Power Point - Gender Justice League

Trans* Health Forum
Agenda for today
History of Policy Changes
WPATH SOC & ICATH – What are the requirements
Apple Care
Private Health Insurance
Puberty Delay & Youth Care
State Employees
Self Care
Income Guidelines for AppleCare & Assistance
Some Reminders
Get help signing up
Free Testing
Folks from Gay City & the We-Are-1
Campaign are here to help you sign
Downstairs at Gay City
Please make sure to write down
your questions on post cards
(available at the check in table)
Please save your questions for
We will read the note cards &
select themes of questions first
then open it up to raised hands
The Exchange is down today for
maintenance 
We can make an appointment for in
person assistance!
February 15th is the deadline
You can sign up any time for free
AppleCare coverage if you qualify
You can always set up an
appointment to come back!
Danni Askini:
Marsha Botzer:
Alison Davidson:
Tobi Hill-Meyer:
Emerson Seekins:
David Ward:
Gender Justice League
Ingersoll Gender Center & The Task Force
Lifelong AIDS Alliance & Ingersoll
We-Are-1 & Gender Justice League
Univ. of Washington & Gender Justice League
Legal Voice & Q-Law
Not on the panel but so important!
Lisa Brodoff, Kris Hermans, Seth Kirby, Dr. Bobbi Dalley, Anand
Kalra, Lisa Motet, Andrew Crey, & So many more!
ACLU of Washington
Human Rights Campaign
Basic Rights Oregon
Ingersoll Gender Center
National Gay and Lesbian
Task Force Action Fund
Seattle University
School of Law – Ronald
A. Peterson Law Clinic
Oasis Youth Center
City of Seattle LGBT
Lambda Legal
Transgender Law Center
Legal Voice
Pierce County AIDS
Pride Foundation
National Center for
Lesbian Rights
Rainbow Center
Equal Rights Washington
Gay City Health Project
Gender Justice League
Greater Seattle
Business Association
National Center for
Transgender Equality
Seattle Counseling
Health Insurance only pays for treatment of a “Disease”
Trans people have had to “accept” being labeled
mentally ill in hopes of increasing access to care
Almost all health insurance companies & surgeons
have guidelines based on WPATH
ICATH does not require a diagnosis of Gender Dysphoria –
Generally only practiced by some PCPs and Therapists
Insurance Reimbursement is perhaps available for ICATH
care for primary care, hormones, or therapy; but large
problems will happen for surgery (prior authorization) that
might require you to “go back to the start”.
AppleCare (Medicaid)
Brief History
What coverage is currently available?
- hormones, doctors visits, mental health care
- Surgeries by “exception to the rule process”
What is the new draft policy?
When is the public hearing?
What about SRS?
When will the new rule be finalized?
[email protected]
AppleCare (Medicaid)
Private Insurance Plans
Private Insurance Plans
• All Plans should cover all medically necessary care
• Therapy, Hormones & Labs, Primary Care Visits, Specialist Visits
• Surgeries as medically necessary (limited by policy)
• Each Plan will have to tell you what care they consider “Medically Necessary”
• Based on WPATH SOC
• Generally covers Top Surgery for Trans men, bottom surgery for Trans
men and women.
• Almost everything else is considered “Cosmetic”
• Remember: Deductibles, Co-Pays, and In-network vs. Out of Network cost
• Most bottom surgeries will be out of state;
check for “In Network vs. Out of Network” rules, make sure to ask
“Do you have any In-network providers who can offer this covered surgery?”
Private Insurance Plans
• In Network:
• Regence & Bridge span
- Marci Bowers
• Group Health
• Tobi Meltzer
Possibly others! Please let us know when you
find out!
Puberty Delay
• Should be covered!
• Some companies may try to impose an arbitrary
age limit of 18
• “Off Label Use” and
“Not listed in Compendium”
• Appeal, Appeal, Appeal!
• AppleCare & Chip currently has proposed 18+
• Help us testify!
Appealing a Denial
Appeal the Denial with your Insurer
 Cite Insurance Commissioner Letter
 Cite WPATH Standards of Care
 Provide evidence of diagnosis of
“Gender Dysphoria”
 Demonstrate that you have followed
 Provide letter from PCP & Therapist
stating this is “Next medically necessary
step” in treatment for G.D.
• For those 65+ and Disabled
• Removed Exclusion
• Didn’t “Add” anything!
• Norvatis LCD - 
• Some surgeries are being covered!
• Get Prior Authorization if possible
• Check Transmedicare.com
for provider list
None we know of in WA yet – but OHSU!
• WA Covered by
Noridian Healthcare Solutions
• Medicare Advantage+ plans (HMO-type)
• Requires Prior Authorization
• Check with Surgeon first!
• Out of State Travel & Coverage
State Employees
All Coverage Started Jan 1st
UMP & HMO Plans
Follows WPATH guidelines
“Transgender Health . . . . . . . . . . . . . . .. (page) 41
The following services associated with a diagnosis of
gender dysphoria are covered:
• Non-surgical services, including but not limited to
hormone therapy, office visits, mental health/counseling,
and tests. Some services and drugs may require
• Surgical services when preauthorized by the plan
Please take a minute to fill out your cards
Pass them forward to Marsha
Self Care
Get Connected to Others! You are Not Alone!
Ingersoll Gender Center every Wednesday Night
Gender Justice League & Q-Law for help with Appeals
Take your time
Denial letters are frustrating and annoying – note the timeline you have
to appeal and take a minute to take care of yourself
Appeal, Appeal, Appeal
At this point – the largest amount of change comes from individuals
appealing denials and holding companies accountable.
File a complaint with the OIC!
Self Care
These Guidelines are very binary!
Work with your provider to identify the care that you need, and work with
them to find the language that works with your insurance company
Take Advantage of your benefits!
PreP is now covered
Visit a therapist if you have been putting it off! It’s covered!
Check out what other self-care benefits are available:
Chiropractic, Massage, and Naturopaths may also be covered in some plans.
Vaccines (Hep B, HPV, DPT), Cancer Screening, Blood Pressure screening,
Preventative Care, Depression screening, and HIV/STD Screening ARE ALL
FREE! $0.00 co-pay!
Washington Health
AppleCare (Medicaid)
We will answer questions from the cards first
Then we will answer on raised hands

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