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A. Schuyler, NP
A. Schuyler, NP, Nurse Practitioner
Category: Health
Satisfied Customers: 16049
Experience:  Board Certified NP, MS, RN. 25 years private practice & hospitalist
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I am planning to have an expensive surgical procedure

Customer Question

I am planning to have an expensive surgical procedure performed. I want help with finding medical insurance to cover the costs. That person needs to have a successful track record of helping others like me.
Submitted: 1 year ago.
Category: Health
Expert:  A. Schuyler, NP replied 1 year ago.

Hello,

Can you tell me more about what you are planning? For instance, one usually has medical insurance and then plans a procedure, not the other way around. Also, no medical insurance will cover cosmetic procedures of any kind except under very limited circumstances, such as reconstruction after an accident or after a mastectomy, for example.

Once I know more about your needs, I may be able to recommend something.

Best regards,

Schuyler

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Customer: replied 1 year ago.
Hello Schuyler,I have a date for gender reassignment surgery. Presently, I have Medicare. I understand that Medicare and other insurance providers will cover procedures such as this. However, insurance companies will look for any loophole to avoid paying claims. I want an expert to close all the loopholes for me and help me to secure the highest payout at the lowest cost. My surgeon takes insurance but not Medicare.
Expert:  A. Schuyler, NP replied 1 year ago.

Thanks for the additional information.

More than two dozen insurance companies pay for gender reassignment. It has become much more available in the last couple of years. All companies have specific requirements that must be met before they will pay. There is no way for an outside expert to determine who is going to pay the most in an individual case. It depends on where you live, and numerous other factors, including whether your surgeon is within their networks. Gender reassignment is also not just one procedure, but a series of procedures with specific medical codes.

Here are the requirements for some of the companies so you can get a feel for what is out there:

http://www.hrc.org/resources/finding-insurance-for-transgender-related-healthcare

First of all, you will need to determine which insurance companies your surgeon does take and work from there. You will also need to make sure that you meet all of the criteria, have all the documents, etc. A social worker affiliated with your surgeon may be able to help with this, if the surgeon employs one.

I'm sorry no one can close loopholes for you. When coverage is denied for any reason, the option is first to ask for review, and if that is denied, to sue. That isn't something anyone can do for you online.

Please let me know if you have questions.

Best regards,

Schuyler

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Customer: replied 1 year ago.
Thanks for your answer.There are experts in every field, including medical insurance. I just don't happen to know any. An expert will use his or her technical knowledge and experience in the field to protect your interests. An expert will help you to avoid known loopholes, smooth out technical hurdles, meet the criteria, acquire the documents and all but preclude a 'coverage denied' scenario.Call it peace of mind. That's worth paying for.
Expert:  A. Schuyler, NP replied 1 year ago.

An independent insurance broker in your local area is the kind of person you need to talk to. They are the experts in what insurance is available in your area. You might try contacting Lambda Legal for help finding one who is especially knowledgeable in gender transition. Here is their contact information: http://www.lambdalegal.org/

Best regards,

Schuyler

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Expert:  A. Schuyler, NP replied 1 year ago.

Also, for someone who "...will help you to avoid known loopholes, smooth out technical hurdles, meet the criteria, acquire the documents and all but preclude a 'coverage denied' scenario...." would most likely be a lawyer familiar with both insurance and gender reassignment issues. Lambda would be able to help you find one.