Early Reassignment Surgery?

[jessilynn]

Is it a thing?

I may be loosing my good insurance, and Medi-Cal has made perfectly clear that they do NOT do the Gender Reassignment surgery, they will only cover a portion of my medicine.

So I was wondering if there is ANY possible way I could convince my doctor to let me go through the surgery earlier.

I am ready, I have been ready for many years.

[Rachel]

Have you been on HRT, seeing a gender therapist and living RLE for a year? If you have not then it may be difficult to have a USA doctor perform GCS. However, you may want to call a few doctors offices that perform GCS to find out their requirements first hand.

[Dena]

Don't forget that insurance will not pay without what they consider a proper diagnosis and they may not pay for an out of country doctor. It might be possible to get surgery early if you payout of pocket but running it through insurance may be near impossible.

[Laura_7]

Its guidelines ... not laws ...

you might contact a few surgeons and tell them your situation.
Imo its well possible if you promise to keep it confidential you might be successful.
There are surgeons who have only a few days waiting time.
As you describe it you have most of the waiting times.
If necessary there are online counselors for letters .
You might ask your insurance what is necessary so its covered.


hugs

[KarynMcD]

and Medi-Cal has made perfectly clear that they do NOT do the Gender Reassignment surgery

Tell them to read their policies:
http://files.medi-cal.ca.gov/pubsdoco/bulletins/artfull/gm201303.asp

21. Policy Clarification: Gender Identity Disorder

Treatment for Gender Identity Disorder (GID) is a covered Medi-Cal benefit when medical necessity has been demonstrated. Effective for dates of service on or after April 1, 2013, policy is clarified as follows. Treatment should follow the latest version of the World Professional Association for Transgender Health (WPATH) document, Standards of Care for the Health of Transsexual, Transgender, and Gender-Nonconforming People.

Covered Medi-Cal benefits include:

    Psychotherapy
    Continuous hormonal therapy
    Laboratory testing to monitor hormone therapy, and
    Gender reassignment surgery that is not cosmetic in nature

Gender reassignment surgery is covered when the individual with GID is at least 18 years of age, has the capacity for fully-informed consent, and the WPATH criteria for the surgery have been met. Covered benefits include mastectomy, orchiectomy, hysterectomy, salpingo-oophorectomy, ovariectomy and genital surgery, including placement of testicular prostheses when indicated. Augmentation mammoplasty for male-to-female individuals (MtF) is a covered benefit only when an appropriate trial of hormone therapy has not resulted in breast enlargement.

Intersex surgery should not be requested or billed using CPT-4 code 55970 (intersex surgery; male to female) or CPT-4 code 55980 (intersex surgery; female to male). Due to the serial nature of surgery for the gender transition, CPT-4 coding should be specific for the procedures performed during each operation. A Treatment Authorization Request (TAR) is necessary only for procedures that currently require a TAR.

The following surgeries are considered cosmetic in nature and are not covered Medi-Cal benefits:

    Reduction thyroid chondroplasty,
    Rhinoplasty
    Facial bone reconstruction
    Face lift, blepharoplasty
    Voice modification surgery
    Hair removal or transplant, and
    Liposuction

Augmentation mammoplasty is not a covered benefit for MtF individuals except as noted above.

[Asche]

As for dealing with insurance:  in the USA, at least, a lot of SRS surgeons will take responsibility for getting the insurance companies to agree to cover it.  After all, they have lot more experience with insurance coverage of SRS than their patients.  If you're in the USA, I would suggest contacting a few surgeons and seeing what approach they suggest.

[jessilynn]

Medi-Cal called it cosmetic. So they wot cover it until I get a lot more therapy. And I don't have the TIME for more therapy.

As far as my current insurance. I'm currently on a Kaiser HMO plan so it's all IN NETWORK.


Sent from my iPhone using Tapatalk

[OCAnne]

Quick answer - YES but it's a lot of work!

Gender Dysphoria Disorder ICD-10-CM F64.1 (current code), apparently what they call it now.  IMO is not the quickest path for those seeking ASAP SRS. http://www.icd10data.com/ICD10CM/Codes/F01-F99/F60-F69/F64-/F64.1

2015 ICD-9-CM Diagnosis Code 302.50 - Trans-sexualism with unspecified sexual history.  Of which can be cured by...wait for it, SRS!   http://www.icd9data.com/2015/Volume1/290-319/300-316/302/302.50.htm

I made the case for trans-sexualism and it worked.

Once I got 302.50.  This came next (very brief version):
HRT for unspecified length of time.
Genital electrolysis.
Legal name and gender change (start of RLE?)
Paid deposits and scheduled consultations for SRS.
Group therapy, which I ended up getting kicked out of.
2 letters from gatekeepers (therapist and Ph.D).
Settled on local surgeon who does not really accept insurance, cash deal.
Note: My SRS surgeon will not operate if you don't have 'letters' and living full time as a woman.

Total Time: 10 months of daily effort from start to finish.

So, again yes, 'Early Reassignment Surgery' is possible but is it worth the time, effort and money?

YTMV (Your Transsexualism May Vary).  I wish everyone seeking SRS has this dream realized.

Thank you,
Anne