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Health insurance & the hysterectomy...after you're legally male

Started by FTMax, March 28, 2015, 03:44:34 PM

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FTMax

Hey guys,

Hoping someone here can give me some advice. My name change just came back in the mail. I'm waiting on a letter from DMV headquarters so I can update my gender marker. I can get new health insurance in a week (26th birthday, thanks Obama), and my plan has been to sign up for this as male so that my testosterone will be covered in the future.

My only concern against doing this immediately is my future hysterectomy. I would like to get one done within the next two years, and ideally I'd like to have it at least partially covered by insurance if it's a possibility. My brain says it should be covered, since as a man, I shouldn't have a uterus, but obviously the opinion on this is going to vary by provider and plan. If anybody has ever had their insurance cover (in whole or in part) their hysto, though they're listed as male on the policy, I'd love to hear about your experience.
T: 12/5/2014 | Top: 4/21/2015 | Hysto: 2/6/2016 | Meta: 3/21/2017

I don't come here anymore, so if you need to get in touch send an email: maxdoeswork AT protonmail.com
  •  

Alexthecat

It probably depends where you live. I don't have personal experience but the ones I have read about resulted in them fighting to get it covered.

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jeni

I believe that with AMA-compliant plans, it should be covered for males if it is covered for females. So yes, Thanks Obama.
-=< Jennifer >=-

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FTMax

Quote from: jeni on March 28, 2015, 04:34:36 PM
I believe that with AMA-compliant plans, it should be covered for males if it is covered for females. So yes, Thanks Obama.

Jeni, that was my thought as well. I'd be going through my state's health insurance marketplace to get coverage, so I'm really not *terribly* worried about it not being covered, but I'm wondering if anyone can recommend specific ways to go about it or any kind of verbiage I should avoid when the time comes to talk with the insurance people.
T: 12/5/2014 | Top: 4/21/2015 | Hysto: 2/6/2016 | Meta: 3/21/2017

I don't come here anymore, so if you need to get in touch send an email: maxdoeswork AT protonmail.com
  •  

Bimmer Guy

Quote from: jeni on March 28, 2015, 04:34:36 PM
I believe that with AMA-compliant plans, it should be covered for males if it is covered for females. So yes, Thanks Obama.

That may be true (if things are covered for one sex, they should be covered for the other), however, I think the fact that this is a trans related surgery would supersede this.  Obama care does NOT cover trans benefits (or at least that is not part of the mandate).

I believe that most guys try to stay female on their insurance until they get hystos, ftmax.  Be certain of how things will impact you before you make the switch.
Top Surgery: 10/10/13 (Garramone)
Testosterone: 9/9/14
Hysto: 10/1/15
Stage 1 Meta: 3/2/16 (including UL, Vaginectomy, Scrotoplasty), (Crane, CA)
Stage 2 Meta: 11/11/16 Testicular implants, phallus and scrotum repositioning, v-nectomy revision.  Additional: Lipo on sides of chest. (Crane, TX)
Fistula Repair 12/21/17 (UPenn Hospital,unsuccessful)
Fistula Repair 6/7/18 (Nikolavsky, successful)
Revision: 1/11/19 Replacement of eroded testicle,  mons resection, cosmetic work on scrotum (Crane, TX)



  •  

FTMax

Quote from: Brett on March 28, 2015, 05:57:30 PM
That may be true (if things are covered for one sex, they should be covered for the other), however, I think the fact that this is a trans related surgery would supersede this.  Obama care does NOT cover trans benefits (or at least that is not part of the mandate).

I believe that most guys try to stay female on their insurance until they get hystos, ftmax.  Be certain of how things will impact you before you make the switch.

Well, if my boss sorts out my insurance, I'll be covered under DC health insurance and they've outlawed trans exclusions in health care. I'm worried that he won't and I'll have to get insurance through Virginia's marketplace, which might be a little trickier.
T: 12/5/2014 | Top: 4/21/2015 | Hysto: 2/6/2016 | Meta: 3/21/2017

I don't come here anymore, so if you need to get in touch send an email: maxdoeswork AT protonmail.com
  •  

HeyTrace19

Try your best to keep the insurance you have until after you have the hysterectomy!  In an ideal world, all policies would cover trans health care to the fullest extent...but most of the country is NOT there yet.  It is better to have a little confusion and pay for your hormones for a year or two than be stuck finding a way to pay for a surgery that is not affordable.  I was so happy to have insurance that covered my procedure (after a big deductible), which ended up being over fifty thousand dollars!  Turns out I had a benign tumor in there with all that stuff and needed an inpatient surgery---since I was still insured as F, it was covered.  Had I been male, even though it was still medically necessary and not transition related, it was not a procedure covered for a male patient. 

Health care is truly NOT affordable!  Costs are exorbitant for everyone.  Many people live in fear of being sick or needing care because they are one major hospital stay away from financial ruin.  Yes, the ACA has made it easier for people to obtain and afford insurance through subsidies, but still the costs are unbelievable.  Those not eligible for a government subsidy or employer plan usually can only afford a high deductible plan, which can be brutal as well.  We have a long way to go in this country with health care reform.  Obama has made a start, but the system is headed for collapse and will need to be completely redesigned.  Wow, sorry to hijack your post with my political rant!

Just be very careful in researching all of your options.  Assume nothing.  Document everything.  Good Luck!
  •  

jeni

Quote from: Brett on March 28, 2015, 05:57:30 PM
That may be true (if things are covered for one sex, they should be covered for the other), however, I think the fact that this is a trans related surgery would supersede this.  Obama care does NOT cover trans benefits (or at least that is not part of the mandate).

I believe that most guys try to stay female on their insurance until they get hystos, ftmax.  Be certain of how things will impact you before you make the switch.

I don't think "trans related surgery" exactly supersedes the mandate, but rather that the treatment might not be covered for either gender for a particular diagnosis. You may be right, in the sense that they also wouldn't pay for an AMAB to have a hysterectomy to treat GD either... But I don't think the marked gender would have an impact here. I don't think an elective hysterectomy would generally be covered for a female in the first place.

Definitely agree that the insurance exclusions should be checked out before choosing a policy or making potentially significant changes, though.
-=< Jennifer >=-

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FTMax

Found this interesting little gem. I currently have BCBS, and haven't had any issues getting my doctor visits and labwork covered, and I can get this plan through work or on my own if I have to.

https://www.mtda.com/bu/cf01214.pdf

It is basically an inside-eyes-only document that says they've removed codes for gender-related procedures...and as an example uses a male on paper individual getting a hysterectomy, which would be covered. Thoughts? The document is from 2013, which is when DC updated its policy on trans health exclusions.
T: 12/5/2014 | Top: 4/21/2015 | Hysto: 2/6/2016 | Meta: 3/21/2017

I don't come here anymore, so if you need to get in touch send an email: maxdoeswork AT protonmail.com
  •  

HeyTrace19

Quote from: ftmax on March 28, 2015, 09:16:19 PM
and I can get this plan through work or on my own if I have to.

Sounds like the one to have for your situation...  It also sounds like they were not announcing this change to members, which seems a little less than forthright, but at least YOU are aware.  We as a nation need to work toward more inclusive coverage that all people can afford, with complete transparency. 

I wonder if your care providers also need to be in DC for that coverage to be applicable... 
  •  

FTMax

My primary doctor and everyone she's ever referred me to have been in DC, so not worried about that :) I'm going to bring it up to my boss next week and see if he's worked out the DC health insurance website yet or not. Fingers crossed!
T: 12/5/2014 | Top: 4/21/2015 | Hysto: 2/6/2016 | Meta: 3/21/2017

I don't come here anymore, so if you need to get in touch send an email: maxdoeswork AT protonmail.com
  •  

aleon515

Under the Affordable Care Act (ACA, aka Obama care), it is against the law to deny surgeries based on gender (so therefore any surgery anybody can get if medically necessary). It doesn't matter if you are covered under the exchange because this is private insurance. HOWEVER, no one has tested this little goodie legally. I am pretty sure that the ACLU and the Transgender Law Center would love a case. I know several people who have effectively fought this without a lawyer, but I also know that insurance companies commonly spit out rejections, so I would expect one.

--Jay
  •  

Bimmer Guy

Quote from: jeni on March 28, 2015, 07:52:40 PM
I don't think "trans related surgery" exactly supersedes the mandate, but rather that the treatment might not be covered for either gender for a particular diagnosis. You may be right, in the sense that they also wouldn't pay for an AMAB to have a hysterectomy to treat GD either... But I don't think the marked gender would have an impact here. I don't think an elective hysterectomy would generally be covered for a female in the first place.

Definitely agree that the insurance exclusions should be checked out before choosing a policy or making potentially significant changes, though.

Correct, but typically FTMs keep their insurance marker as female in case their provider can figure out a way to define their hysterectomy as "medically necessary".  It is a standard, common approach for FTMs.
Top Surgery: 10/10/13 (Garramone)
Testosterone: 9/9/14
Hysto: 10/1/15
Stage 1 Meta: 3/2/16 (including UL, Vaginectomy, Scrotoplasty), (Crane, CA)
Stage 2 Meta: 11/11/16 Testicular implants, phallus and scrotum repositioning, v-nectomy revision.  Additional: Lipo on sides of chest. (Crane, TX)
Fistula Repair 12/21/17 (UPenn Hospital,unsuccessful)
Fistula Repair 6/7/18 (Nikolavsky, successful)
Revision: 1/11/19 Replacement of eroded testicle,  mons resection, cosmetic work on scrotum (Crane, TX)



  •  

FTMax

Quote from: Brett on March 29, 2015, 06:30:43 PM
Correct, but typically FTMs keep their insurance marker as female in case their provider can figure out a way to define their hysterectomy as "medically necessary".  It is a standard, common approach for FTMs.

But hypothetically if insurance companies aren't allowed to discriminate with coverage based on gender marker, wouldn't this become a non-issue?
T: 12/5/2014 | Top: 4/21/2015 | Hysto: 2/6/2016 | Meta: 3/21/2017

I don't come here anymore, so if you need to get in touch send an email: maxdoeswork AT protonmail.com
  •  

jeni

Quote from: ftmax on March 29, 2015, 07:09:38 PM
But hypothetically if insurance companies aren't allowed to discriminate with coverage based on gender marker, wouldn't this become a non-issue?

I suppose it's less likely to receive careful scrutiny if the gender marker fits the expectations.
-=< Jennifer >=-

  •  

mac1

Quote from: ftmax on March 28, 2015, 03:44:34 PM
Hey guys,

.................

My only concern against doing this immediately is my future hysterectomy. I would like to get one done within the next two years, and ideally I'd like to have it at least partially covered by insurance if it's a possibility. My brain says it should be covered, since as a man, I shouldn't have a uterus, but obviously the opinion on this is going to vary by provider and plan. If anybody has ever had their insurance cover (in whole or in part) their hysto, though they're listed as male on the policy, I'd love to hear about your experience.

That would be equivalent to a woman getting prostate surgery. Would it be covered by insurance?
  •  

Alexthecat

Quote from: ftmax on March 29, 2015, 07:09:38 PM
But hypothetically if insurance companies aren't allowed to discriminate with coverage based on gender marker, wouldn't this become a non-issue?
In an ideal world yes, but insurance companies do not want to pay for things so anything a bit out there will be denied and you have to fight to get it covered.

  •  

Ayden

I seem to remember reading that the mandatory healthy care passed was subject to state laws. Any truth to that? If it is, I would think that it would depend on what state you lived in if you had certain things covered. I've been out of the country too long to be really in the know.
  •  

Bimmer Guy

Quote from: ftmax on March 29, 2015, 07:09:38 PM
But hypothetically if insurance companies aren't allowed to discriminate with coverage based on gender marker, wouldn't this become a non-issue?

Quote from: Ayden on March 29, 2015, 09:15:32 PM
I seem to remember reading that the mandatory healthy care passed was subject to state laws. Any truth to that? If it is, I would think that it would depend on what state you lived in if you had certain things covered. I've been out of the country too long to be really in the know.

I believe it depends on the state.  ftmax, it is up to you.  I personally wouldn't change my gender marker on my insurance until I had all surgeries related to my birth sex completed. 
Top Surgery: 10/10/13 (Garramone)
Testosterone: 9/9/14
Hysto: 10/1/15
Stage 1 Meta: 3/2/16 (including UL, Vaginectomy, Scrotoplasty), (Crane, CA)
Stage 2 Meta: 11/11/16 Testicular implants, phallus and scrotum repositioning, v-nectomy revision.  Additional: Lipo on sides of chest. (Crane, TX)
Fistula Repair 12/21/17 (UPenn Hospital,unsuccessful)
Fistula Repair 6/7/18 (Nikolavsky, successful)
Revision: 1/11/19 Replacement of eroded testicle,  mons resection, cosmetic work on scrotum (Crane, TX)



  •  

Ayden

I'm with Brett, personally. Unless I knew for certain that it would not preclude me from getting surgeries covered, I wouldn't change my marker. Of course, you should do what you feel is the right thing for you.
  •