It's never simple, of course. It took quite a bit of persistence. Lucent's HR organization has beeen wonderful, but the insurance companies are not terribly cooperative. Here's my understanding of how it's handled.
You must choose a primary care physician on the plan. Choose a GP or other MD whom you are willing to go to for your routine medical needs, and as a first step for your special needs. Be sure your GP is supportive of your transition and that you are open with him/her. You cannot get proper general purpose medical care unless your GP knows what is going on with your body.
Of course, in practice, most qualified GID specialists are not on the MBC network. In this case, your options are to ask for an off-network referral, or to cover the costs of the counselling yourself. The details of off-network referrals are unclear, but you have nothing to lose by trying.
Start by calling the MBC hotline and ask for a referral. They will ask for the nature of the issue (they'll want to look up a tentative diagnosis to find a counsellor qualified in that area) so tell them Gender Identity Disorder.
You must plan ahead for this, because of the rules of the HCRA. You decide on your annual amount in November to cover the next calendar year. This amount is deducted from your paycheck each month the next year, and you can spend it on any medical need.
I have not tried this, and I cannot be sure it will work. You will certainly need a receipt, and you may need to show that it is necessary for your mental health. They give, as an example, the cost of a wig needed for the mental health of a cancer patient who loses their hair. You may need a written perscription from a doctor who can write perscriptions (an MD or Psychiatrist.)
Another approach is to have it done by a dermatologist or a nurse associated with a dermatologist. It still won't be covered by the medical plan, but it should be no problem getting the appropriate paperwork for the HCRA.
If your dermatologist can document that you have a skin condition that medically requires electrolysis, such as pseudofolliculitis barbae, you may be able to get it covered on the medical plan.
It is not yet clear if laser treatments are an appropriate and permanent treatment suitable for the transitioning transsexual. Preliminary results suggest that some lasers have temporary results and some other types have more permanent results but only eliminate 30% to 70% of your hairs. If you can have permanent laser treatment done by a dermatologist or their nurses, you may have a less expensive solution that you can certainly apply to your HCRA.
In the case of Lucent employees, it will require persistance and probably require an appeal. Plan well in advance. You will probably encounter resistance and will have to file and refile. Start the process as soon as you have an approximate surgery date, as it may take several months to have the insurance approval.
It is very important to go through the "pre-certification" process. If you don't pre-cert, you will pay a penalty. If you pre-certify and are approved, you should be able to work with the surgeon to arrange for direct payment by the insurance company. (With a pre-certification, they have written agreement from the insurance company that payment will be made.)
If your pre-cert is denied by the insurance company, get a written Statement of Benefits showing the reason for denial. Be sure that Lucent HR and that EQUAL! have a copy of the denial, as they can escalate to the insurance company. Follow the advice of HR. They will probably have you appeal using the insurance company procedures.
If your paperwork is lost by the insurance company (this seems to happen quite a bit) keep re-filing. Record the date, time, and name of the person you speak to, and any committments they make to you, each time you call them. (This is good advice in any case.)
In theory, it should not be necessary for you to pre-pay and be reimbursed. However, that's what Sharon did. Be prepared to do this.
Here are some letters she wrote with details:
There were two attachments to Sharon's advice letter:
Proposed language for policy inclusion (not used).
Position paper why it should be covered.
Discussion of various procedures that are sometimes involved in SRS, and reasons why such procedures would be covered for other diagnoses.
Links to resources useful for background.
Math showing the cost for Lucent to be 18 cents per year per employee.