does anyone know the steps to apply for payment for GRS from Medicare

[stephaniec]

I was talking to my therapist yesterday and she told me to look into getting Medicare to pay for my surgery because I just became eligible for Medicare through my disability, but I have no clue how to do that , so if anyone has applied for payment or know the process I'd be greatly appreciative . thanks That's for gender reassignment surgery

[iKate]

Have you talked to any navigators or similar? They would be able to help you.

[stephaniec]

Have you talked to any navigators or similar? They would be able to help you.

what's a navigator

[Randi]

Unfortunately the surgeon must accept Medicare as payment in full, and I don't know  of any surgeon that  currently does that.  Perhaps some university teaching hospitals may do that in the future.

You are not allowed to pay the difference between what the surgeon charges and what Medicare pays.

[stephaniec]

there was a 75 year old woman in Chicago that got the surgery a few months ago . She bought her case to the courts and won against Medicare and had the surgery so there is at least one surgeon that will do it. The surgeon works for the hospital network where my doctors are so maybe I should investigate my own health care net work. I was just wonder about the process. Do I work through the doctor or do I approach Medicare separately.

[Randi]

This website may be of use.

http://transmedicare.com/

[stephaniec]

This website may be of use.

http://transmedicare.com/

thanks much appreciated

[Flan]

there was a 75 year old woman in Chicago that got the surgery a few months ago . She bought her case to the courts and won against Medicare and had the surgery so there is at least one surgeon that will do it. The surgeon works for the hospital network where my doctors are so maybe I should investigate my own health care net work. I was just wonder about the process. Do I work through the doctor or do I approach Medicare separately.

Her surgeon was Loren S. Schechter
http://www.uplasticsurgery.com/gender-confirmation-surgery/

Since it would be in network (the hospital) your MD would have to submit a pre-auth for the surgical service and submit as to the necessity (and maybe other paperwork regarding the gender dysphoria diagnosis and treatment).

[FTMax]

I think it depends on the surgeon. I know at least for top surgery for us guys, I've heard some surgeons want a pre-authorization from your insurance before they'll initiate any paperwork. Mine offered to initiate contact with my insurance.

GRS is a bit pricier though, so the situation may be a little different.

[stephaniec]

thanks everyone it was like a homework assignment from my therapist to find out/

[Emily E]

I know this information may be a little out of date but when my dad was on Medicare he had a hard time getting some doctors (specialists and the like) to accept him as a patient so he got supplemental insurance (designed to cover the difference between what Medicare pays and the doctors' fees) which he said cost him like 20 dollars a month and once he had that he never had a doctor refuse him as a patient.  So I don't know if the affordable care act changed how that works but it might be worth looking into if only to help entice a doctor into accepting you as a patient. 

[traci_k]

Strphanie,

The doctor who did the surgery was Dr Schecter and he did it at Weiss  here in Chicago. Your best bet would be to contact him and have his office work through the approvals from Medicare and the intermediary.


Best Wishes on getting it through.

Hugs,

[Alexis2107]

My therapist helped someone get their surgery done and paid for by medicare in Indiana.  Someone asked this same question some time ago, I can try to dig up their name if you would like me to.

[Alexis2107]

On another note, one of my trans woman friends had got approved for SRS to be paid for by the VA, I noticed you were a retired vet... have you looked into this route, as well?

[stephaniec]

Her surgeon was Loren S. Schechter
http://www.uplasticsurgery.com/gender-confirmation-surgery/

Since it would be in network (the hospital) your MD would have to submit a pre-auth for the surgical service and submit as to the necessity (and maybe other paperwork regarding the gender dysphoria diagnosis and treatment).

I just sent that Dr. an email for information on GRS

[stephaniec]

On another note, one of my trans woman friends had got approved for SRS to be paid for by the VA, I noticed you were a retired vet... have you looked into this route, as well?

not yet , but I will . I just starting to try to see what I can do. thanks

[justpat]

   Keep rowing Steph we are both in the same boat. I have a consult in July in the meantime I will try to find out some info from the VA ,wish me luck on that one, but I do have a lot of friends there maybe someone has heard something. Also I have two huge group meetings on the 17th and 20th and a medical  symposium on the 14th and 15th of next month you can bet I will be networking a lot and will keep you in the loop.    Patty

[stephaniec]

yes a mega good luck

[Randi]

According to this publication the VA does not provide or fund Sex reassignment surgery.

http://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=2863

2C(4) Sex reassignment surgery. Sex reassignment surgery includes any of a variety of
surgical procedures (including vaginoplasty and breast augmentation in MtF transsexuals and
mastectomy and phalloplasty in FtM transsexuals) done simultaneously or sequentially with the
explicit goal of transitioning from one sex to another. This term includes surgical revision of a
previous sex reassignment surgery for cosmetic purposes. NOTE: This term does not apply to
non-surgical therapy (e.g., hormone therapy, mental health care, etc.) or intersex Veterans in
need of surgery to correct inborn conditions related to reproductive or sexual anatomy or to
correct a functional defect.

(c) Sex reassignment surgery as defined in subparagraph 2c(4), will not be provided or
funded.

On another note, one of my trans woman friends had got approved for SRS to be paid for by the VA, I noticed you were a retired vet... have you looked into this route, as well?

[stephaniec]

According to this publication the VA does not provide or fund Sex reassignment surgery.

http://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=2863

2C(4) Sex reassignment surgery. Sex reassignment surgery includes any of a variety of
surgical procedures (including vaginoplasty and breast augmentation in MtF transsexuals and
mastectomy and phalloplasty in FtM transsexuals) done simultaneously or sequentially with the
explicit goal of transitioning from one sex to another. This term includes surgical revision of a
previous sex reassignment surgery for cosmetic purposes. NOTE: This term does not apply to
non-surgical therapy (e.g., hormone therapy, mental health care, etc.) or intersex Veterans in
need of surgery to correct inborn conditions related to reproductive or sexual anatomy or to
correct a functional defect.

(c) Sex reassignment surgery as defined in subparagraph 2c(4), will not be provided or
funded.

I contacted that surgeon in Chicago and they emailed me a bunch of information and said they work with the insurance companies. All I have to do now is hope they accept Medicare. I know they done it all ready , but I don't know how many there willing to do. I'm going to go through the stuff they sent . they want me to contact them once I go through the stuff to talk about the insurance and I'll see what they say.