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Genital Surgery Must Be Provided To Trans Woman Through Medicare Program

Started by stephaniec, January 29, 2016, 03:16:15 PM

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stephaniec

Genital Surgery Must Be Provided To Trans Woman Through Medicare Program

http://www.buzzfeed.com/dominicholden/genital-surgery-must-be-provided-to-trans-woman-through-medi#.cyK0lzkyX3

BuzzFeed/posted on Jan. 29, 2016, at 11:36 a.m. By Dominic Holden BuzzFeed News Reporter

"Charlene Lauderdale was denied coverage for the procedures by her private insurance firm, which is funded through Medicare. But for the first time this month, a U.S. Department of Health and Human Services panel found that the insurance provider must cover the procedures. "
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itsApril

Outstanding, but now . . .

. . . will folks be able to find a capable surgeon willing to take Medicare assignment?
-April
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BeverlyAnn

Quote from: itsApril on January 29, 2016, 06:14:34 PM
Outstanding, but now . . .

. . . will folks be able to find a capable surgeon willing to take Medicare assignment?

That is the $64,000 question!
Always forgive your enemies; nothing annoys them so much. - Oscar Wilde



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ChasingAlice

When will legislation govern that someone has to do these surgeries. As far as I'm concerned Medicare/Medicade can cover the travel cost if no providers are local.

Tysilio

This is great news!

Quote from: itsApril. . . will folks be able to find a capable surgeon willing to take Medicare assignment?

From the article linked in Stephanie's post: "...Lauderdale was covered by United Healthcare through Medicare Advantage, a government-run program that compensates private insurers for patients who qualify for subsidized health care. Lauderdale was denied coverage for the procedures in 2014, leading to a series of appeals resulting in this month's decision in her favor."

The way this works is that one consults a surgeon as the first step in getting coverage; the surgeon then sends a request for authorization to the insurance provider. If coverage is denied, then the patient goes through an appeals process, generally with the support of the surgeon.

It follows from this that since Ms. Lauderdale's surgeon applied for coverage by Medicare, that one surgeon, at least, is willing to accept payment from that source. If Ms. Lauderdale is smart and persistent enough to have pursued this to a successful outcome, I'd be willing to bet that she's also smart enough to have chosen her surgeon wisely.

I'd also be willing to bet that there are others. Many surgeons do actually believe that their primary job is to help people, and they put that ahead of lining their pockets.

In my opinion (for what it's worth) it's unethical for a qualified surgeon to refuse to accept insurance for medically necessary procedures.
Never bring an umbrella to a coyote fight.
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JLT1

Coverage is great.  Bowers will accept it and I think there are others.  However, if the surgery costs $24000, how much are they going to pay?

Jen
To move forward is to leave behind that which has become dear. It is a call into the wild, into becoming someone currently unknown to us. For most, it is a call too frightening and too challenging to heed. For some, it is a call to be more than we were capable of being, both now and in the future.
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Tysilio

Quote from: JLT1Coverage is great.  Bowers will accept it and I think there are others.  However, if the surgery costs $24000, how much are they going to pay?

Good question. It will certainly be a lot less than that, which is why I made the point about not all surgeons being in the business just to line their pockets. But surgeons in other specialties from orthopedics to neurosurgery mostly treat patients whose care is covered by insurance of one kind or another, including Medicare, all of which pay less than what the surgeon bills; the surgeons still manage to make a more than decent living.

It's also worth remembering that when we say "X surgery costs X amount of money" when the patient pays out of pocket, we're talking about an all-inclusive amount, covering doctors' fees, anesthesia, operating room time, a hospital stay if needed, etc. When insurance is involved, all those things are typically billed as separate items; some will be billed by the hospital, some by the individual doctors.
Never bring an umbrella to a coyote fight.
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Joelene9

Quote from: JLT1 on January 30, 2016, 07:32:18 PM
Coverage is great.  Bowers will accept it and I think there are others.  However, if the surgery costs $24000, how much are they going to pay?

Jen
My 9 treatments of immunogloubulins (IVIG) for my neuropathy (CIDP) costs around $90,000 thus far not counting the nurse visits. I pay $2.00 each for each bottle, the IV accessories plus the nurse visit. Medicaid pays the rest. Heart bypass surgeries are around $70K-200K.

http://www.cidpusa.org/ivig-cost.htm

Joelene
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