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! ♪

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