Presentation on theme: "Trans* Health Forum. Agenda for today History of Policy Changes WPATH SOC & ICATH – What are the requirements Apple Care Private Health Insurance."— Presentation transcript:
Trans* Health Forum
Agenda for today History of Policy Changes WPATH SOC & ICATH – What are the requirements Apple Care Private Health Insurance Puberty Delay & Youth Care Medicare State Employees Self Care Income Guidelines for AppleCare & Assistance Q&A
Some Reminders Questions -Please make sure to write down your questions on post cards (available at the check in table) -Please save your questions for Q&A -We will read the note cards & select themes of questions first then open it up to raised hands Get help signing up Folks from Gay City & the We-Are-1 Campaign are here to help you sign up! The Exchange is down today for maintenance We can make an appointment for in person assistance! February 15 th is the deadline You can sign up any time for free AppleCare coverage if you qualify Free Testing Downstairs at Gay City You can always set up an appointment to come back!
Panelists Danni Askini: Gender Justice League Marsha Botzer: Ingersoll Gender Center & The Task Force Alison Davidson: Lifelong AIDS Alliance & Ingersoll Tobi Hill-Meyer: We-Are-1 & Gender Justice League Emerson Seekins: Univ. of Washington & Gender Justice League David Ward: Legal Voice & Q-Law Not on the panel but so important! Lisa Brodoff, Kris Hermans, Seth Kirby, Dr. Bobbi Dalley, Anand Kalra, Lisa Motet, Andrew Crey, & So many more!
ACLU of Washington Basic Rights Oregon City of Seattle LGBT Commission Equal Rights Washington Gay City Health Project Gender Justice League Greater Seattle Business Association Human Rights Campaign Ingersoll Gender Center Lambda Legal Legal Voice Lifelong National Center for Lesbian Rights National Center for Transgender Equality National Gay and Lesbian Task Force Action Fund Oasis Youth Center Pierce County AIDS Foundation Pride Foundation Rainbow Center Seattle Counseling Service Seattle University School of Law – Ronald A. Peterson Law Clinic Transgender Law Center
HISTORY, WPATH & ICATH Health Insurance only pays for treatment of a “Disease” Trans people have had to “accept” being labeled mentally ill in hopes of increasing access to care Almost all health insurance companies & surgeons have guidelines based on WPATH ICATH does not require a diagnosis of Gender Dysphoria – Generally only practiced by some PCPs and Therapists Insurance Reimbursement is perhaps available for ICATH care for primary care, hormones, or therapy; but large problems will happen for surgery (prior authorization) that might require you to “go back to the start”.
AppleCare (Medicaid) Brief History What coverage is currently available? - hormones, doctors visits, mental health care - Surgeries by “exception to the rule process” What is the new draft policy? When is the public hearing? What about SRS? When will the new rule be finalized?
Private Insurance Plans
All Plans should cover all medically necessary care Therapy, Hormones & Labs, Primary Care Visits, Specialist Visits Surgeries as medically necessary (limited by policy) Each Plan will have to tell you what care they consider “Medically Necessary” Based on WPATH SOC Generally covers Top Surgery for Trans men, bottom surgery for Trans men and women. Almost everything else is considered “Cosmetic” Remember: Deductibles, Co-Pays, and In-network vs. Out of Network cost Most bottom surgeries will be out of state; check for “In Network vs. Out of Network” rules, make sure to ask “Do you have any In-network providers who can offer this covered surgery?”
Private Insurance Plans In Network: Regence & Bridge span - Marci Bowers Group Health Tobi Meltzer Possibly others! Please let us know when you find out!
Puberty Delay Should be covered! However: Some companies may try to impose an arbitrary age limit of 18 “Off Label Use” and “Not listed in Compendium” Appeal, Appeal, Appeal! AppleCare & Chip currently has proposed 18+ Help us testify!
Appealing a Denial
Appeal the Denial with your Insurer Cite Insurance Commissioner Letter Cite WPATH Standards of Care Provide evidence of diagnosis of “Gender Dysphoria” Demonstrate that you have followed WPATH SOC Provide letter from PCP & Therapist stating this is “Next medically necessary step” in treatment for G.D.
Medicare For those 65+ and Disabled Removed Exclusion Didn’t “Add” anything! Norvatis LCD - Some surgeries are being covered! Get Prior Authorization if possible Check Transmedicare.com for provider list None we know of in WA yet – but OHSU!
Medicare WA Covered by Noridian Healthcare Solutions Medicare Advantage+ plans (HMO-type) Requires Prior Authorization Check with Surgeon first! Out of State Travel & Coverage https://www.noridianmedicare.com/shared/parta/bulletins/2014/2119_sep/invalidation_of_ncd_140.3_transsexual_surgery.html
State Employees All Coverage Started Jan 1 st UMP & HMO Plans Follows WPATH guidelines “Transgender Health (page) 41 The following services associated with a diagnosis of gender dysphoria are covered: Non-surgical services, including but not limited to hormone therapy, office visits, mental health/counseling, and tests. Some services and drugs may require preauthorization. Surgical services when preauthorized by the plan
Q&A Please take a minute to fill out your cards Pass them forward to Marsha
Self Care Get Connected to Others! You are Not Alone! Ingersoll Gender Center every Wednesday Night Gender Justice League & Q-Law for help with Appeals Take your time Denial letters are frustrating and annoying – note the timeline you have to appeal and take a minute to take care of yourself Appeal, Appeal, Appeal At this point – the largest amount of change comes from individuals appealing denials and holding companies accountable. File a complaint with the OIC!
Self Care These Guidelines are very binary! Work with your provider to identify the care that you need, and work with them to find the language that works with your insurance company Take Advantage of your benefits! PreP is now covered Visit a therapist if you have been putting it off! It’s covered! Check out what other self-care benefits are available: Chiropractic, Massage, and Naturopaths may also be covered in some plans. Vaccines (Hep B, HPV, DPT), Cancer Screening, Blood Pressure screening, Preventative Care, Depression screening, and HIV/STD Screening ARE ALL FREE! $0.00 co-pay!
Washington Health Exchange
Q&A We will answer questions from the cards first Then we will answer on raised hands