Insurance Coverage for Transgender Care

Trans Insurance Roadmap video series

The era of routine exclusion of transgender-related care is over. No one should be paying for hormones, surgeries, or puberty-delaying treatment out of pocket anymore.

Our Trans Insurance Roadmap videos are the place to start learning about your health care rights. The videos cover the basics of learning what your plan will cover, how to apply for coverage, and what your options are if you are denied.

does my plan cover trans care

How do I know what my plan covers?

If you watched Video 1, you know you need two documents to start to determine what is covered under your plan:

  1. Your insurance plan document (your health insurance policy)
  2. Generic insurance company medical policy on gender reassignment

Learn more about what the plan document it is and how to get it: How do I get a copy of my health insurance policy?

Find your insurance company's policy on gender reassignment here: Transgender Insurance Medical Policies

Challenging insurance denials and exclusions

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 hormones or surgery because your child is not 18
  • Explicit exclusion for all trans care in a 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 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?

If you've watched the videos and know that you need legal assistance, 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

Get help now!