Art of Transliness

Adrian: I have had a very positive experience with my insurance company largely due to the fact of the inclusiveness of my plan and the fact that my mother is the director of my insurance. That being said, I gave her a call to ask her about your situation and this is what she had to say:

1) An insurance company cannot “drop” anyone because of a medical condition that they cover. That defeats the whole purpose of insurance. The point is to have a pool of buyers and each buyer comes with a risk, you group many low risk people with a couple of high risk people and the healthy people pay for the cost of care of the unhealthy people, and what’s left over is profit. Insurance companies of all kinds are designed to be able to pay for the coverage of their risky individuals. If an insurance company dropped every risky individual after that person’s risk comes to fruition, not only would that be illegal, but that would undermine the system entirely. You should not be dropped if you start physically transitioning and you absolutely won’t be dropped just because of a suspicion.

2) Even if your insurance company does not cover your trans*health related expenses, that does not mean that they will discontinue the rest of your coverage. Just because you send them a claim for covering your testosterone and they say no doesn’t mean that they can just stop covering everything else you’re eligible for. An insurance company is obligated to comply with the terms of the plan that you are paying for. You are paying for a service, they have to provide it to you.

Things you can do:

Call your insurance company or check online to see the services that you’re eligible for. Ask if you the treatment that you desire is covered by your plan. Unless your insurance company says in extremely specific and exclusive words that it will not cover any trans* related healthcare, you should be fine to inquire more deeply about the possibility of coverage.

We wrote an article on how to find out if testosterone is covered by your insurance that you may also find useful.

Be careful about your inquiry, however, because your account could be red-flagged if you continually ask about services that your plan does not cover. But your account will never be red-flagged for services that it does cover, so if you’re one of the lucky guys whose insurance company covers these medical expenses, ask away!

Don’t be upset with your therapist, I believe that after a certain amount of sessions with a patient they are required to submit some sort of clinical diagnosis to your insurance company. So just keep that in mind.

I hope this information is useful!