are specifically in there to allow enby people access to health care.