Private Trans Insurance Coverage for Gender-Affirming Treatment & Surgery [An Introduction]

Apicha Community Health Center Nov 25, 2015  

Apicha CHC

As we’ve covered previously in our trans insurance coverage blog post, in the last year, there have been several exciting changes to the laws regarding insurance coverage for gender-affirming treatment and surgery in New York State that you should be aware of.

To quickly summarize, last December, there was a clarification of a regulations stating that “an issuer may not deny medically necessary treatment…solely on the basis that the treatment is for gender dysphoria.

“Put in simpler terms, many private insurance providers are now required to cover gender-affirming surgeries and treatment.

Additionally, the state of New York has given approval for certain surgeries and other trans-related care to be covered by Medicaid.


Insurance is not the only challenge the trans community has had to face. Read more here.


We at Apicha Community Health Center understand that dealing with insurance companies can be very tricky, so we wanted to provide more information about getting trans insurance coverage for costs associated with these surgeries.

How Can Apicha CHC Patients Get Trans Insurance Coverage?

Medicaid and private insurance companies require letters from your primary care provider (PCP) and mental health providers confirming that surgery is appropriate for you. Getting these letters may take several appointments with providers, so it is a good idea to let us know when you begin thinking about having gender-affirming surgery.

We will help set up appointments with mental health providers. Please understand that this may take time. Most insurance companies are now requiring providers to state in the letters that they have an ongoing “provider and patient relationship,” which may take several visits to establish. If you are seeing a mental health provider in the community, we will help to coordinate with your community mental health provider about getting letters.

Please check first with your insurance company or surgeon about trans insurance coverage for necessary procedures and about the need for letters. Please let us know the name of your surgeon so we assist with coordination. If you are paying out of pocket, please follow the same instructions.

New York State Wants to Know if Insurance Companies are Following the Law

If you’ve had difficulties using your private health coverage for gender-affirming medical care and procedures, the LGBT Task Force of an organization called Health Care Access for All New York is collecting these experiences. These experiences will be shared at “listening sessions” with state officials to be held this fall in three locations: Albany, New York City and Rochester.

The goal of these sessions is to identify systemic problems with insurer compliance with the transgender coverage regulation, so that members of and advocates for the trans community can work with state officials and insurers to address the problems. The sessions will be invitation-only and will not be open to the public or media for confidentiality purposes.

If you have stories to share, please fill out the form at https://www.surveymonkey.com/r/NYTransHealth.

If You’re Trans, Live in New York City, and Don’t Have a Medical Provider, Consider Coming to Apicha CHC!

Check our calendar for the next Trans Orientation Sessions for trans folk to come in and learn about Apicha CHC’s Trans Health Clinic.

This clinic is for the specific needs of transgender and gender non-conforming, gender variant and genderqueer individuals.

Our Trans Health services include:

  • Personalized Primary Care
  • Routine Check-Up and Immunization
  • Initiation and Maintenance of Hormone Therapy
  • Short-Term Mental Health Services
  • Care Management
  • Trans Groups

Please feel free to request an appointment or stop by a Trans Orientation Session to learn more about trans health, Apicha CHC’s Trans Health Clinic, and trans insurance coverage.

Transgender Resources

 


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