What did they exactly say? HIPAA protects the confidentiality of patients in medical facilities, so your doctor can't go and call your best friend tell them you have diabetes or something. Technically, your HR person should be able to answer your questions about the plan regarding your medical issues without disclosing that information. Be explicit when you consider your trans status a medical condition, do it in writing, email or something.
I called and said I needed a surgical procedure covered, which was excluded. I told them I had the necessary paper work. HR told me they couldn't make any decisions. I went to branch manager, and explained the situation as well, currently i'm stuck in limbo and not really sure who to go to next.
You might want to ask about an appeals process for the insurance company, wherein your doctor can write a letter to the company in support of your medical need for the procedure in spite of the exclusion. I don't know how successful it would be if the exclusion is explicit though.
Cigna told me I do not have to appeal them, because they cover it. I need to some how get my company to allow it. It's very frustrating, i've been battling since February.
I was actually in the same position, it should be covered (it's a CA based policy even if he's employed in MA), but there's a specific exclusion in the policy I have (thanks to my dad's company). The one difference is I did get in touch with the Transgender Law Center and after a handful of back and forth emails I was told I was basically SOL in legalese
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That's a "self-funded" plan, where a company pays all the expenses and simply hires Blue Cross or Cigna or whoever to administer the benefits. Here in California, all insurance must offer transgender benefits...except self -funded plans. I have the feeling that might be what's going on in the OP's case as well. Basically, the only recourse you'd have is to sue the company for discrimination, which might or might not work. Interestingly, Medicare just revised their policy of automatically denying transgender claims, saying the practice was based on "outdated" data, so you might have more of a leg to stand on than you did two weeks ago. Obviously, though, lawsuits are expensive, lengthy, difficult , by no means guaranteed, and I am not a lawyer.
Disclosure: I'm a lawyer by education and training but I mostly do legal academic work. I do, however, have particular expertise in trans insurance issues
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Employers, when deciding what to cover for their employees, do have a right to add riders to their policies including and excluding certain things they may or may not wish to cover. That is their choice. In order to make an exception for you they would have to make the change(s) for all employees, so you are battling your company, and not the insurer. For example many religiously-based companies will not cover birth control ,IVF, etc. because of their belief system.
As for their HIPAA excuse, well, if you are voluntarily allowing them access to your medical stuff that is not a violation, because it is you who is doing so. It sounds like they just do not want to deal with your query, and/or are ignorant as to what HIPAA actually encompasses. That's the short version, and I hope it gives you more information as to how you want to tackle it. Good luck!
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As for their HIPAA excuse, well, if you are voluntarily allowing them access to your medical stuff that is not a violation, because it is you who is doing so. It sounds like they just do not want to deal with your query, and/or are ignorant as to what HIPAA actually encompasses. That's the short version, and I hope it gives you more information as to how you want to tackle it. Good luck!
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