Insurance for Transgender Program

Medical and mental health care provided by the UMHS-CGSP may be covered by the insurance you currently have or obtain in the future. It is very important that you investigate your insurance coverage carefully before services begin. This may mean talking with a benefits representative where you work or talking with various insurance companies and their representative. Typically, there is a 1-800 phone number for subscriber information on your insurance card or a listing for an 800 number that you can reach through the operator.

We are glad to bill your insurer or to provide you with the necessary documentation to submit to your provider for reimbursement. However, we are not able to determine your coverage or benefits or advise you regarding which policy to obtain. Our expertise and primary responsibility is the provision of health care, and our staff does not have the training to be well-informed and knowledgeable regarding the many health care insurance company plans that may be available to you.

When, or if, the health care provider submits a bill to your insurance company, it is no guarantee that the insurer will cover it. It is a request for payment that your insurance can deny if it is not in accordance with your policy specifications. In the event that your insurance does not pay any or only a portion of the cost of your health care, the entire bill or remaining balance is your responsibility.

  1. You might contact the insurance representative and state that "I am a subscriber and want information about my policy" or "I am investigating various plans and would like information about the different policies and coverage options you offer." You may be specifically interested in mental health coverage, medical office visits, prescription coverage, and various laboratory and outpatient procedures such as x-rays, surgical coverage, hospitalization, deductibles, and co-pays.
  2. You may want to find out if there is a major medical rider on your policy or on the policy you are considering. Riders are additional insurance coverage features usually available at an additional cost that allows for some adjustment to an individual’s policy.
  3. You may want to ask if you can assign benefits to your insurance company, which authorizes them to pay your health care provider directly, or if it is necessary for you to pay, obtain a receipt and forward this to the insurer for reimbursement.
  4. When determining mental health care coverage, you may want to specifically ask if coverage includes services provided by fully certified clinical social workers, psychologists or psychiatrists. Also, see if you are limited to the use of providers who are part of the insurance plan's provider group. If so, ask if this applies to seeing someone outside the system that has a unique specialty not otherwise available and if out of network referrals can be made.
  5. You may want to investigate whether or not you need to have a referral from a specific physician or physician group in order to be covered for mental health or medical services. Check to see if you need authorization before services are begun.