Insurance Coverage for Trans* related procedures in Australia

[Jo-is-amazing]

Hi Guys
I know that there are a number of trans* girls here are from Australia, and I was wondering what exactly does medicare/ private health cover pay for here?
I recently discovered that my parents Medibank Private cover continues to apply for me until I am 25, So with that in mind I want to know;
- Are there any transition related costs I could claim under medicare or private health insurance, in particular;
- Is SRS covered by medicare/ private health insurance
- and should I choose to go overseas, is it likely my health insurance will pay out at least some of the cost?

I have no idea about any of it
Its just something that I thought would take me a decade to get might be available to me a lot sooner
So what are some of your experiences with it?

[TashaEve]

If you find out any of this I'd be keen to know.

I contacted HBF (my current provider) and they told me they wouldn't cover ANYTHING to do with transition as they deemed it a cosmetic surgery. They also suggested other insurance companies wouldn't either for the same reasons.
I did manage to claim a hormone implant from them though. $80 back, out of $50 a week for the last 4-5 years. Probs not worth it.
But like my partner said, they are more about covering accident and injury in Aus.

Medicare DO cover some medical expenses. I have been covered for:
-A portion of my psychiatric expenses
-A portion of my endo appointment costs
-Medical imaging and blood tests (as directed by my Endo specialist)
-GP visits for referrals (excepting Abbott's new American inspired 'Sick Tax')
-Hormones are usually on the PBS, but I probably still spend $50 a month on those.
These are minor things in comparison to GRS but they would add up quickly.

The things that I (and probs you too) want to know about are the surgical "options."
Does medicare cover:
-GRS/SRS
-Tracheal shave
-Other "cosmetic" surgeries (boobies, FFS)
-Any of the above done overseas?

I checked the full listing on Medicare's covered surgeries and couldn't find GRS (under any name).

Thinking of getting a bank loan for my GRS. Otherwise I'll be saving till I'm dead. Other options include sitting naked in a tank of piranhas. 

[Jo-is-amazing]

That's the thing in my mind it might be cheaper to sue and have the definition changed if that's the case. I have no idea though...so if mine doesn't cover it I'll seek legal advice and see what happens

Although in the end piranha's might be my only option :p

[TashaEve]

I think the best way to find out may be to simply ask them.

[Jo-is-amazing]

I absolutely agree :p
It's just defining trans related surgeries as "cosmetic" makes me really angry

[TashaEve]

Agreed. Should be a matter of your psych stressing the importance of the operation/s to medicare.

Even if they contributed just a portion, that would at least prompt local doctors to do these surgeries and we wouldn't necessarily have to fly overseas for it.

[Cindy]

Just been into this!

SRS is done under private cover in Australia (there is no public hospital available) and you can get the Medicare rebate for all of the procedure. My insurance HCF is paying the gap for each procedure. Since I have to travel from Adelaide to Melbourne I can claim travel and accommodation on the Pathserve (?) scheme, including for a person to accompany me.

It is not cosmetic surgery your medics just need to sign off that it is life saving surgery not available in the public arena.

I'm going to Andy Ives and he is very knowledgable about how to deal with the financials. Spoke to another girl last night who has just completed her surgery a few months ago, out of pocket expense was about $10,000

BTW this whole discussion of access to public health system is a hot item in the ANZPATH conference in October (www.anzpath.org) you should be attending to lend support to changing the archaic rules we are under!!

[TashaEve]

That's really good news Cindy.
(I was kinda hoping you'd chip in on this )

Will definitely be in attendance at the conference. Haven't grabbed tickets yet, nor picked my outfit.

[Girl Power]

Thank you so much for the info Cindy. I'm about to organise my SRS in the next few months. Looking at going to Melbourne as well.

[kaye]

I'm going to Andy Ives and he is very knowledgable about how to deal with the financials. Spoke to another girl last night who has just completed her surgery a few months ago, out of pocket expense was about $10,000

What's the point? Might as well just get in done in Thailand; it's about 10k there.

[ElleA]

I saw Andy for a Breast Augmentation in September last year, couldn't have been happier.

Unfortunately for both BA's and SRS medicare and private health will cover little if not none of the expenses.

The BA with Andy was $10,300, which might seem like a lot but I have had CIS friends that didn't know I had a BA and would have sworn my boobs were real, they look and feel pretty amazing so I couldn't be happier.

As for SRS, I haven't done it yet myself but I do know that it cost $9000 for the surgery plus Anaesthetic Fee of $3550, medicare will rebate $2393.35 of that totalling $10,156.65

I also contact HCF (My Private Health Insurer) and they said they would cover a further $2957 So I was looking around the $7000 mark all in.
I couldn't get a straight answer from medicare as to whether they would cover some of the Anaesthetic fees as well but that might bring it down further.

Either way I haven't quite decided what I want to do in terms of surgery and the types of techniques used in Australia vs those used overseas, but the fact of having the surgeon close by and not having to leave Australia if I need any after care is a big plus in my eyes.

Each to their own I guess

[Jo-is-amazing]

So that price tag puts him in line with a lot of the Thai surgeons, that seems really cheap, is that just the out of pocket once private health is deducted or is that the full price (for srs I Mean)

I'm tempted.to go with Andy because it effectively means I could have srs in the summer of 16/17, which is my ideal time at the moment. Otherwise I'll have to wait the best part of a decade to have it done by one of the American/ Canadian surgeons (I wouldn't really want to go to Thailand)

[DanielleA]

With my medicare card, each set of pills I get from the pharmacy cost no more than like $6 each and I would pay $120 to see a particular psychologist then would get back a little over eighty something dollars.

[Sarah leah]

Hi girls,

Been researching this very topic myself today at lunchtime and came across this: (included source also)

...if you need breast reconstruction procedures for any of the following make sure you check the Medicare rebates listed below, as Medicare may cover 75% (which is usually the hospital stay).


•Bilateral Breast Reduction (Item no. 45520) – Medicare Rebate is $675.35 (1 side)
•Tubular Breast Reconstruction (Item no. 45559) – Medicare Rebate is $852.60 (1 side)
•Abdominoplasty (Item no. 30177) – Medicare Rebate is $739
•Breast Augmentation for asymmetry (Item no. 45524) – Medicare Rebate $556.25 (1 side)
•Breast Implants for breast deformity (Item no. 45528) – Medicare Rebate $834.30 (1 side)
•Breast Lift for Asymmetry (Item no. 45556) – Medicare Rebate $574.55 (1 side)
•Breast Lift after pregnancy – Youngest child must be between 1-7 years old (Item no. 45558) – Medicare Rebate $861.75 (both sides)
•Breast Augmentaion (No Item no.) – Medicare Rebate NIL

Source:
plasticsurgeryhub, 2014, 'I need a boob job, can Medicare help?', Feb 27, 2014
<http://www.plasticsurgeryhub.com.au/need-boob-job-can-medicare-help/>

I know many of us end up with slightly less fuller breasts and this could be a loophole for many of us when we get birth certificates changes as we are legally female.

What is tuberous breasts:

http://medical-dictionary.thefreedictionary.com/Tuberous+Breast+Deformity

http://books.google.com.au/books?id=4BOrAg3hkGIC&pg=PA301&dq=Tubular+Breast&hl=en&sa=X&ei=kqBIVPbPEuPwmAWzroCABA&ved=0CCgQ6AEwAg#v=onepage&q=Tubular%20Breast&f=false

I hope this sparks debate and gets people thinking outside the box

[ElleA]

Hi Sarah, I looked in to this with Andy Ives, he has to send off a letter of recommendation and wait for your case to be seen by a board. They make the ultimate decision and for me they decided not to cover anything. Andy said he was happy to do this for patients but he had never had a trans mtf patient be successful in this attempt.

[ElleA]

Jo with private health and Medicare my out of pocket would be around $7000 keep in mind this is with HCF and every fund is different and cover things in different ways.

[Jo-is-amazing]

I'm with Medibank private at the moment, and I expect they will cover me
Because Im under 25 and (keeping my fingers crossed) I'll be 20/21 by the time I get SRS, Im covered by my parents policy anyways and my Dad has promised me that he is more than willing to change to the plan with the highest rebate for srs.

So in the end its a matter of no consequence, if its possible to get a rebate for it, Ima get a rebate

[ElleA]

Cool bananas, I guess that's what I was getting at mostly. Not all health insurers will cover any of the srs procedure. But Medibank is pretty big so you would think they would.

[Cindy]

HCF said they would cover it, but they can be fickle, depends upon the person who process or so it seems. Not just for GCS they have been the same for medical procedures that my wife has been through. Even accepted and rejected MRI's at different times for the same medical reason.

Maybe it is time we talk to the providers about how to deal with this? I know they are very annoyed on how we are being treated by medicare and the insurance companies. In fact I reckon we can bring Tim Wilson into this, he was VERY supportive at the conference. He has already started the Supreme Court looking at the need for the Family court to be involved in approval for cross sex hormones for adolescents.

[Cindy]

BTW I'm going to Andy Feb 24 2015.