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+--- Thread: Appealing to insurance's decision on top surgery (/t-appealing-to-insurance-s-decision-on-top-surgery)
Appealing to insurance's decision on top surgery - LindaB - 10-25-2015
Hi,
I'm new to this forum. My ftm son turned 18 recently and plans to have top surgery in December. He has United Healthcare Insurance through his father's employer. They have denied coverage of this surgery because they don't cover transgender care. I plan to appeal on the basis that it is discriminatory, and that top surgery for a transgender male individual is not cosmetic. Having breasts causes him great distress, as I'm sure you can understand. I would like advise on how to appeal to a company that says they will not cover any transgender care. By the way, we live in Illinois. Insurance is through John Deere, whose world headquarters is in Moline, Illinois.
RE: Appealing to insurance's decision on top surgery - Joshua - 10-25-2015
Thank you for advocating for your son, Linda. I hope these links are helpful:
How to Appeal a Health Insurance Denial
Your Guide To the Appeals Process
Q. Health insurance plans that exclude services related to gender transition often say they are “cosmetic” or “experimental.” Is this true?
Quote:A. No. The myth that transition-related care is “cosmetic” or “experimental” is discriminatory and out of touch with current medical thinking. The AMA and WPATH have specifically rejected these arguments, and courts have affirmed their conclusion. In a case brought by Gay and Lesbian Advocates and Defenders (GLAD), O’Donnabhain v. Commissioner, for instance, the Internal Revenue Service lost its claim that such treatments were cosmetic and experimental when a transgender woman deducted her SRS procedures as a medical expense.
Q. What should I do if I am denied coverage for transition-related health care?
Quote:A. Get a copy of your health insurance policy to see if there is any discriminatory exclusion language. If so, find out what the process is to appeal a denial of coverage. You will likely need to provide written documentation from your doctor that this treatment is deemed medically necessary for you.
Use official statements from any of the following leading professional medical organizations as backup for your argument that transition-related care is not cosmetic or elective and should be covered:
American Academy of Family Physicians
American College of Obstetricians and Gynecologists
American Medical Association
American Psychological Association
American Psychiatric Association
National Association of Social Workers
World Professional Association for Transgender Health
Contact Lambda Legal’s Help Desk (toll-free: 866-542-8336 or www.lambdalegal.org/help)
What are my rights regarding health insurance?
Quote:If you think you have been improperly denied insurance benefits, you may also file an appeal with your insurance plan and have it reviewed by an independent review organization. You can find more information about insurance appeals here: http://www.healthcare.gov/using-insurance/managing/appealing-denials/index.html.