Blue cross blue shield texas hormone replacement therapy

Academic Blue – BCBSTX

The UH Endorsed Student Health Insurance (Academic Blue – BCBSTX) plan covers Transgender Services as follows.

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Academic Blue – BCBSTX
Gender Assignment Surgery and Gender Reassignment Surgery with Related Services
Does Blue Cross Blue Shield Federal cover hormone replacement therapy?
Does BCBS Texas cover gender reassignment?
Does Blue Cross Blue Shield of Texas cover chiropractic?

Transsexualism/Gender Identity Disorder Expense

Benefits are payable for Eligible Expenses incurred by a Covered Person for the treatment of transsexualism/gender identity disorder on the same basis as any other Sickness according to the limits and maximums shown in the Schedule of Benefits. The Eligible Expenses must be incurred while the Covered Person is insured for these benefits.

Eligible Expenses include:

mental health counseling (subject to the limitations applicable to inpatient and outpatient treatment of Mental and Nervous Disorders);
hormone replacement therapy;
sexual reassignment surgery:
1. for female to male: mastectomy, hysterectomy, salpingo-oophorectomy, vaginectomy, metoidioplasty, scrotoplasty, urethroplasty, placement of testicular prosthesis, phalloplasty; or
2. for male to female: orchiectomy, penectomy, vaginoplasty, clitoroplasty, labiaplasty.

The Company will pay the Covered Percentage of the Eligible Expenses incurred in excess of the Deductible Amount.

No benefits will be paid for the Eligible Expense above under any other similar benefit provision contained in this Policy.

Outpatient Expenses (In-Network) 80% of Reasonable and Customary (R&C) unless otherwise stated.**

Prime Therapeutics - Prescription Drugs Information
(Outside UH Health Center)
$20 generic, $50 brand name, $70 non-formulary brand

Toll Free: 888-275-3235

Emergency Room (In-Network) 80% of R&C subject to $150 Hospital copay per visit.

Surgery Expense (In-Network) or Out of Hospital) 80% of R&C unless otherwise stated**

*Copayment plus the cost difference between the brand-name drug or supplies per prescription for which there is a generic drug or supply available.

** Subject to deductibles, copays, limitations, and exclusions.

The above summary is not a guarantee of benefits. Contact BlueCross Blue Shield of Texas Customer Service at (855) 267-0214 for benefits information.

My wife is MtF, and she finally got a letter from her therapist to start HRT! Yay! Since then we've been researching local physicians and calling to make an appointment. We made one for early January, but the staff said that in the past, they haven't been able to get the blood work cost covered by BCBS of TX and patients in the past have had to pay out of pocket, which is ~$1000 for the first appointment. Yikes. It's...doable for us, but not sustainable if she's going to need regular blood work. From what I've seen, the prescriptions are at least affordable and we shouldn't have issues there. Does anyone else have experience with getting BCBS of TX to cover blood work for HRT?

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Current: Blue Cross Blue Shield of Texas - Gender Assignment Surgery and Gender Reassignment Surgery with Related Services

Index Voice Therapy And Surgery [0 of 32]

Policy: Gender Assignment Surgery and Gender Reassignment Surgery with Related Services
Policy Number: SUR717.001
Last Update: 2021-01-15
Issued in: Texas

Body Contouring:

F. Secondary Sexual Characteristic (Masculinizing or Feminizing) Gender Reassignment Surgeries and Related Services:
Procedures or services to create and maintain gender specific characteristics (masculinization or feminization) as part of the overall desired gender reassignment services treatment plan may be considered medically necessary for the treatment of gender dysphoria ONLY. These procedures may include the following:
Liposuction/lipofilling or body contouring or modeling of waist, buttocks, hips, and thighs reduction;

Facial Reconstruction:

F. Secondary Sexual Characteristic (Masculinizing or Feminizing) Gender Reassignment Surgeries and Related Services:
Procedures or services to create and maintain gender specific characteristics (masculinization or feminization) as part of the overall desired gender reassignment services treatment plan may be considered medically necessary for the treatment of gender dysphoria ONLY. These procedures may include the following:
Abdominoplasty;
Blepharoplasty;
Brow lift;
Calf implants;
Cheek implants;
Chin or nose implants;
External penile prosthesis (vacuum erection devices);
Face lift (rhytidectomy);
Facial bone reconstruction/sculpturing/reduction, includes jaw shortening;
Forehead lift or contouring;
Hair removal (may include donor skin sites) or hair transplantation (electrolysis or hairplasty);
Laryngoplasty;
Lip reduction or lip enhancement;
Liposuction/lipofilling or body contouring or modeling of waist, buttocks, hips, and thighs reduction;
Neck tightening;
Pectoral implants;
Reduction thyroid chondroplasty or trachea shaving (reduction of Adam’s apple);
Redundant/excessive skin removal;
Rhinoplasty (nose correction);
Skin resurfacing;
Testicular expanders;
Voice modification surgery; and/or
Voice (speech) therapy or voice lessons.
NOTE 4: Preparatory or ancillary procedures (such as anesthesia, tissue harvesting for skin, fat, nerve or muscle grafting, etc.) and supplies or equipment (such as stents, prosthesis, implants, etc.) that are required for the procedures listed above are considered an integral part of the MtF or FtM transition process.

NOTE 5: Surgical repairs or revisions related to MtF or FtM procedures may be required, such as removal and replacement of prostheses.

Fertility Preservation:

H. Gender Reassignment Reproductive Services:
Procurement, cryopreservation/freezing, storage/banking, and thawing of reproductive tissues, such as oocytes, ovaries, embryos, spermatozoa, and testicular tissue may be considered medically necessary for individuals with gender dysphoria because gender reassignment services, such as long-term cross-sex hormone therapy or surgical procedures, may render an individual infertile whether or not the individual has reproduced in the past.

Updated on Nov 23, 2021

Does Blue Cross Blue Shield Federal cover hormone replacement therapy?

Blue Cross Blue Shield does not cover bioidentical hormone therapy or bioidentical hormone pellets, and it's far from being the only health insurer that won't cover bioidentical hormone therapy.