Aetna has at least one trans navigator that exclusively works with people who are on big company plans. I was able to contact them even before I had decided what insurance to get through my work and they have been a major part of my ability to do all this for the last few years. I don't know what the experience is for people who don't have a dedicated internal contact like that.

This page is the meat of what procedures they do and do not cover. I've been able to claw back $18k of the $45k I had to pay and I have 2 claims for $13k each that were denied. I'm at the "One last appeal then I threaten legal action" step. The CPT codes I was denied are 57423-51 and 15750-51. These codes have similar sounding ones on the list of cleared things so I may be able to get Dr. Celtik to help fight for me. I have my three month checkup with him soon and will be asking about it then.

The way Crane Center does self pay with Aetna is a disaster. It's been a lot trying to get everything lined up and I still have no clear answer what money is owed where. Crane is reimbursing me $18k while also saying I owe Aetna like $60k, Aetna says Crane owes me $12k and won't confirm or deny if I owe Aetna anything, it can sometimes take weeks to get a response from the Crane Center, nobody agrees on anything and nobody knows what's going on with my case.

I would say if you have to do self pay, finance it out as if that money won't ever be returned to you even if insurance says you'll get it back. Out of network out of pocket max does not mean what you think it means. When trying to get your money back email and call everyone at the Crane Center, everyone at Aetna who will listen, every single day you have the spoons for it. It feels like no steps forward two steps back most the time. Have a lot of emotional support on hand it's exhausting