Informed Consent

[jessilynn]

So I have a question, but first a bit of Demographic information is in order; before answering I live in the San Jose/ Santa Clara, California Bay area. So I am looking for information regarding my state.

This coming friday I am going to talk with a counselor from Kaiser. It is the "mental health" department. Apparently being a transgender means I have some sort of mental ailment. And they don't want to call me transgender until it is "diagnosed" as if it WERE a mental ailment.

I am obviously wanting to start Hormone Replacement therapy. Now I was wondering can I claim informed consent?. Rather than having to see the therapist for months on end

I see it in the manner that I am the patient, I am informed, and am giving my consent and having to live with the consequences.


Or is it still up to this shrink to decide? Because honestly I don't think it should be up to the therapist to decide if I truly am transgender?
If so, how can I convince this shrink otherwise? I've never been good at expressing myself.

In my opinion I have been waiting for far too long to do this.

[JLT1]

Most often you need a letter from a psychologist.  However, it'upto the MD.

Jen

[jessilynn]

Most often you need a letter from a psychologist.  However, it'upto the MD.

Jen

I mean I understand that, but if I show the therapist that I am indeed informed, is there a way to get informed consent and the letter? I just don't want to wait anymore. I feel completely wrong in my body.
As I said I have put this off for way too long.

[JLT1]

I don't know.  Talk to the psychologist.

Jen

[FTMax]

I have only seen 3 reasons why people don't go the informed consent route:

1) There isn't a doctor or a clinic that follows these standards in a commutable distance.

2) They personally feel that they need to speak to a mental health professional for whatever reason.

3) Their insurance will cover later steps in their transition, but only if they follow certain guidelines.

#3 was the only hang up for me personally, and it sounds like it may be for you too. I had to do some research and see what all my insurance would cover if I was willing to jump through some hoops for them. At the time I started HRT, they weren't willing to cover anything surgical even if I saw a therapist for X number of months. So it made more sense to me to go the informed consent route, thus saving money on therapy that could then be applied to surgery.

You'll need to figure out what your transition goals are and compare that with what your insurance will cover. If they'll completely cover SRS but only if you see a therapist for 6 months and get a diagnosis - that's a small price to pay.

[Laura_7]

Well there should be quite a few gender therapists covered by your plan...
so you might ask for a list or look on the internet and call them up how long until a letter for hrt...

[iKate]

Find a LGBT clinic. They are usually a 1 stop shop with mental health professionals and prescribing doctor(s).

In NYC the informed consent clinics operate that way.

[Laura_7]

Here is a list (there are more places meanwhile... and plannedparenthood might be a possibility... they also might have counselors and docs...)

https://www.susans.org/forums/index.php/topic,105294.msg794094.html#msg794094

[jessilynn]

I have only seen 3 reasons why people don't go the informed consent route:

1) There isn't a doctor or a clinic that follows these standards in a commutable distance.

2) They personally feel that they need to speak to a mental health professional for whatever reason.

3) Their insurance will cover later steps in their transition, but only if they follow certain guidelines.

#3 was the only hang up for me personally, and it sounds like it may be for you too. I had to do some research and see what all my insurance would cover if I was willing to jump through some hoops for them. At the time I started HRT, they weren't willing to cover anything surgical even if I saw a therapist for X number of months. So it made more sense to me to go the informed consent route, thus saving money on therapy that could then be applied to surgery.

You'll need to figure out what your transition goals are and compare that with what your insurance will cover. If they'll completely cover SRS but only if you see a therapist for 6 months and get a diagnosis - that's a small price to pay.

Well Kaiser DOES cover it.

And honestly all insurances SHOULD cover trans people. I thought by law they had to.

[FTMax]

Well Kaiser DOES cover it.

And honestly all insurances SHOULD cover trans people. I thought by law they had to.

They should, but none of us is in any position to tell them that as individuals.

Legally, if the plan is offered by the Affordable Care Act/Obamacare, I believe the standard is that if a treatment/procedure is covered for one person under the plan, it is covered for everyone on the same plan as long as your doctor is saying it is medically necessary - it nullifies gender coding of treatments and procedures. Ciswomen experiencing menopause or who are post-hysterectomy often undergo HRT to boost their estrogen back up. That is covered by insurance. Therefore HRT for transwomen should also be covered by the same plan. I don't think plans outside of the ACA are required to follow these guidelines. Somebody jump in here if I've got it wrong.

The best thing you could do would be to call the benefits number on your insurance card and lay out what you would like to do. They will be able to tell you what they would cover if you were to skip the mental health portion and see a doctor who follows informed consent. AFAIK, Kaiser is generally regarded as one of the better insurance providers for transfolks, so they may be on board for letting you find someone who does informed consent. Though if I remember correctly, most of their facilities are kind of a one-stop shop with all in-network providers in house. So they may allow you to go informed consent, but it would probably be out of network.

[CarlyMcx]

Kaiser has their own way of doing things, but on the good side, they pay for everything, and going outside them can get quite expensive.  I found they key to dealing with Kaiser is you have to know how to hack their system to get to the right people and get what you need.  So if you don't get what you need out of the therapist you are supposed to see, then try a workaround and go past the gatekeepers and straight to their gender therapy folks.

This information is for Mills College students, but might help you.  Kaiser has some kind of gender therapy unit in Oakland.  This PDF has some information on some specific doctors there.  It can't hurt to call and ask.

http://www.mills.edu/diversity/lgbtq_guide_to_navigating_kaiser.pdf

Here is another link about the Kaiser transitions center:  https://mydoctor.kaiserpermanente.org/ncal/facilities/region/eastbay/area_master/departments/transgender.jsp

Yes I know working the burocracy is a lot of work, but the few "informed consent" doctors I know about like to get paid cash up front, and they are insanely expensive.

Hope this helps.