i’m 19 years old, and a transgender individual (ftm). I recently had a bilateral mastectomy with Dr. Beverly Fischer to treat adult onset gender dysphoria. I was billed $8650 on a care credit credit card that i opened specifically for this procedure.
i saved up around 2000 dollars, as i am a 19 year old working part time at minimum wage jobs and am responsible for certain bills (phone bills, car bills, medical bills, essentials, etc). i gathered all the paperwork, received a letter from a licensed therapist, requested an itemized receipt, called my insurance ahead of time to confirm the procedure was covered- and it was. i printed out a page from my benefits statement highlighting the codes that were covered and matched the procedures with the same codes. i had received a diagnoses from a licensed medical professional at chase brexton in Columbia Maryland months ahead of my surgery date and had been undergoing hormone replacement therapy, which is not required for this particular procedure but is mentioned in other procedures as a requirement. i prepared in every way i could think of.
however, a month after my procedure, my insurance submitted an eob that stated my coverage was denied because modifier code 50 is not eligible for reimbursement.
after some research, and asking my doctor, it was revealed that modifier code 50 means Bilateral and it is indeed covered under my plan. i called my insurance, they hung up on me. i called again and they agreed to review my claim.
a month later, we receive an email about an updated eob. they reviewed my claim and came to the conclusion that modifier code 50 is indeed eligible, and will be processed on 2 lines instead of one (essentially changing it to 2 single mastectomys). however, coverage is still denied. this time, there is no indicated reason as to why my coverage was denied, other than it simply is.
i will be making the request as to why my claim was denied, but at the moment i fear my insurance will continue leading me in circles and is determined not to reimburse me.
my position at work is part time seasonal associate, and i may be laid off once the season is over. i’m 19 years old, i have no degree, my family is unable to help me with my bills.
please share this around, to anyone you know.
i am in desperate need of help and support. if you can, please make a donation to my kofi https://ko-fi.com/craziefuzi , every single bit counts and is immensely appreciated.
i also work as a freelance digital artist, my commissions are not very frequent, and buying art from me is another way to support me.
thank you so much for your time, and please, spread this around. give me advice, support, anything you think could help, i greatly appreciate it.
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