Gender Affirming Care via Cigna

Here is Cigna’s Gender-Affirming Care Policy.

Remember table 1 and 2 are coverage with medical necessity and table 3 is non covered.

Included Health contact details:

• Online: www.includedhealth.com/jpmc (accessible via My-Health on me@jpmc)
• Phone: The care team is available (877) 266 - 2861.
• Mobile app: downloadable from the iPhone or Android app store (search: Included Health )

8 a.m. to 9 p.m. Eastern Monday – Friday

Remember you can also call 800-790-3086 to get assistance.

How to Electrolysis:

This step-by-step (sort of) guide should help you get electrolysis (mostly) covered by Cigna. It should end up costing you something like $15 per session, which is insanely cheap as electrolysis goes.

The general plan is:

1. Get and submit a behavioral health letter of medical necessity for clearance. You may be able to get this from the EAP counselors. The letter must include:
   • Diagnosis code F.64.0 gender dysphoria
   • Procedure code cpt 17380 for electrolysis
   • Say specifically the targeted area of treatment (the face/neck ) (or groin area- has to have authorization for Gender reassignment surgery approved prior to this electrolysis)
2. Get Included Health to
   • perform a search for electrolysis providers in your area,
   • find nobody in-network with reasonable driving distance,
   • and recommend a non-network provider.
3. Get a primary doctor or surgeon as the ordering md to:
   • Prepare clinical information / Letter of medical necessity that supports the surgery or procedure that is being requested that includes:
     • All the same information as the behavioral health letter
     • Their tax id, fax number, address, etc.
   • Fill out and sign the Medical-Network Adequacy Provision Exception Form with:
     • Location of services
     • Electrolysis location
     • Their tax id, fax number, address, etc.
     • The reason for requesting electrolysis network adequacy is there are no in network providers per Included Health.
     • See notes below on how to fill out this form
   • The entire package - behavioral health, medical necessity, and network adequacy — gets faxed together to 833-213-9222 (the number on the NAP Medical form’s first page).
4. Wait 10 business days, then pester Cigna (Transgender care team) until they give you pre-approval. Do not proceed without approval, or reimbursement will be denied.
5. Find out from Cigna your coverage budget per-session.
   • Call 800-790-3086.
   • Ask to speak with an LGBT One Guide Representative.
   • Get them to quote you the Maximum Reimbursable Rate for Electrolysis CPT 17380.
   • Arrange your sessions to spend about this much per session. (You may need more sessions.)
6. Get the electrolysis clinic to provide receipts with:
   • Letter head with name of location, address, phone and fax number
   • Amount billed
   • Diagnosis code F.64.0 gender dysphoria
   • Procedure code CPT 17380 for electrolysis
   • A written or diagram of area on each treatment session
7. Pay up front out of pocket and get the full receipts.
8. E-mail the receipts to Jacki.Trammell@CignaHealthcare.com who will work with you on the claim for reimbursement.
9. Pray. (It should be fine.)

Filling out the Medical-Network Adequacy Provision (NAP) Exception Request Form

Page One

This is all personal information for you, the patient.

Page Two

• Provider Information:

  • This is the doctor who is “prescribing” electrolysis.
  • The “Office Information” section refers again to physician services, not electrolysis services.
  • You are probably not requesting Network Adequacy for this provider.

• Facility Information:

  • This is the place that’s going to do your electrolysis.
  • If the electrologist won’t provide a tax ID number (or has no fax), explain their reasoning in the “Additional Infomation” section on page 3.
  • You are indeed requesting Network Adequacy for this facility.

• Service Infomation:

  • Electrolysis for face and neck -- There are no in-network providers of, nor facilities for, this service within the patient's service area, per search via both Included Health and Cigna's own transgender care coordination team.

Page Three

• Past Medical History:
  • Primary Diagnosis Code: F.64.0
  • Primary Diagnosis Description: Gender Disphoria
  • All else: Leave blank
• Service Requested:
  • Procedure Name: Electrolysis
  • CPT Code: 17380
  • # of Units: 99
    • (One line of this is enough…)
  • Is this a request for…: No, and No.
• Additional Infomation:
  • Note here if the electrologist won’t provide a TIN or FAX number, and why they say.
  • Where Performed: Other - Electrologist's Office
• Authorization:
  • Contact Name: Your doctor
  • HCP Signer’s Name: Your doctor
  • Name of the person completing the form: Your doctor

Then what?

Send it to your doctor in as pre-filled a state as possible so they have an easy time with it. Remind your doctor to include both letters and the form in a package and to fax to the NAP Medical number on the first page of the form. (Currently that’s 833-213-9222.)

If you still have questions, call Cigna (number on the back of your card, or 800-790-3086) and ask for the transgender care team. (You may need to ask for “operator” to get past the robot.)