Insurance

Medical and mental health care provided by the University of Michigan Health System Comprehensive Gender Services Program may be covered by the insurance you currently have or obtain in the future. It is very important that you investigate your insurance coverage carefully. This may mean talking with a benefits representative where you work, with various insurance companies and their representative (typically there is a 1-800 subscriber information number on your insurance card or one available through an 800 number directory that you can reach through the operator.).

We are glad to bill your insurer or to provide you with the necessary documentation to submit to your provider for reimbursement. However, we are not able to determine your coverage or benefits or advise you regarding which policy to obtain. Our expertise and primary responsibility is the provision of health care, and therefore our staff has neither the time nor the training to be well-informed and current regarding health care insurance.

When, or if, the health care provider submits a bill to your insurance company, it is no guarantee that the insurer will cover it. It is a request for payment that your insurance can deny if it is not in accordance with your policy specifications. In the event that your insurance does not pay any or only a portion of the cost of your health care, the entire bill or remaining balance is your responsibility.

1. You might contact the insurance representative and state that "I am a subscriber and want information about my policy" or "I am investigating various plans and would like information about the different policies and coverage options you offer." You may be specifically interested in mental health coverage, medical office visits, prescription coverage, and various laboratory and outpatient procedures such as x-rays, surgical coverage, hospitalization, deductibles and co-pays.
2. It is a good idea to check to see if there is an annual lifetime maximum (per year or for the term of the policy).
3. You may want to find out if there is a major medical rider on your policy or on the policy you are considering.
4. You may want to ask if you can assign benefits to your insurance company - authorizing them to pay your health care provider directly, or if it is necessary for you to pay, get a receipt and then forward it to the insurer for reimbursement.
5. When determining mental health care coverage, you may want to specifically ask if coverage includes services provided by fully certified clinical social workers, psychologists, or psychiatrists. Also, see if you are limited to the use of providers who are part of the insurance plan's provider group. If so, does this apply to seeing someone outside the system that has a unique specialty not otherwise available; and can "out of panel" referrals be made?
6. You may want to investigate whether or not you need to have a referral from a specific physician or physician group in order to be covered for mental health or medical services. Check to see if you need authorization before services are begun.