Video 4: Denied trans health care under insurance? Know your rights!


♪ Hi, I’m Noah Lewis, Executive Director of Transcend Legal We’re excited that we finished our three-part video series on how to get trans health care covered under insurance

In those videos, we explained start-to-finish how to get the care you need—covering everything from getting a therapist letter, to choosing a surgeon, to making an appeal So, with the information we’ve already given to you, many of you will be able to get your coverage without any further assistance Sometimes all it takes is a simple email or phone call to get coverage We’d be thrilled if a video series were all we had to do to end discrimination against trans people in health insurance But we know it’s not

There are still people who need legal assistance In fact, there are people who need legal assistance and don’t even know it because they’ve been given misinformation about their plan or don’t realize they have the option to challenge any denials or exclusions For example, a woman contacted us the other day She said that her insurance clearly excluded any breast reconstruction or facial surgeries But I looked up the plan and I saw that, in fact, it covered breast reconstruction—and that we could make a good case for it covering facial surgery, too

So, if you’ve been told that something is not covered, and especially if there is an explicit exclusion, that is exactly when you want to seek out legal assistance to help you understand how to challenge such an exclusion At this point, if you haven’t yet applied for surgery, pretty much everyone has some legal protections that they can use to challenge a denial of coverage Some cases are easier to challenge than others, but if you are able and willing to take a stand, you have that option So, if you have insurance, and are not getting the care that you need, you have to decide if now is the time to learn about what your legal rights are You may want to know if your legal challenge will work

I can’t answer that question without first looking at your specific situation But I have successfully helped many people appeal denials of coverage, get coverage in the face of an explicit exclusion, or have had employers or schools remove an exclusion So, while prior results do not guarantee a similar outcome, we think it’s worth consulting with an attorney to find out what your rights are If we don’t think you have a decent shot, we’re going to explain that to you, and we’re probably not going to take your case We don’t want to waste anyone’s time or money

Most of all—the only way we’ll know if a legal challenge will work is if you try I’m Charlie Arrowood, an attorney with Transcend Legal Our ideal clients are people who are motivated to make things happen for them People who understand that they have rights that are being violated and want to do something about it You’re probably one of those people, seeing as you’ve already taken the step of watching this video

So, what does working with Transcend Legal look like? The first step is having a consultation In a consultation, we’ll look at your specific plan documents and any denial letters you may have already received, and we’ll give you a careful analysis of the legal protections in place for you Sometimes we in the trans community may try to do things on our own But thinking you can handle your insurance issue entirely on your own carries risks First, you might not know about the full range of protections available to you

We as lawyers are familiar with the legal protections in place, we know the ins and outs If you rely on your medical provider’s staff or another trans person—or worse, the insurance company or your employer—to tell you what your legal rights are, you’re not going to get the full picture, and you may even get misinformation A second reason why it’s important to get legal help is because of what happens if the appeal doesn’t work If your appeals aren’t done properly, it can mean forfeiting your rights for good So it’s best to get legal assistance before you appeal

A third reason to speak with an attorney sooner rather than later is deadlines There are strict deadlines to file legal claims sometimes as short as forty five days The deadlines for discrimination claims are not found in your plan booklet So if you’ve received a denial, talk with an attorney as soon as possible to preserve all of your rights Or if you’re about to file for preauthorization and think you’ll receive a denial, talk with an attorney first so that the attorney can make sure that all of the necessary information is included, and can help you appeal the denial right away

So what is this going to cost you? To have a comprehensive evaluation of your rights, we offer a consultation for $75 At the end of the consultation, you will know, what your plan covers, if it will cover your care without a fight, or, if you need to a challenge a denial, how difficult it will be and what you will need to do If you’ve already paid out-of-pocket, we can tell you how to file a claim, what your chances of success will be, and what your rights are if it’s denied If there is an explicit exclusion, we can evaluate how likely your employer or school will be to change the plan And what if the consultation isn’t enough? What if you need us to represent you as well? We offer flat fees that are less than the cost of paying out of pocket for surgery

In some cases, there is the possibility of being able to recover attorneys fees and get additional compensation through a settlement agreement, though we can make no guarantees about that Transcend Legal was created to help fill a need There are no other legal organizations dedicated to helping trans people get trans care covered under insurance and ending discrimination in health insurance We do what we can to provide affordable legal services, but it costs money to do this To keep the organization running, we have to charge fees

By working with us, you’re not just helping yourself You’re also helping the whole trans community That’s because we help you get coverage, and we also help fight to remove barriers to health care that affect other trans people So the money for legal fees is not just going for one surgery, but rather for the surgery of every trans person at that company or everyone who uses that insurance company And if we have to go to court, you’ll be helping countless trans people by setting legal precedent saying that trans exclusions are discrimination

We’re a small organization, and we can only take on so many clients at a time Because of the video series, more people are contacting us for assistance We won’t be able to represent everyone we have a consultation with If you are about to have surgery and pay out of pocket, it’s important to speak with an attorney as soon as possible to ensure that you have done everything you need to do to be reimbursed And if you have an employer-based plan, now is the time when employers are evaluating their plans for next year

You only have a month or two where it is easy for an employer to remove the exclusion If you wait until January, it’s going to be harder for them to change the plan and they’ll be less likely to do it voluntarily Here’s another important factor Regulations under the Affordable Care Act—or Obamacare—say that transgender care cannot be excluded from health insurance plans But the Trump administration is about to propose rolling back those protections

Even if that happens, we still believe that trans people are protected under the law, but the absence of the regulations makes our job harder So if you act now to get your care covered—your chances are going to be better I founded Transcend Legal to try to meet an unmet need We have the skills and knowledge to help trans people get health care and to end trans exclusions But the bottom line is that we can’t end trans health discrimination by ourselves

We need other trans people to be active participants in creating trans equality We need people to step up and assert their rights And that includes contributing financially to this effort We are not backed by large grants or wealthy donors We’re accountable to our clients, and to the trans community, and that gives us the freedom to provide the services that trans people need now without waiting for anyone else to give us permission

So if you would like to be a part of this effort to end trans health discrimination, then please sign up for a consultation And if you don’t need a consultation, please donate $75 so that someone else can get the help that they need Please join us today, so that, before too long, all trans people can get the care that they need Thank you for being a part of this! ♪

Source: Youtube


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