Sidney Velcns
Kimberly Moreland, MD

March 13,2013

Appeal Bepartment
Consolidated Health Plans
2077 RuoSEvEltAvE
Springfield, MA 01104

To WhomltMay l:oncern:

This letter is to inform you that we are dissatisfied with the coverage we received for the following services performed at the University or
wisconsin Hospital.

Sidney Vetens. (005-) ID #_Eroup#_

DOS: 12/27/2017 through 

Sidney purchased health insurance coverage rrom Consolidated Health Plans rather than continuing on With her other, less expensive,
options because your plan advertises that Gender Amrmation Surgery is a covered benefit She chose an ln-Networlt facility [the University
ofwisconsin Hos lal] and received prior autho za on from l:le lot this procedure on 10/16/20] 7. The nation Bursement range
accepted by institutions performing this procedure is between $19,000 and 325,0", it seemed clear to us that, given CHP Benefit of up to
$25,000, a suBstantial portion of the costs should be absorbed By the insurance However, the UW Hospital, which contracts with CHP to
cover UW students, notified us that Because of their contract with CH P, they are required to Bill nearly four times the amount accepted at
other institutions as paymentin full lor the same SErvlcEs, in addition, they are allowed to "balance bill" students for this semce given the
"maximum henerit' sopulate in the Summary of Benefits. Faced With a potential, outrageous payment ors7s,oaa (quoted by
phone from the University Hospital department), we challenged this figure. The UW Hospital repeatedly threatened to cancel the
procedure unless we agreed to an up rront cash payment of sza,aBu prior to the procedure. They accepted this amount as payment in lull for
the surgery and all associated services, consistent With the nationwide ranges mentioned above. They made clear that they would not have
allowed us to have the surgery without this lull payment beforehand.

 

 

   

The result is that sidney has paid 100% of the costs (32mm) uubuf--pnckal for a procedure that has a $25,000 Benef according to your
Summary offianefils, When we discussed this With a service representative for CHP and asked to speak with a supervisor, we were told to
"call the Better Business Bureau." We were told that CHP does not reimburse patients ror receipts from an Hospital. We were
told that in order to have oualiried ror reimbursement based on patient receipts, we would have to choose an Duttuf-Natwork racility

We are contacting you to malte you aware that we feel we have been the victims ofa and Switch" scam on the part orthe LIW Hospital
and CHP We purchased health coverage from l:le Based entirely on the advertised benefit for Gender Reassignment Surgery Because or
unrair Billing agreements Between CHP and UW Hospital, we received none of the promised coverage.

 

Patients without any health insurance coverage, at all, pay the same amount at this hospital for this procedure We reel that
this discrim' ation in Billing/insurance coverage practices is specirically because Sidney is transgender there is no precedent for
appropriate g/reimbursement strateges between cm and uw Hospital even though Gender Reassignment Surgery is adverosed as a
covered benefit in contrast l:le does not use these same reimbursement strategies ror patients who need maternity care or common
surgenes like hysterectomies or mzslacmmlas, Those patients would never be forced to pay their hospital Bill entirely nutcoltpucket when
obtaining those covered services at an ln-Networlt Hospital

 

We are including the medical receipts rrom the hospital to document our claim With you and insist on fair reimbursement ror sidneys costs,
it makes no sense that you provide the option orreimbursement from me al receipts to a patient who has had the same procedure atany
other hospital nationwide, but not rroni a hospital which has an estaBlished relationship with CHP

 

We have already contacted the UW Hospital with our concerns and they have referred us haclt to you. You should also be aware that we have
contacted a maior media outlet and are pursuing puBlic disclosure of the discriminatory practices we have experienced so that others can
avoid purchasing l:le policies that fraudulently adverose insurance coverage for these procedures.

Sincerely,

Sidney Vetens

Kimberly Moreland. MD