Michigan insurance policies and trans health coverage |
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A reader notes that some policies in Michigan all coverage of trans health services. Please note that this does not mean ALL policies in Michigan or all Blue Cross policies cover trans health services. If you live in Michigan and/or have Blue Cross, you must review your own policy and its exclusions to determine if you will get coverage.
I thought you might be interested in knowing that Michigan Blue Cross Blue Shield does cover SRS, as seen in this posting on transgendermichigan:
I’ve been following the emails on insurance since that is the area of advocacy that I focus on. Someone asked about “which policies” and what one does to qualify, so I thought I’d provide some info. I’ll be speaking more about insurance advocacy in a health workshop at Trans Empowerment Day at Affirmations on April 12. If anyone has corrections or more info regarding insurance, please do not hesitate to contact me!The plans referred to in recent emails are Blue Cross Blue Shield of Michigan (BCBSM) individual plans. BCBSM is the “insurer of last resort” in Michigan, which is a concept that doesn’t exist in most states. What this means is that BCBSM is required to sell these individual plans to residents (at least 6 months residency) without “underwriting” which means there is no medical exam and if you can pay the premium, you can be in the plan.
When I spoke to BCBSM reps on the phone in the summer of 2006, they assured by that ALL of the individual plans included trans coverage (for what that means, read below). However, a recent posting suggests that now some of the plans do not. (I suspect that the ones that do not would be the less expensive ones.)
BCBSM plans that cover transition-related surgeries will only cover what they they call genital surgery, which also includes hysterectomy. They used to cover top surgery, but they do not anymore—with the anecdotally reported exception that one provider appears to be able to get it covered, possibly by coding it as genital surgery.
One difficulty with the BCBSM plans is that they cover services by doctors who are “in network” with BCBSM or who are in a BCBS network that has agreements with BCBSM. Otherwise, you pay out of pocket and attempt to get BCBSM to reimburse you, and their coverage is for a percentage of the “reasonable and customary”. Since so few experienced surgeons are in-network providers for BCBS, this severely limits the surgical options. (For example, there appears to be no in-network provider who is experienced in metoidioplasty surgeries.)
Know that there are some BCBSM group plans (employer plans) which also have inclusive coverage, with the same limitations. However, this is not true of all the employer plans, many of which still have exclusions. I currently know of only two Blue Care Network HMO plans which have inclusive coverage: the University of Michigan employee Premier Blue plan and their graduate student employee plan. These follow essentially the same lines as the BCBSM plans, with the notable exception that the latter covers top surgery as well. (I was involved in negotiating that plan through my union, which is why it covers top surgery.)
Hope this is answers some questions. If anyone out there is at a major employer with BCBSM coverage and wants to do some advocacy around these plans through their LGBT employee resource group, I’d love to talk to you…
Best to all,
Andre Wilson
fifthwheel2004@…
see story at:
http://www.aflcio.org/aboutus/heartofthemovement/
I should add that insurance does have a 6 month pre-existing condition clause where you have to wait it out. Under the diagnostic code
30285-55980 which Dr. Neal Wilson in Detroit uses for genital surgery it is covered. Its how I plan on getting surgery, although it does take several months after sending out the request to hear from blue cross, and trust me the wait is horrible lol.
