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.
We can work with you to answer questions you may have, provide referrals, and see if you might be eligible for affordable health care coverage. See below for some resources for accessing gender-affirming care in Western North Carolina.
If you have questions or would like to make an appointment to speak with someone, please fill out our interest form hosted by FormAssembly and we’ll get back to you! You can also call us at 828-210-3404 (press 1) and mention trans health or 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.
Podemos responder las preguntas que tengas, evaluar si eres elegible para aseguranzas médicas a bajo costo y generar referidos a otras organizaciones relevantes para ti. A continuación, tenemos una lista de recursos para cuidados de salud con perspectiva de género en el Oeste de Carolina del Norte.
Si tienes preguntas o te gustaría hacer una cita para conversar con alguien de nuestro equipo, por favor llena este formulario y nos pondremos en contacto contigo. 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)
Know what healthcare you want
- 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
- 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
- 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
- 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: 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
- 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
- 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
- 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/