Trans & Queer Health Project
Navigating health insurance and health care access is an intimidating process and can be scary, especially if you’re trans or gender non-conforming. At Pisgah Legal Services, we offer a safe space where trained staff can help people identify health insurance plans that are right for them and understand options for accessing gender-affirming care.
El sistema de salud y aseguranzas médicas puede ser un mundo intimidante y confuso para la mayoría de las personas. Esto es mucho más evidente si te identificas como queer o de algún género no-conformista. Pisgah Legal Services ofrece un espacio seguro con profesionales entrenados para asistir a personas que necesitan opciones de salud con perspectiva de género. Nuestro equipo puede ayudarte a identificar opciones que sean apropiadas para tus necesidades individuales.
Click here to fill out our interest form hosted by FormAssembly.
Haga clic aquí para rellenar nuestro formulario de interés alojado por FormAssembly.
You can also call us at 828-210-3404 (press 1) and mention trans health or gender-affirming care.
También puedes llamarnos al 828-210-3404, presiona la opción 3 y menciona que necesitas asistencia con opciones de salud con perspectiva de género.
Resources for Accessing Gender-Affirming Care (WNC)
Recursos para acceder al tratamiento de afirmación de género (WNC)
Know what healthcare you want / Saber que tratamiento quiere Saber que tratamiento quiere
- UCSF on Estrogen: https://transcare.ucsf.edu/article/information-estrogen-hormone-therapy
- UCSF on Testosterone: https://transcare.ucsf.edu/article/information-testosterone-hormone-therapy
- Johns Hopkins overview of common surgical procedures: https://www.hopkinsmedicine.org/health/wellness-and-prevention/gender-affirmation-surgeries
Know what your plan covers / Entender que cubre tu aseguranza
- For youth starting care, reach out to Campaign for Southern Equality: https://southernequality.org/ncresources/
- Any categorical exclusions should be in the Explanation of Coverage (EOC)
- Note: In NC, Medicaid has no specific policy to cover or not cover gender affirming care – this doesn’t mean you can’t get care, but there won’t be a specific policy online to reference
- National Center for Transgender Equality on health plans: https://transequality.org/health-coverage-guide/what-your-plan-covers
- Trans Legal Defense and Education Fund on health plans: https://transhealthproject.org/trans-health-insurance-tutorial/understanding-your-plan/
Understand healthcare costs on your plan / Entender el costo de tratamiento bajo tu aseguranza
- Talk to a Navigator!
- Check your Summary of Benefits and Coverage (SBC)
- For HRT, look up your prescription in the formulary to find the tier and match it to the tier costs on your SBC
- For surgery, look at costs for inpatient or outpatient surgical procedures, and look at your out of pocket maximum – many procedures will hit your out of pocket maximum
- Medicaid: call the Medicaid Ombudsman at 877-201-3750 or go to https://ncmedicaidombudsman.org/
Find an informed provider / Buscar un proveedor informado
- Campaign for Southern Equality Trans in the South directory: https://southernequality.org/resources/transinthesouth/
- OutCare OutList: https://www.outcarehealth.org/outlist/
- WPATH Provider Search: https://www.wpath.org/provider/search
- If you have a trusted provider, ask them for a referral to a different specialty!
Pre-authorization / Preautorización: Work with your provider and insurance company
- National Center for Transgender Equality on preauthorization: https://transequality.org/health-coverage-guide/applying-for-preauthorization
- Trans Legal Defense and Education Fund on applying for coverage: https://transhealthproject.org/trans-health-insurance-tutorial/applying-for-coverage/
Denials/issues / Denegaciónes/problemas
- Trans Legal Defense and Education Fund on denials: https://transhealthproject.org/trans-health-insurance-tutorial/understanding-denials/
- Contact Pisgah Legal Services: 828-253-0406, request assistance from Benefits team
- Medicaid: call the Medicaid Ombudsman at 877-201-3750 or go to https://ncmedicaidombudsman.org/
- ACA/Marketplace: contact a Navigator to use complex case process or appeal process
- World Professional Organization for Transgender Health Standards of Care (can be used to justify medical necessity): https://www.wpath.org/
Paying for healthcare / Pagando por tratamiento
- Jim Collins Foundation, surgical grants: https://jimcollinsfoundation.org/
- Point of Pride, HRT & surgical grants: https://pointofpride.org/
- WNCCHS Transgender Health Program, sliding scale HRT, primary care, and referrals: https://www.wncchs.org/trans-health
Other resources / Otros recursos
- Trans Lifeline: (877) 565-8860 or https://translifeline.org
- The Trevor Project, youth up to age 24, also offers text and chat support: 866-488-7386, https://thetrevorproject.org
- SAGE National LGBT Elder Hotline: 877-360-LGBT or https://sageusa.org
- Tranzmission, WNC virtual support groups: https://tranzmission.org/
- Youth OutRight, local support groups for ages 11-24: https://www.youthoutright.org/
- Cornbread and Roses, sliding scale therapy and support groups: https://www.cbrcounseling.org/