- Insurance coverage for top surgery, not on testosterone?
- December 4th, 17:31
I am pursuing top surgery.
I have Horizon Blue Cross Blue Shield of New Jersey (NJ Direct). They offer coverage for gender reassignment surgery.
I am not on testosterone. (Ideally I would want to start hormones now, but insurance says you have to be on T for 1 year before getting top surgery, and top surgery is my priority. I hope to get it by this summer.)
I am very confused about the language in my insurance policy, and need your help deciphering it.
The description of gender identity disorder within my manual mentions the "typical course of action," triadic therapy, which means, 1. hormones 2. real-life experience in the desired role 3. surgery to change genitalia and other characteristics. Then it says,
"However, the diagnosis of GID invites the consideration of a variety of therapeutic options, only one of which is the complete therapeutic triad. Clinicians have become increasingly aware that not all persons with GID need or want all three elements of triadic therapy."
Stated in the policy:
"I. Contract exclusions and/or limitations for gender reassignment surgery, including related services such as medical counseling, psychological clearance for surgery in the absence of a need for behavioral health therapeutic services, and hormonal therapy, will determine the available benefit for gender reassignment surgery.
III. C. For those members without a medical contraindication, the member has undergone a minimum of 12 months of continuous hormonal therapy when recommended by a mental health professional and provided under the supervision of a physician"
Do I HAVE to be on hormones unless I have a medical reason that could stop me from taking them? Or would insurance accept that I identify as a genderqueer ftm and do not want hormones because they do not align with my gender? I will be able to meet all other criteria in the policy. But I'm also worried that if they do grant me coverage, my PCP will be obligated to wait a while before recommending me for testosterone.
Has anyone had experience with Blue Cross, BCBS NJ, or heard of folks off of testosterone getting coverage for top surgery? Is there any medical contraindication I could easily use, like depression? Is there a way I can talk to an insurance representative about the policy, like any key phrase I should use? When I ask questions, even 'administrators' simply say I have to submit my claim. I'm getting desperate, trying to figure out if I should just forget about insurance, pay for it myself, and start T now.