Exciting News!

Just a quick note because I need to share my excitement with someone. My insurance company approved my top surgery! This drops my total cost from about $8500 to about $5000.

I just needed to share.

Much love,
Ty

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6 thoughts on “Exciting News!”

  1. Hey Tyler, I was wondering how you found out your insurance company would cover the surgery? Did you call them with a specific code, and ask them to check if it was covered? Any info about this would be appreciated – I’m pretty positive my insurance won’t cover any part of it, but I figure I better do as much as I can to find out for sure!

    1. I have Aetna (if that helps) and I just logged into the member website and searched “gender surgery”. Mine was covered with a Prior Authorization (PA). Because there were no in-network providers for the procedure, they covered an out-of-network provider at in-network rates, of a little more savings ($500-600).

      I know Dr. Rumer’s office provided me with some CPT Procedure codes when I consulted with her. These are the codes that “define” each procedure. If I remember correctly, it’s CPT codes 19303-50 and 19350-50 for the mastectomy and reconstruction, respectively, if I remember correctly. You may want to call Dr. Rumer’s office and ask for the exact CPT codes for your procedures. Then you can call your insurance company and verify coverage with them using these. They may also require a diagnosis code…typically what they’re looking for is F64.1 – Gender identity disorder in adolescence and adulthood or similar.

      Something else to consider is asking them what their appeals/ redetermination process is if they don’t cover it. Have the office submit the PA and have it denied and then start the process of fighting it.

      I actually work on the PA processing end for the pharmacy end an insurance company right now, so if there’s anything else I can do to help with this, please let me know. I’d be happy to try to help any way I can.

      1. Thanks! all this info is really helpful. I’m not sure whether I’d attempt to fight it – seems like a lost cause if they outright deny it, but we’ll see. First step is to go on the website (which I’ve been dreading!)

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