Gender care and coverage overview

What does my insurance cover regarding gender affirming care?

We need your member ID and group number to check your benefit booklet to see if gender-affirming care is covered or if specific gender-affirming services are included. Please contact customer service (the number is on the back of your insurance card) or our gender care team for that information.

What if I don't have coverage, the insurance under my employer doesn't offer coverage, or the service I want is not covered?

What is included in the specific insurance product you have, and who the decision maker will be, varies depending on how you get your insurance. You can always reach out to the gender services team to learn more about your unique plan and what your care options are.

Are there individual plans available for purchase?

There may be an option to purchase an individual plan either as your primary insurance or a supplement to an employer policy. We recommend making sure you are eligible for services before purchasing. For contact information and more details about buying a plan, visit bluecrossmn.com/contact.

What hair removal provider can I go to? How do I get hair removal if hair removal businesses don't accept insurance?

If your plan provides coverage for gender affirming care, and if the provider is contracted with Blue Cross, they will submit claims on your behalf. If the provider is not contracted with us, you can get hair removal services from a provider of your choice but will need to pay up-front and submit claims to get reimbursed. Please contact gender.services@bluecrossmn.com for assistance with submitting these claims. 

Will a hair removal provider be considered in-network or out-of-network?

If your plan provides coverage for gender affirming care, they will be considered in-network.

Do I need a mental health provider letter of medical necessity for hormones/HRT?

This depends on your specific health plan and the medication being prescribed. Please call the number on the back of your insurance card and/or Customer Service to confirm benefits and coverage requirements.

How do I submit hair removal claims for reimbursement?

Please contact gender.services@bluecrossmn.com if you need assistance submitting a hair removal claim.

What is the process for getting a letter of medical necessity?

Steps:

1. Find a health provider if you do not already have one. If you need assistance, reach out to our Gender Services Team.
2. Print out a copy or email the medical policy to your health provider and ask them to write a letter that addresses all the required criteria listed in the medical policy.
3. Find a provider you feel comfortable with for your procedure. If you need assistance or have questions about provider options, reach out to our Gender Services Team.
4. Send your letter(s) to your provider(s).
5. Your provider(s) will send your letter(s) to Blue Cross Blue Shield of Minnesota with their clinical information when submitting the Prior Authorization request for your surgery. 

Who can write the letter of medical necessity for me? Who/what type of provider qualifies per the medical policy?

Providers that meet the Minnesota Department of Human Services (MDH) qualifications for a mental health professional can write this letter. MDH has two categories for this.

Minnesota Statutes §245.4871 Subd. 26 is a Mental Health Practitioner that has at least a bachelor's degree in behavioral health or has worked with individuals with mental health concerns for at least 4,000 hours AND receives treatment supervision.

Minnesota Statutes §245.4871 Subd. 27 is a Mental Health Professional who is independently licensed. These can include psychiatrists, registered nurses that specialize in mental health, psychologists, social workers, counselors or marriage and family therapists. Common credentials (letters) associated with Mental Health Professionals in Minnesota are LICW, LMFT, LPCC, LP, MD, PMHNP and FNP.

Does my health provider need to have specific letters behind their name to write me a letter for medical necessity?

Please see above.

Who should I send the health provider's letter of medical necessity to, once obtained?

Keep a copy for your records. If this is for hair removal services only, please email the letter to gender.services@bluecrossmn.com. If this is for surgery, please email/provide the letter to your surgeon's office, who will send the letter(s) to Blue Cross with their Prior Authorization paperwork.

What kind of documentation is required to get covered for gender-affirming care or service(s)?

You need a letter from your health provider that is written addressing and validating the requirements that are listed in the medical policy needed to meet the criteria for the service.

If you are seeking bottom surgery, you will need two letters: one from your health provider and the second from a health professional who you do not have an ongoing relationship with but has only provided an evaluation.

How do I qualify for voice surgery? Do I need a letter from my treating speech therapist (in addition to my health provider)?

If your plan provides coverage for gender affirming care, medical necessity must be documented. You will need to do this via a letter from your treating speech therapist (who will indicate that speech therapy was tried and failed, and surgery will provide further benefit) and your health provider.

How does my surgeon, or other providers, get my letter from my health provider regarding medical necessity?

You will need to provide a copy of the letter by mail, email or in-person. Please ask your surgeon's office how they would like to obtain a copy of the letter.

Where can I change the name or gender listed in my insurance file?

This depends on your plan, so please contact our team at gender.services@bluecrossmn.com or (866) 694-9361 for a personalized answer.

I have BluePlus/Medicaid. Can you help me?

Yes, we have a dedicated team member who works with Medical Assistance (Medicaid) members. Please email gender.services@bluecrossmn.com or (866) 694-9361 and provide your name, the name listed on your health insurance card, member ID, date of birth and what you need assistance with.

Where can I find an affirming provider?

We can help you find a provider. Email us at gender.services@bluecrossmn.com or call (866) 694-9361.

Do Medical Assistance (Medicaid) plans administered by Blue Cross use the DHS policy or the BCBSMN policy for gender affirming care?

If you have a Medicaid plan through Blue Cross, then the BCBSMN policy is what applies.

What if I need to travel out-of-state for a provider? Does my insurance pay travel expenses?

This depends on your plan so please contact our team at gender.services@bluecrossmn.com or (866) 694-9361 for a personalized answer.

Do I need to be on hormones for a specific amount of time to ‘qualify’ for surgery?

The response to this question depends on your plan, so please read the answer below that correlates with your plan.

• Plans that use the BCBSMN Gender Affirming Medical Policy: Hormone therapy is not required for some surgeries and is recommended for a duration of 12 months for others (as appropriate to your gender goals). This includes Medicare Advantage Plans.
• Medicare: Here is an article with some information on this question. However, we highly recommend contacting Medicare for an answer to this question.
• Federal Employee Plans (FEP) - Member must meet the following criteria: 
  • Living 12 months of continuous, full-time, real-life experience as desired gender (including place of employment, family, social and community activities)
  • 6 months of continuous hormone therapy appropriate to the member's gender identity (not required for mastectomy)