Top Surgery Insurance Loop Hole

[Nygeel]

This was an issue for me too.  Even though I lived separately from my parents I was still considered dependent but by the time the year of my 24th birthday rolled around, that no longer applied.  Since you're 24 years old now Nygeel; even if you still live at home, you're now considered independent by FAFSA.  "Be 24 years of age or older by December 31 of the award year"  Your parents income is now irrelevant.

Either way, it's still not practical.

[Epi]

Either way, it's still not practical.

I'm very confused Nygeel.  What exactly are you wanting, or for that matter, waiting to happen?  You've said going to a 4-year (even though you qualify for FAFSA and could attend a university that has insurance which covers HRT/SRS) isn't practical and wouldn't be a good idea with the 2-year degree you got.  Trying to find full-time employment is difficult; the place you volunteer only hires individuals with graduate degrees, but that requires normally you have a 4-year degree first.

What would be practical to you Nygeel?  Is committing insurance fraud really practical?  I'd say you have a lot of feasible options that don't involve fraud.

[MaxAloysius]

With Medicare (Aussie national health) 75% of the 'scheduled fee' will be covered, and a private health fund can cover the rest, though my surgery will actually cost me several thousand more on top of that (twice! T.T). It is put down on the books as a 'subcutaneous bilateral mastectomy'.

It is perfectly legal, and from what I can gather all top surgery in Australia is put through the books this way. My surgeon told me that had I already had my gender changed through Medicare before the surgery, or before my second surgery/revisions, then it would be put through under gynecomastia and still be covered.

[Bahzi]

In the end, someone else, such as myself, pay more than their fair share because you won't and that's not right.  (Next the federal government will bail them out too!)

Planned Parenthood has HRT services for transgendered patients, as I recall, there are a lot of Planned Parenthoods.  Also, Bahzi is it absolutely necessary you take the insurance offered by your employer?  Is there an opt-out option so you can find your own coverage (possibly where your employer pays a percentage of it)?

I've paid my 'fair share', and then some, thank you.  I paid into this plan for 2 years and never used it until HRT, because unlike the other people at my work, I don't smoke and am not overweight/have a drinking problem.  They drive up the rates with their chronic, self-inflicted conditions,  and it costs way more than a few blood panels.  The only option for HRT in my city charged $380 after in-network discounts for blood work, and I had to have that done every 3 months for the first year and a half.  I can barely manage my $200 premium, I don't even make $10 an hour.  After moving soon, I'll probably have to go down to the basic plan next year when it's open enrollment again, for now I'm locked in through the year.

I and a few other co-workers researched dumping our employers plan and finding private coverage, but no, our employer wouldn't pay any of it, and the rates for anything approximating the same coverage were way higher than we'd be paying through the company, because they pay half.   I haven't looked into it again since the reform, but I didn't even qualify for most private policies last year because of my mental health history.  It would have involved a lot of lying to get covered, even though my hospitalizations were years and figuratively a lifetime ago.

Only some Planned Parenthood's offer HRT services, and none anywhere near me.  We're in talks with the local PP's about trans care right now, but PP recently lost a lot of funding, so it's unlikely they'll be able to offer that service here anytime soon.

My credit's already pretty crappy, and I've had collection agencies after me before, old hat.  I finally got out of debt and am rebuilding credit, but this is worth ruining it again for me, because this is what I need to do to function currently and to keep living.  If I get busted, I'll deal with the consequences, but I've had enough disadvantages in life that I don't feel guilty for how things are being billed.   *shrug*

[thefire]

I've thought of a serious reduction if I get the money together one day but can't get "permission" to have top surgery, that maybe I could get a major reduction from D to A and tell them to make me as flat as possible?  But yeah, I'd still need the nipples scaled down. I couldn't go around shirtless like that.

[Epi]

I've paid my 'fair share', and then some, thank you.  I paid into this plan for 2 years and never used it until HRT, because unlike the other people at my work, I don't smoke and am not overweight/have a drinking problem.  They drive up the rates with their chronic, self-inflicted conditions,  and it costs way more than a few blood panels.  The only option for HRT in my city charged $380 after in-network discounts for blood work, and I had to have that done every 3 months for the first year and a half.  I can barely manage my $200 premium, I don't even make $10 an hour.  After moving soon, I'll probably have to go down to the basic plan next year when it's open enrollment again, for now I'm locked in through the year.

I and a few other co-workers researched dumping our employers plan and finding private coverage, but no, our employer wouldn't pay any of it, and the rates for anything approximating the same coverage were way higher than we'd be paying through the company, because they pay half.   I haven't looked into it again since the reform, but I didn't even qualify for most private policies last year because of my mental health history.  It would have involved a lot of lying to get covered, even though my hospitalizations were years and figuratively a lifetime ago.

Only some Planned Parenthood's offer HRT services, and none anywhere near me.  We're in talks with the local PP's about trans care right now, but PP recently lost a lot of funding, so it's unlikely they'll be able to offer that service here anytime soon.

My credit's already pretty crappy, and I've had collection agencies after me before, old hat.  I finally got out of debt and am rebuilding credit, but this is worth ruining it again for me, because this is what I need to do to function currently and to keep living.  If I get busted, I'll deal with the consequences, but I've had enough disadvantages in life that I don't feel guilty for how things are being billed.   *shrug*

2 years, you think that's a long time?  2 years is nothing.  Clearly you don't know how the world is out there.  You think Uncle Sam cares that there are senior citizens living below the poverty line that still have to pay $500/month for their health coverage?!  No.  You complain about $200/month now and that you don't even  make $10/hour.  If I was you I'd reexamine my life plan, because at 27 if you don't have any real job skills to get a decent paying job, what makes you think that will change?  It won't.

Who do you think pays the difference for when you default on something?  Everyone but you. If you can't afford something, DON'T BUY IT.  Simple as that.

Frankly, I don't think you understand what being at a disadvantage really means.  You've never had to beg for food on the streets, have you?  Your parents didn't die unexpectedly while you were still a teenager leaving you and your siblings wards of the state to be cast out onto the streets on your 18th birthday?  You're clearly not satisfied with the way things are, yet you won't lift a finger it seems to do anything that requires honesty and a little hard work.

I know plenty of people who would be grateful in this economy to have your job and health insurance.

[Bahzi]

2 years, you think that's a long time?  2 years is nothing.  Clearly you don't know how the world is out there.  You think Uncle Sam cares that there are senior citizens living below the poverty line that still have to pay $500/month for their health coverage?!  No.  You complain about $200/month now and that you don't even  make $10/hour.  If I was you I'd reexamine my life plan, because at 27 if you don't have any real job skills to get a decent paying job, what makes you think that will change?  It won't.

Who do you think pays the difference for when you default on something?  Everyone but you. If you can't afford something, DON'T BUY IT.  Simple as that.

Frankly, I don't think you understand what being at a disadvantage really means.  You've never had to beg for food on the streets, have you?  Your parents didn't die unexpectedly while you were still a teenager leaving you and your siblings wards of the state to be cast out onto the streets on your 18th birthday?  You're clearly not satisfied with the way things are, yet you won't lift a finger it seems to do anything that requires honesty and a little hard work.

I know plenty of people who would be grateful in this economy to have your job and health insurance.

You don't know me, let's set that straight for the record.   What kind of self-righteous, embittered person assumes things about someone's whole life and experiences like that?  Seriously, dude? 

I got a fortune cookie today that said 'Good health is the greatest wealth one can have, cherish it', and I do.  I have many health and mental health conditions that did put me at a severe disadvantage, to say the least.  I was on disability for a short period, and got off it as soon as I was able to because of my own hard work.  I do work hard, for my sanity, every day.  2 years at the same job is a very long time for someone with my issues.  It's a privilege to be (mostly) able-bodied and have as many conditions as I do and not be on medications for them.  Much of that is due to my own hard work though. 

I work a high stress job 45-50 hours a week, that I am very grateful to have, thank you (and I'm one of the hardest workers they've got in return), and afterwards, I come home and work out for 1-2 hours because exercise is the only thing that stabilizes my moods and regulates my sleep schedule, since the psych meds I used to take gave me a neuromuscular condition (as well as immune system and heart problems) that makes it difficult for me to do a lot of jobs.

I never wanted to go on those meds since I had pre-existing conditions I feared they'd exacerbate, they were court mandated after I fought back against the four cops who brought me in on false charges and beat the ->-bleeped-<- out of me for fun because I 'looked like a dyke', and refused to undress for them.  I had no money for a lawyer, and my public defender bullied me into taking an NGRI plea, then after spending 2 months locked up in a state institution, I had to take whatever psych cocktail the doctors wanted for a year, and have been dealing with all the adverse health effects they caused ever sense.

The debts I ran up were federal loans for college from back before my mental health issues became prevalent, and that's what I've been paying off by working so many hours (as well as bills I ran up when I was psychotic during my first manic episode when I was 19), so I can finally go back to school soon.  Yes, I'm 27, and I've not made all the right choices so far in life, but I'm still trying.  I know all my issues are still 'first world problems', I keep it all in perspective.  I don't have a lot of time, but I'm involved in local trans organizing and activism, because I do want to reach out to others who haven't had some of the advantages I have, like my job. 

I don't think my life is one big hardship, I have some amazing friends, I'm as healthy as I've ever been, my job has been supportive of my transition, and I rarely, if ever talk about my problems; people never know I'm bipolar or agoraphobic, or have PTSD unless I tell them.  Which I typically don't- I don't want sympathy, but it would be nice if strangers wouldn't make assumptions based on some notion they have that everyone else has an 'entitlement attitude'.   There's disagreeing with someone, and then there's personal attacks.   

[Epi]

You don't know me, let's set that straight for the record.   What kind of self-righteous, embittered person assumes things about someone's whole life and experiences like that?  Seriously, dude? 

I got a fortune cookie today that said 'Good health is the greatest wealth one can have, cherish it', and I do.  I have many health and mental health conditions that did put me at a severe disadvantage, to say the least.  I was on disability for a short period, and got off it as soon as I was able to because of my own hard work.  I do work hard, for my sanity, every day.  2 years at the same job is a very long time for someone with my issues.  It's a privilege to be (mostly) able-bodied and have as many conditions as I do and not be on medications for them.  Much of that is due to my own hard work though. 

I work a high stress job 45-50 hours a week, that I am very grateful to have, thank you (and I'm one of the hardest workers they've got in return), and afterwards, I come home and work out for 1-2 hours because exercise is the only thing that stabilizes my moods and regulates my sleep schedule, since the psych meds I used to take gave me a neuromuscular condition (as well as immune system and heart problems) that makes it difficult for me to do a lot of jobs.

I never wanted to go on those meds since I had pre-existing conditions I feared they'd exacerbate, they were court mandated after I fought back against the four cops who brought me in on false charges and beat the ->-bleeped-<- out of me for fun because I 'looked like a dyke', and refused to undress for them.  I had no money for a lawyer, and my public defender bullied me into taking an NGRI plea, then after spending 2 months locked up in a state institution, I had to take whatever psych cocktail the doctors wanted for a year, and have been dealing with all the adverse health effects they caused ever sense.

The debts I ran up were federal loans for college from back before my mental health issues became prevalent, and that's what I've been paying off by working so many hours (as well as bills I ran up when I was psychotic during my first manic episode when I was 19), so I can finally go back to school soon.  Yes, I'm 27, and I've not made all the right choices so far in life, but I'm still trying.  I know all my issues are still 'first world problems', I keep it all in perspective.  I don't have a lot of time, but I'm involved in local trans organizing and activism, because I do want to reach out to others who haven't had some of the advantages I have, like my job. 

I don't think my life is one big hardship, I have some amazing friends, I'm as healthy as I've ever been, my job has been supportive of my transition, and I rarely, if ever talk about my problems; people never know I'm bipolar or agoraphobic, or have PTSD unless I tell them.  Which I typically don't- I don't want sympathy, but it would be nice if strangers wouldn't make assumptions based on some notion they have that everyone else has an 'entitlement attitude'.   There's disagreeing with someone, and then there's personal attacks.

So you're arrested, regardless of the charges, and instead of acting civil you become combative and commit battery upon a police officer?   And it's their fault they had to restrain you?   You most likely would have been released on your own recognizance in 72 hours, you really shot yourself in the foot with that one.

If I was the arresting officer you would have been treated with respect, but the second you put the safety of not only myself, my staff but the public as well at risk I would have not hesitated to use necessary force to restrain you and prevent you from injuring others or yourself.

You really should consider looking into Teacher Loan Forgiveness.  It is probably one of the best ways now to have Federal Stafford loans forgiven.  Being a teacher is one of the most honorable and rewarding professions there are, plus it has good union benefits.

But frankly, I really can't rationalize your logic.  Since I've worked 6 times longer than you have does that mean I am 6 times more entitled to commit insurance fraud?  This is really a matter of forward thinking.  I would like to see that not only my grandmother, but your grandmother are taken care of.  But with the rising cost of health care at one point it will become even more difficult to provide adequate care.  Insurance companies commit malpractice constantly in order to make up for lost "profits", which is wrong.  But committing fraud because you're dissatisfied with your health coverage isn't right either.  How can we expect or demand professional integrity from healthcare insurance and providers if the insuree/patient doesn't conduct themselves in the same manner? 

Everyone is entitled to what they earn, but fraud is stealing.  If you stole it, you didn't not earn it.

[Bahzi]

So you're arrested, regardless of the charges, and instead of acting civil you become combative and commit battery upon a police officer?   And it's their fault they had to restrain you?   You most likely would have been released on your own recognizance in 72 hours, you really shot yourself in the foot with that one.

If I was the arresting officer you would have been treated with respect, but the second you put the safety of not only myself, my staff but the public as well at risk I would have not hesitated to use necessary force to restrain you and prevent you from injuring others or yourself.

Uh, no, I didn't 'become combative' until after I had a black eye and a busted jaw, I hadn't attacked (physically or otherwise) anyone.  I wasn't even manic at the time, my mother knew that and called the cops on me after we had a disagreement and I walked out, she told them I was psychotic because she couldn't control me anymore and couldn't take it.  She's admitted this and apologized since.   

TRIGGER WARNING:

The officers told my mother I'd be taken to a local hospital's psych emergency center.  I went quietly, and knew I'd be in a 72 hour hold, and accepted it.  I'd signed myself in at my parent's request (they threatened to leave me downtown with no way home when I was a teenager if I didn't) before, so I knew the drill.  The officer didn't take me there, he took me to the jail's psych emergency center, and attacked me when I called him out on it (I never raised my voice or was disrespectful, just calmly explained that I knew the difference) and refused to strip naked in front of the male officers after they made sexually harassing comments towards me and mocked my gender presentation.  They 'offered' to do it for me, 'restraining' me by punching me in the face repeatedly while others held me down and ripped my pants off (literally ripped, mind you).  What would you have done as a sexual assault survivor in this situation?  I ended their attack by 'assaulting' one of the officers, and then they gave me my jeans back to put on, walked me down the hall and booked me, gave me an arraignment date, and turned me loose on the streets.  Does that sound like what should have happened if I were insane, or it was really a psych emergency arrest? 

There you go making assumptions again, does that feel good, to tell someone how their situation was their own fault without any knowledge of what happened?  You ARE being an ->-bleeped-<-, make no mistake.  I'm contacting a mod, this has gone far enough.