This was a process: it has been long, sometimes humiliating and often frustrating. However, even with a discount, the final price for me to have FFS went over $50,000 US. I found motivation easily. I also found discouragement and frustration even easier to come by. I started the process in June of 2013, and got my approval letter March of this year. Part of the problem was that my employer, who had offered a choice in carriers, cancelled my carrier and went with the cheaper carrier effective January 1, 2014. As a result, all of the calls, letters, recommendations and endless explanations I had gone through needed to start again. Then, there was the plan change.
My new insurance plan stated that they would pay for SRS and with sufficient medical justification, breast augmentation. Other surgeries, such as tracheal shave and rhinoplasty would be addressed on a case by case basis. We do know that several of us have transitioned over the past few years with the same low cost carrier and none managed to meet the requirements. The biggest problem is that they would not tell anyone what was needed; just constant reviews and denials for feedback. In the end, this was what I needed:
1. A letter of recommendation from my primary care physician. The form and requirements of a WPATH recommendation for SRS from a psychologist had to be followed. In addition, the letter had to address my physical health and any possible undo risks of surgery.
2. A letter of recommendation from my psychologist, following WPATH SRS standards.
3. A letter from the surgeon stating what was being done and why as well as a letter under the WPATH guidelines for a psychologist recommending SRS.
4. A plan, from me, detailing my journey to becoming a woman, including dates for milestones: When I started with my psychologist, when I started HRT, when I started RLE, when I will be changing my legal name and gender (with court appointment documentation), when I will have SRS (with letter from surgeon documenting date).
5. The surgeon (Dr. Z) was also kind enough to provide legal references to two court decisions stating that FFS was a medical treatment for GID and not a cosmetic surgery. Dr Z also provided them with recognized insurance codes for the treatment. (These two items were critical.)
Overall, most of this is needed for SRS, from the surgeon or for the actual transition. The only additional item was the letter from my primary care physician. I called and called and finally found someone who worked with me. She was fantastic. No, it was not fair. Now we know, now we can make it easier for those who follow and perhaps, those who have already transitioned.
Hugs,
Jen
