how do I see if my insurance covers top surgery?

[ceresvulcan]

I have insurance through my employer and I've been on t almost a year and I'd love to start figuring out his likely it is for me to get top surgery maybe this next year. how do I do that?

Comments

[climberblues]

Ask your insurance company where you can find the summary plan description. Some places call it something different, but basically you want the nitty gritty details. In there you'll want to look for any mention of gender related items, whether it's called GID, transsexualism, etc. Usually if it's mentioned at all, it would be as an exclusion (i.e. something that is not covered). If it's covered, it may not be explicitly mentioned.

Another thing you can ask insurance for is their policy on gender identity dysphoria-related care. If it's usually covered, this will tell you the requirements (e.g. 2 letters from psychs). In some cases, if the insurance carrier has both plans that cover it and those that don't, this will give both a justification for a general policy of exclusion, plus the requirements for those plans that cover it.

Your HR department may be able to provide you the first of those documents, but typically will not have the second and would refer you to the insurance company.

Even if your plan excludes it, you would likely be able to appeal that exclusion and win on grounds of medical necessity, but that is a longer path to tread.

If you call the insurance company, I'd strongly encourage you to keep a written record of the date, who you spoke with, and what they said. You may call and ask the same questions and get different answers if you talk to different people. If someone doesn't have the answer, you can ask to talk to a manager.