Friday, June 12, 2015

Transjenner Insurance

Bruce Jenner may be the celebrity-du-jour of the transgender set, but he's certainly not the only member of it. While he and his extended family can most likely afford to pay for the procedure(s) out-of-pocket, most folks lack the requisite funds to do so.

And just how much does this process cost? Well:

"The total typical cost of a transition usually includes: expenses incurred in the year before surgery, during which hormone therapy, counseling and living full-time as the target sex are recommended; the cost of the surgery and follow-up care; and ongoing costs after the surgery, including hormone therapy for life and continued doctor visits."

All told, a successful (for certain values of "success") transition seems to run between $40,000 and $50,000. That's a lot of scratch for a non-celebrity, so to what other source might one turn for help?

If you thought "health insurance," give yourself a cigar (preferably a candy one: tobacco use results in higher insurance rates). Now, you may be thinking "Henry, I understood that health insurance covers only medically necessary procedures; how can this possibly fit that bill?"

And you'd be right again.


My initial reaction was "no way a health insurance policy covers this."

But then alert reader and FoIB Jeff M sent me this gem:

"Obamacare to cover majority of transgender woman's sex reassignment surgery costs ... with the help of Obamacare, Larson says she is looking at paying $5,000 out of pocket for the surgery."

Surely that can't be right: what carrier in its right mind would cover such a thing?

Turns out, more than a few: Aetna, Anthem Blue Cross Blue Shield, Cigna and several others cover the surgery (or surgeries), subject to a very specific definition of medical necessity. Interestingly, UHC generally doesn't.

And those plans that do offer coverage treat it the "same as any other illness;" that is, subject to deductibles and co-insurance, as well as any network pricing issues. So depending on what plan one has, out-of-pocket could be as little as a few thousand dollars. Reason #4,835 why premiums are skyrocketing.

Ah, what brave, new world.
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