Insurance Guide
Claim Denial Resources
Claim Denied? Check out the Appeal Flowchart.
Find out why a claim was denied
If you feel you’ve been discriminated against you have right to file a complaint
Comprehensive Guide
Insurance Plans
North Dakota Insurance
ND Medicaid Navigators: https://ndcpd.org/NDnavigator/
ND Medicaid Medication Coverage: http://www.hidesigns.com/ndmedicaid/pdl
ND Medicaid Transgender Coverage: Gender Policy PDF
- Covers Puberty Blockers
- Covers Hormone Therapy
- Covers several Affirming Surgeries
VA Services (Veterans)
Hormone Therapy and other services are open for Veterans: https://www.patientcare.va.gov/lgbt/
Medicare (Typically Over 65)
Anyone on Medicare should have full coverage options: https://transequality.org/know-your-rights/medicare
Public and Employer Plans
You need to check their handbook and ask. Make sure to ask about hormones, surgery, kind of prescriptions covered (some plans don’t cover T-Gel for example), and lab work.
Minnesota Insurance
Typically Minnesota Insurance is fully inclusive: https://www.outfront.org/health-care-coverage
Insurance Coverage Question and Answers
Understanding Basic Insurance
Comprehensive breakdown of insurance terms in a friendly comedy style: https://www.youtube.com/watch?v=-wpHszfnJns
Does my Plan Cover my Trans/Non-Binary Thing I Want to Do?
The best place to look is in your full plan handbook. They tend to be fifty or more pages long. You’re looking for any exclusion to care or any mention of transgender care. If your plan strictly mentions covering care, they should, with the exception of everything covered in the video above.
How Common is Gender Diverse Healthcare Coverage These Days?
It is extremely uncommon for plans to restrict hormone therapy. More and more plans also include surgery, but employer based plans are the most likely to not have them. However, insurance has gotten less useful for the consumer, so coverage on all procedures has become more difficult for all populations. While this is all subject to change, the constitutionality and medical necessity of transgender care is very strong and established. Many states that are currently attempting to challenge or restrict trans care are being met in court and losing these fights as of time of writing (10/6/22).
What If I Try to Get Something and My Insurance Denies It?
If you’re attempting to get a service that is considered medically necessary, you can fight to get coverage and appeal denials. Rumors suggest insurance companies auto-deny most claims. The suggestion is to expect needing to appeal and doing it multiple times. Make sure your health provider who is requesting the service is heavily involved in clarifying the medically necessary aspect of the care. Sometimes plans do cover specific care, but don’t have providers who actually do it in network. You can also get appeals in these cases to get out-of-network surgeons or providers covered. Every plan will be different, with different requirements, but a lot of folks have success if they’re able to keep the pressure up.
I Just Really Need Surgery and My Insurance Refuses to Work With Me!
Many trans people find themselves in this situation or are not insured for a dozen different reasons where obtaining insurance is not possible. While there is no great and easy answer to this, there are a few recommendations depending on what’s possible. These are with harm reduction in mind and no plan here is a guarantee for coverage. These are ideas to think about, consider, and explore if they could work. The best thing you can do is ask the surgeon you’re working with what other patients have done. Make sure you know what plans have worked with them.
- Can you move to a state with better insurance coverage?
- Different states have different laws, MN tends to be favorable. Moving is a Qualifying Life Event, which also allows a window into the marketplace to pick public options or apply for Medicaid.
- Can you work at a job just for the insurance?
- Many companies do boast fantastic and inclusive insurance. Many trans people work at Starbucks part-time or full time simply for the insurance coverage. While it’s additional work, the cost savings can be in the tens of thousands of dollars.
- Can you temporarily quit?
- Losing a job is another Qualify Life Event. Having little to no income could make you qualified for state Medicaid, which can cover surgery. If it is possible to stay with a friend, keep living costs low, then this could be used to qualify for Medicaid and potentially get surgery covered through it.
- Look for Sliding Fee Scale Surgeons
- These tend to be scheduling out a very long time for service, there are options here as well. The surgery tab includes such things!