Gaining Knowledge About My Coverage

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Winter is a 29-year-old, Brooklyn resident who works in sales and marketing. He was referred to Community Health Advocates (CHA) by a friend because he was having trouble getting his health insurance plan to cover transgender health services. He had COBRA coverage after leaving a job and the services he needed were denied by that plan.  He soon secured different coverage through his new employer, however, that plan also would not cover the services his doctor had confirmed he needed.  To move forward, a CHA case handler advised Winter on how to negotiate with the insurance company and helped Winter with his appeals. “My advocate helped me talk to the new insurance company about what was covered specifically and what was excluded and then we looked into surgeons together.” Winter was finally able to get the services he needed after working with CHA for several months. “I probably could not have done the things I have done without having an advocate.” When asked if he has advice for others having insurance problems he says, “Call up an advocate! As someone who is trans, knowing that trying to get an insurance company to cover that is sort of a lost cause. I just always had these advocates working with me. I felt this reassurance that something was going to work out, and then it did.” As of December 2014 insurance companies are no longer allowed to deny transgender health services in New York, if a medical provider has deemed it medically necessary. Winter is excited and encouraged by this change, even though it did not come in time for his surgery, “If only that happened three months before! But it’s exciting, and now my questions are more about my gender marker … so I know CHA was looking into that and I am also.”