Challenging insurance denials and exclusions
The era of routine exclusion of transgender-related care is over. No one should be paying for puberty suppression treatment, hormones, or surgeries out-of-pocket anymore.
Many laws prohibit discrimination in insurance, so if you've received a denial, it's important to speak with an attorney to learn what your rights are.
Here are some examples of things that can be readily challenged:
- Denials saying facial feminization or breast augmentation is "not medically necessary"
- Denial of puberty delay treatment (GnRH)
- Denial of surgery because your child is not 18
- Explicit exclusion for all trans care in an employer-based plan
- Special cap (such as $75,000) for trans-related care
- Being on hormones before FTM top surgery
- Many other things can also be challenged
Many states also have issued insurance bulletins prohibiting bans on transgender health care. Virtually all insurance companies cover transgender-related health care in some of their plans, but you need to know if your specific plan is one of them.
What are my rights?
We offer consultations for $75. At the end of the consultation, you will know the following:
How to get coverage
- How to challenge a denial
- How to file a claim for reimbursement if you've paid out of pocket
- How to challenge an explicit exclusion
- Your chances of successfully getting coverage
- If you'll be able to proceed on your own or if representation is advisable