Lost in the Crowdfund: Seeking other means when coverage falls short

Multnomah County, OR – In recent years, crowdfunding has become a new economic factor with over 9 billion dollars in revenue. The industry is split into five distinct areas: Royalty, Equity, and Debt based systems, as well as the two most widely known areas: Reward oriented companies like Kickstarter or Indigogo as well as Donation, focused companies such as GoFundMe.  Donation based fundraising has become a major source of aid, funding everything from school tuition, charitable causes, personal emergencies and medical expenses.

Many in the Trans* community resort to crowdfunding in lieu of insurance coverage for their gender affirming procedures.  Insurance providers often cover the set of surgeries in the “bottom surgery” category, yet other procedures such as breast augmentation and facial feminization are still considered cosmetic.  GoFundMe even has a page dedicated to this topic, titled “Gender Confirmation Surgery Cost and Funding Guide.”  After providing the basics of what is typically covered by insurance vs. what is often not, the writer encourages Trans* individuals to share their story in addition to asking for donations.  This is a sadly needed supplement by those who lack health coverage for a vital step towards their true identity.

A Woman in Need

Meet Victoria, a transgender woman living in Oregon who suffers from PTSD, partially as a result of her intense gender dysphoria.  She is on Medicare, which helps with her disabilities, but makes transition-related health coverage reachable only after jumping hoops with therapy and doctor signatures.  Upon being asked to be Maid of Honor in a friend’s wedding, Victoria’s excitement has commingled with an acute increase in dysphoria, specifically in regards to her breast size.  The dress selection is a part of her duties, and she says “I didn’t want that to impact her wedding.”

With the initiative of her friend, Leah, Victoria has a GoFundMe campaign to raise money for her breast augmentation surgery.  Although it is possible to receive the approval for coverage by Medicare, this would prove very difficult for Victoria.  “Finding a therapist who takes Medicare has been extremely difficult,” she says. ” It’s difficult to find because I’m trans, to find a therapist who is trans-friendly and who takes Medicare.”

There was a time when Victoria had such a therapist and utilized them in order to receive her gender marker change.  She saw this therapist for the required time, at which point she was able to secure the necessary signature to go ahead with the switch.  But now, she tells us, “The therapist I went to stopped practicing.  Her license is expired, and her letter would therefore not be valid according to Medicare.”  Even if she were to find a new therapist in time, Medicare would not cover the full cost of her sessions, leaving her with unmanageable copays after her disability costs.

The fundraising campaign is doing well, having raised over two of the $6,000+ plus needed to reach their goal of surgery.  Victoria would like to have surgery within the next 12 months, to give her enough time for recovery and becoming comfortable with her new breasts.  Without the necessary health coverage, she is relying on people she will never meet to have a surgery she very much needs.  But it can be disheartening to utilize such efforts to find peace in her body.  “It is ridiculous that someone can set up a GoFundMe for Michael Cohen’s defense a garnish over $100,000 in a single day while trans women have to signal boost their necessary surgery money on a daily basis in the hopes of reaching the needed goal,” she exclaims.  “Most people who contribute once to a fund aren’t likely to again, as chances are they are trans themselves and have systemic economic issues which limit their ability to do so.”

Little Help for Needed Health

The Trans* community progressively seeks medical aid to achieve their goals.  Employee insurance often covers hormones, mental health counseling, and surgeries.  But the real issue lies in Medicare and other government-funded insurance for under and unemployed Trans* people.  According to transequality.org, Medicare terminated a policy that excluded what had been termed “Transsexual Surgery” in May 2014.  “This means,” the site reads, “that coverage decisions for transition-related surgeries will be made individually on the basis of medical need… [emphasis added].”  In many cases, however, the term “medical need” is left up to a vast array of interpretations, often at the expense of Trans* individuals seeking health benefits.  One of the most common examples of this seems to be breast augmentation for Trans* women.

In November 2015, Basic Rights Oregon issued an FAQ document detailing Oregon Health Plan’s coverage of gender dysphoria, which had been enacted that January.  Before discussing covered services, eligibility, and “Coordinated Care Organizations,” the document offers a disclaimer. The newness of this coverage invites possible challenges, not least of all “getting approval for any transition-related care you may need.”  Since then, oregonlive.com, The Oregonian’s online format, has issued multiple articles regarding transition-related coverage bending more often towards FTM individuals than their MTF counterparts.

Journalist Casey Parks reported in April 2016 that, while breast reduction and chest reconstruction were offered from the start for transgender men, it took the state much longer to approve breast augmentation in addition to bottom surgeries.  In October 2015, The Oregon Health Evidence Review Commission was confronted by Megan Bird, a gynecologist with Legacy Health.  Despite her evidence that a BA is a “basic part of trans health care,” members of the Commission still considered it cosmetic.  One argued that other women with small breasts did not receive coverage to pay for the procedure.

A lack of resources of all sorts is another major hindrance to insurance coverage.  Parks reported in another article that “Oregon does not have enough doctors and therapists willing or able to treat transgender patients.”  The state had anticipated a potential of 175 patients to take advantage of public health benefits in 2015, which in reality exceeded 700.  Those approved for surgery face lengthy waitlists, exhausting travel distance, and approval flip-flopping by providers and insurance companies.  A Trans* care provider directory on Oregontranshealth.com lists just five surgeons, of which two provide chest surgeries and one urologist offering vaginoplasties.  Dr. Daniel Dugi trained with specialists in Belgium and Serbia, using cadavers to practice new techniques.

But this is hardly enough to address trans Oregonians in the timely manner they need. According to the 2015 U.S. Transgender Survey, 12% of those questioned reported being unemployed, with 30% living in poverty.  In an estimated 19,750 Trans* people in Oregon as of 2016, this means a large number of people rely on the state for their benefits.  Benefits that seem to have a lot of trouble reaching these people in the manner they need.

This brings us back to our friend, Victoria.  Although the state of affairs for Trans* people is improving, she is one for whom it is not moving fast enough.  Without ready aid for coverage, she is left to find other means for her much-needed breast augmentation.  Essentially out of options, crowdfunding has become her last hope.  In turn, she asks others to learn from her story.  “My advice…is during your therapy, while you may be focused on getting the gender marker changed, take that time to also get the letters for surgery you desire.  That is something I did not do, and I am now being made to suffer it.”

To donate to Victoria’s breast augmentation fundraiser, click the link below:
Victoria’s GoFundMe Campaign

References:

https://www.gofundme.com/c/blog/gender-confirmation-surgery
https://transequality.org/know-your-rights/medicare

https://www.oregonlive.com/transgender-health/2016/04/oregon_transwomen.html
https://www.oregonlive.com/transgender-health/2016/04/oregon_health_plan_transgender.html

https://www.oregonlive.com/transgender-health/2016/05/ohsu_daniel_dugi.html