Places where Top surgery is covered

[JohnAlex]

So I don't know if this exists, but I did hear from another trans friend that he heard of places, cities, where there were laws saying that insurance companies must cover transgender surgery, at least top surgery.
If that exists, I would totally want to move there and set up residency.

Does anyone know if places like this exist? 
Or if there is any insurance companies that on their own will cover top surgery?

Again, that same friend said he knew of another friend who told him that Kaiser covers top surgery in California.  I don't know if this is true also.

[ChaoticTribe]

No, I am actually almost completely certain that there is not one single place where the law can require insurance to cover top surgery.

In fact, many guys grow up with the average penises, testicles, etc but develop a condition called gynecomastia where they grow breasts, and I have NEVER heard of that being covered, and generally insurance is MUCH more helpful to people who AREN'T transgender unfortunately.

NOW if you live in California and work for the county as in being a post office worker, trashman, etc I do believe they have requirements in place that the insurance you would get through work (ONLY as being one of the county or government workers) will cover transgender care such as hormone therapies and surgeries. That is the one and only case I have ever heard of that happening, and I believe it may be limited to the Sanfrancisco area only.

That said, I found my top surgeon for only 4,200$ by calling regular plastic surgeons and asking if they do gynecomastia surgery. Anyone who specializes in transgender people always costs more from my experience, and fat and glandular tissue is the same up top whether you had an M on your birth certificate or not, so I am going that route.

The only thing your average insurance company is EVER likely to cover is hysterectomy and other below the belt removals of typically present organs. Otherwise there's going to be a medical code that simply screams *trans. The only exception is if you can find a doctor willing to fudge paperwork enough to say you have a disease that requires double mastectomy, in which case they'd probably have to imply cancer to the insurance company. Not a lot of docs will do that.

[Darth_Taco]

I'm going to be honest, I know very little about this and continue to look for new information. I'll tell you what little I know though. I really don't know anywhere that requires insurance companies to cover any aspect of transition, but I do know that some will cover it regardless. I think there's an Anthem Blue Cross plan that covers transition, but I wouldn't know which one.

I've heard of Kaiser doing it, but I'm not 100% sure. My boyfriend has Kaiser through his job, but he says they don't cover that stuff on his plan. That really doesn't mean much though since insurance companies can have countless plans and the three he has to choose from at work just happen not to offer it.

I know students and faculty members at certain Universities will cover certain aspects of transitions, and good amount of them are here in California. It's actually the number 1 reason I moved here to go to college @_@. Screw the "college experience", I'd rather have my transition covered now and enjoy the rest of my life xD. Anyway, I'm still researching which ones for when time for me to transfer comes.

So far, that's all I know. Hopefully someone else here knows more.

[Arch]

What about SF?

Darth, the UC system is good for transition expenses.

[Darth_Taco]

What about SF?

Darth, the UC system is good for transition expenses.

That's actually what I'm going for :'D.

Ok, I looked some stuff up again since I was inspired to do so (and because I was bored). It seems that Anthem Blue Cross terminated their coverage of GRS in 2009 XP. Not sure if they still cover hormones or not, but surgery pretty much seems out with them since top surgery would be in that category.

I also remembered to bring something up. You'd be moving from Washington, right? Well, I moved to California from Nevada, and it cost me a really good chunk of money @_@. I think it was well over $3,000, and I live like 3 blocks from the bad side of Compton XP. I'm curious how you would plan to move here since I expect it to cost you significantly more. If getting your transition covered if the only reason for moving here, I really don't think it's a good idea. I think I need to rephrase what I said earlier. I came to California for a multitude of reasons, transition coverage is simply at the top of my list as to which college I choose since I can get a business degree almost anywhere. Sorry for not bringing this up earlier, I just remembered XP.[/color]

[Arch]

That's actually what I'm going for :'D.

Grad or ugrad? I think only a couple of UCs have business for undergrads. That's really more of a Cal State thing.

[Epi]

NOW if you live in California and work for the county as in being a post office worker, trashman, etc I do believe they have requirements in place that the insurance you would get through work (ONLY as being one of the county or government workers) will cover transgender care such as hormone therapies and surgeries. That is the one and only case I have ever heard of that happening, and I believe it may be limited to the Sanfrancisco area only.

Statewide in CA only the UC offers insurance plans that cover HRT and SRS up to a certain amount.  SF City & County may offer insurance options as well, but the remainder are subject to whatever contract their city/county and union negotiated, usually it's with the nearest medical foundation, clinic or hospital.  Private companies in the Silicon Valley offer way more than the government.

I think I need to rephrase what I said earlier. I came to California for a multitude of reasons, transition coverage is simply at the top of my list as to which college I choose since I can get a business degree almost anywhere. Sorry for not bringing this up earlier, I just remembered XP.[/color]

The CSU system would be the ones to offer degrees in the business field, unless you were intending to minor in it or are seeking an MBA.  The UC's are public research universities.  Some are land, space grants, others medical research with hospitals which is why the UC is able to offer better coverage than the state system.  There are private universities and colleges that have insurance plans which do cover HRT and SRS, Stanford University being one (Go Cardinal!)

[ChaoticTribe]

What is this I hear, Stanford University offers insurance covering surgery? Would that include bottom surgery? If so I wonder whether it would be worth enrolling just for the insurance. Then again, couldn't college easily cost the amount SRS would be anyway??

[Epi]

What is this I hear, Stanford University offers insurance covering surgery? Would that include bottom surgery? If so I wonder whether it would be worth enrolling just for the insurance. Then again, couldn't college easily cost the amount SRS would be anyway??

As of 2010 their insurance offers coverage.  I'm not completely sure of the the particulars but Stanford also has its own hospital (teaching) and medical offices so most things they're able to do within their own network.  As for enrollment, it's not a public university and is extremely competitive.  However, they've probably got a better financial aid package than the public universities.  Last I remember if you or your family made under $60,000 a year your tuition, room and board were covered.  If you or your family made under $80,000 a year only your tuition was completely covered.  The UC system has a similar financial aid package called the Blue + Gold Opportunity Plan, but insurance coverage varies slightly from campus to campus.  Also, because of some unconstitutional assembly bills passed in the state of CA financial aid is not as accessible as it used to be.

[MaxAloysius]

In fact, many guys grow up with the average penises, testicles, etc but develop a condition called gynecomastia where they grow breasts, and I have NEVER heard of that being covered, and generally insurance is MUCH more helpful to people who AREN'T transgender unfortunately.

Okay, I'll be honest, I skimmed this topic at best, but this flailed off of the page at me. Surgery for gynecomastia is covered by Medicare (national health) in Australia, and further covered by private insurance. This means that top surgery and/or revisions are covered here no matter whether you're legally male or female at the time.

[MrTesto]

In the US, civil rights laws have no jurisdiction or power over what gets covered by health insurance plans.

I know I might sound like a wet blanket, but there are some important things to keep in mind when planning for surgery. When there is coverage for surgeries by employer-sponsored plans, the actual costs and timelines are often affected by the fact that many or most of the experienced SRS surgeons do not work with health insurance plans, so the patient has to pay up front and then get reimbursement from the insurance company. (That is often even true for complications, so be sure to save up extra if your procedure has chance of that, or if you have a complex medical history which may require extra monitoring or care.)

Another factor to plan for (even when surgeons are willing to bill insurance up front is that most of the current plans require a much stricter process for documenting readiness. It's common for there to be two letters needed, perhaps with minimum time in therapy. For people who have started hormones under informed consent, it's important to get enough time with a therapist who can attest to readiness for lower surgery especially.

Good news is that the IRS has agreed that transition costs are deductible from taxes. Also, more companies are covering surgeries for employees, as are some colleges, and that number is only expected to grow in the years ahead.

[Epi]

In the US, civil rights laws have no jurisdiction or power over what gets covered by health insurance plans.

This is not true at all.  You can't deny or limit coverage because of someones skin color or religion.  The ADA specifically covers all health care plans and services, for an insurance company/medical provider (Medicare being one) to ignore that would be a violation of federal law. Also, jurisdiction in layman's terms refers to a governing legal body or a state/county/city entity which has the legal authority to enforce (draft, interpret, etc) laws in their area.  While the legislative body may not have the authority to enforce our civil rights laws, the judicial branch of our government does enforce these laws. 

[Arch]

The CSU system would be the ones to offer degrees in the business field, unless you were intending to minor in it or are seeking an MBA.  The UC's are public research universities. 

I know of at least two UCs that offer a Bach in Business Administration, but there may be one or two more. And I have heard that other campuses offer degrees in related fields. And the UCs have generous health care benefits for trans students. What kind of trans coverage does the CSU system provide? I've never read up on it at all.

[MrTesto]

I'm not a lawyer, but this is my understanding from having worked in trans health  care advocacy for 15+ years, including working with large companies around getting coverage for trans employees. It's possible that I am using terms with lay meanings rather than technical ones, so I appreciate any clarity.

....The ADA specifically covers all health care plans and services, for an insurance company/medical provider (Medicare being one) to ignore that would be a violation of federal law. ...

The Americans with Disabilities Act was written to specifically exclude transsexualism. (Thanks, Jesse Helms.) To wit: "(5) The term disability does not include -- (i) Transvestism, transsexualism, pedophilia, exhibitionism, voyeurism, gender identity disorders not resulting from physical impairments, or other sexual behavior disorders;" Sec.36.104 Definitions. see http://www.ada.gov/reg3a.html

It will be interesting to see how the recent changes in national health care policies and laws affect trans people. (Especially the law about not discriminating in care, from HHS.) But if the example of [non trans] women gives any clues, it will be a very long road. Discrimination on the basis of sex was prohibited in 1964 (workplace, including benefits) and 1972 (students)...yet it is just this year that health insurance companies have been required to provide coverage of contraception.

...Also, jurisdiction in layman's terms refers to a governing legal body or a state/county/city entity which has the legal authority to enforce (draft, interpret, etc) laws in their area.  While the legislative body may not have the authority to enforce our civil rights laws, the judicial branch of our government does enforce these laws. 

As you have noted, even when civil rights laws exist to protect marginalized groups, our rights and access to equal treatment are easily violated. The years of legal cases, fought at great personal and financial cost, can sometimes - sometimes - bring about the justice promised by hard-won legislation. Even when cases are won, the appeals process lengthens the duration that a trans person must subject themself to public scrutiny and ridicule, often paying a high price personally, even when the legal fees are covered. Only after those appeals will the judicial branch "enforce" the laws.

For those of us seeking access to health care and life affirming surgeries, those years and sometimes decades of struggle may be just too difficult to survive. And many more trans people cannot even begin to access the legal system which holds a dim promise of access to our civil rights.

So it may be more accurate to restate my point without the word "jurisdiction." The fact that civil rights laws protect transgender people at the state level has no bearing on whether insurance companies, or even subsidized coverage, must cover transgender-related care. Recent federal policies may start to change that...depending on how the election goes. And the Affordable Care Act might have an impact. But as things are now, the fights have to be won on both fronts. We are making a lot more progress in the private sector, but that benefits people who can get and keep jobs which provide that coverage. (And, as mentioned above, students who go to schools that cover surgeries, if they can navigate the approval and appeal process before they graduate.)

I know this was long - thanks for reading, and if there's something I missed, I'd love to hear about it.

[Epi]

The Americans with Disabilities Act was written to specifically exclude transsexualism. (Thanks, Jesse Helms.) To wit: "(5) The term disability does not include -- (i) Transvestism, transsexualism, pedophilia, exhibitionism, voyeurism, gender identity disorders not resulting from physical impairments, or other sexual behavior disorders;" Sec.36.104 Definitions. see http://www.ada.gov/reg3a.html

To say that civil rights in general have no bearing on matters related to insurance and medical coverage isn't necessarily true, but sadly at the federal level there are very little protections for trans people.  I'm well aware that the ADA does exclude transsexualism, however that doesn't mean others reading this are as well and that also doesn't mean lower courts in more liberal states haven't passed their own laws and ordinances protecting individuals against employment discrimination and access to social services not only on the basis of disability but sexual orientation and gender identity or expression as well.  IMO when said laws are in place it is a matter of whether the individual (or individuals if a class action) being discrimination against exercise their rights by enforcing these laws through use of the courts, which isn't easy.  Civil rights whether it was access to equal education, voting or the right to even drink from the same foundation took a long time. 

What we have here currently is our own "Plessy v. Ferguson".  Separate health coverage for trans related matters does exist, but is nearly inaccessible to the majority of trans people and obviously unequal.  What we need is our own "Brown v. Board" to provide us equal protections because as it stands separate IS inherently unequal.  (Brown v. Board was filed in 1951 and the decision wasn't handed down until 1954.  Despite that however still even 10+ years later public institutions were still segregated.)

The fact that civil rights laws protect transgender people at the state level has no bearing on whether insurance companies, or even subsidized coverage, must cover transgender-related care...[/url]

Depending on what state, county or city that may be right.  These positive changes are not just in the private sector, but public as well.  Some places have amended their laws and ordinances to include all county, city employees and contracted by either protections against discrimination in hiring.  Depending on the position a lot of county and city workers are unionized which comes with even more protections.  I haven't heard of anyone doing it yet, but depending on where it is entirely possible that if you were hired into a job with said legal protections specifically stated in the law and they were the ones who contracted and provide the medical insurance, then as part of your employment they cannot discrimination against you in regards to the medical coverage they provide.  It would come down to either the insurance company that has been contracted to work with the employer was in violation of the law and would be found to be in violation or the employer would be responsible for the employees trans related expenses.  Now, the kicker IMO is I don't think the laws will be what carries the case but rather the union protections in the employees contract providing them with the coverage.  The more ambiguous the language the better.  I think more people now than before are aware of their rights or a lack of and more favoring legal precedent is being set that eventually we will see positive change but it really requires more people in positions like this stand up.  There are tons of other examples, but the cheapest by far is to let the liberal union attorneys handle it.  I understand though not everyone is union or living somewhere with these types of protections already in place but these things don't just end up on the Supreme Courts desk overnight.

I'd really like to see legislation at the federal level protecting trans individuals from a gauntlet of things, I just don't see that happening overnight or anytime soon though.  I think we're all in it for the long haul and it's going to take a lot of small battlefield victories until we win the war, but that doesn't mean at the state, county and city levels some of us don't already have protections in place still open for further favoring interpretation.

[Epi]

I know of at least two UCs that offer a Bach in Business Administration, but there may be one or two more. And I have heard that other campuses offer degrees in related fields. And the UCs have generous health care benefits for trans students. What kind of trans coverage does the CSU system provide? I've never read up on it at all.

BBA or BSBA?  I think there's also Business Management. I don't believe all the CSU campuses offer coverage, off the top of my head I can only think of CSULA right now.  Taco would have to look into each of the CSU and UC campuses depending on the field of study he wanted to pursue to see the degrees offered (and if coverage, what kind of coverage would be available to him).

[ChaoticTribe]

There are NO laws requiring insurance to cover transgender care, including anti discrimination laws. The law regards transition basically the way it regards plastic surgery unfortunately.

This is because there haven't been large enough studies to gain recognition among American Medical Institutions to prove that gender affirming surgery is necessary or even beneficial to transgender people. I know it is, I experience that. I also feel the pain and distress and psychological damage of the current discord, but I can't prove that to them because they use specific methods just like many cancer treatments that work and have saved lives are not covered by ANY insurance because 'special people' didn't say it works.

Also, many people with painful clinical diseases such as endometriosis can't get their insurance to cover the surgeries they want or need, which I only know as it is one possibilty for what is causing the intense pain and bleeding I currently have, and I have been doing research and seen that again and again. Yet NO ONE denies endometriosis is a physically harmful disease, while some uneducated people don't understand trans issues.

[ChaoticTribe]

With that said, they can't refuse a transgender person approved care, such as a physical exam, antibiotics, wisdom tooth removal, etc. THAT is what the law would consider discrimination- them not granting coverage on things they normally would.

[Epi]

There are NO laws requiring insurance to cover transgender care, including anti discrimination laws. The law regards transition basically the way it regards plastic surgery unfortunately.

There are no federal protections, but this isn't just a cut and dry, black and white deal.  Some lower level governments have passed laws offering varying protections.  Another thing that usually comes with that in both the private and public sector are contracts.  While the contract may not be able to offer everyone in a particular state further protections and guarantees, it is enforceable if breached regardless if there aren't any federal or state laws providing the very same protections.

...they use specific methods just like many cancer treatments that work and have saved lives are not covered by ANY insurance because 'special people' didn't say it works.

I really can't explain in a forum post how the system works because frankly the bureaucratic process is complicated.  There is a system of checks and balances set up, one looking over the other, regulating another, etc.  One major thing to consider is are these "special treatments" FDA approved?  If not, the insurance company could become liable if they paid for a non-FDA approved treatment and the patient died in addition they would be in violation of varying laws and strict regulations for going outside them.  I don't necessarily agree with these things myself, but that's how it is.  However,  that doesn't mean you or I should accept these things for how they are, laws were made to be further interpreted.

Also, many people with painful clinical diseases such as endometriosis can't get their insurance to cover the surgeries they want or need

There is a difference between want and need, legally want is irrelevant so I won't address that, however if deemed a medical necessity that is a completely different story.  There is no doubt insurance companies are predatory scum sucking bottom dwellers who don't play by the same rules as everyone else does, that doesn't mean however they can't be held accountable for their unethical and unlawful practices. But you must take into account some of these individuals very well could have medical insurance plans that does not offer this type of coverage or it specifically states they have to to do certain things first or see certain physicians or specialists or they have a cap which they have reached.  Without seeing their policies I can't really offer much specific information either, but I can say that if you have an employment contract that guarantees you any and all necessary medical coverage (and you haven't reach your cap or don't have one) through whomever they've contracted then by all means hold them to it.

Off the top of my head here are some different examples of how these types of things work with employment contracts.

Susie drinks, recently she got a DUI.  It was decided Susie needed to go to rehab, her employers insurance paid because her contract guaranteed her any and all necessary medical treatment and she had selected the insurance policy that specifically covered alcohol/drug rehabilitation at one of its own facilities.

Hank injured his hand and was out on workers comp for a few months.  Nobody really liked Hank so while he was gone he was fired and dropped from the insurance despite the fact he had a union contract.  Hank discovered he had been dropped when he started receiving thousands of dollars in medical bills.  Hank knew this was a breach of his contract and contacted the union attorneys who quickly rectified the situation.  Hank was back on the insurance and to work shortly after regardless of the fact no one really liked Hank.

Sam is a non-probationary employee with a contract in a state that specifically has laws against the discrimination of LGBT in employment hiring.  Sam has an employment contract that guarantees him any and all necessary medical treatment and provides him with the option of 3 different medical plans, varying from HMO to PPO, $500,000 cap to unlimited within the network and for FDA approved treatments and drugs, etc.  Sam is also trans and while the insurance many not offer coverage (whether it specifically excludes or not), Sam's contract has guaranteed him equal access to necessary medical treatment.  Now, the exact amount of coverage would be dependent upon which plan Sam picked, however, if there were no comparable plans available to offer Sam equal access to medical treatment as his coworkers then Sam would have every right to enforce the contract.

[Paul]

If you're in NY near the Albany Area CDPHP is a GREAT plan and covers EVERYTHING (everything meaning both surgeries).  My top surgery next year is only costing me $150 (that's my co-payment through my plan I get through work so different plans may have slightly different prices) and if I choose to do bottom surgery it will only be $1,000 ($800 of which I get reimbursed from work).  They also cover my T ($10 co-pay a month).  I do have to by my needles outright, but that's like $5 a month so it's not bad. 

@Chaotic - I'm going through a Regular Plastic Surgeon here as well.  He has done top surgery for other Trans guys around here and I've seen pictures of his results and they're very good; I was pleased.  I can't wait til next May! :-D