I’m starting a new job with great benefits, except the health insurance options don’t cover out-of-network providers unless it’s an emergency (like breaking a leg abroad).
I’m trans and my surgeon is out-of-network. I’ve already had several procedures with him as part of a multi-stage process, and only one or two minor surgeries remain. I’ve asked the surgeon’s office if they could file for continuity of care with my new insurance, and they said they would try.
Does anyone know of any health plans that specifically cover out-of-network care? Or are there other options I could explore? I’ve also asked the surgeon if they might consider finishing pro-bono if no insurance options work out.
Age: 30, Location: New York, Income: $50,000/year.
Some PPO plans offer broader out-of-network coverage, but they are usually more expensive. You might want to look into supplemental insurance plans specifically for surgical needs, though these tend to have limited coverage. Consider reaching out to an insurance broker to see if they can help find a plan that fits your situation.
Continuity of care might be your best shot. If approved, your insurance might temporarily cover the surgeon as in-network for the remainder of your treatment. Make sure the office submits detailed documentation about why continuity is necessary.
If your surgeon agrees to pro-bono care, that would be ideal, but it’s worth exploring payment plans or financing options if insurance can’t help. Some surgeons are willing to negotiate fees for existing patients with special circumstances.
Some high-end marketplace plans might offer limited out-of-network coverage. Check if any of them are available in your area, but they’ll likely have high premiums and deductibles.
Have you considered reaching out to your new employer’s HR department? Sometimes they can advocate for exceptions or guide you to resources for complex situations like this.
Depending on your location in New York, there might be state programs or assistance for trans health care. Some organizations also provide grants or financial aid for gender-affirming surgeries.