Insurance coverage for transgender care

Challenging insurance denials and exclusions

get insurance? get trans surgery!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

Get help now!

The third Trans Insurance Roadmap video is here!

Transcend Legal is excited to share with you the third video in a series explaining how to get transgender-related health care covered under insurance. We’ll be releasing more videos in this series over the next 2 weeks. Stay tuned to video.transcendlegal.org.