GCS coverage

[Emjay]

Hi all,

So I've begun looking into getting gcs and was excited to see that there is now a surgeon in my city who can perform it. 

I contacted them for more information and they checked with my insurance to determine if I have coverage and found that my particular plan does have a transgender surgery exclusion so as far as I can tell I'm out of luck for now.  Has anyone had any luck getting these reversed at all?

I'm currently looking into switching to my employers insurance, which I know does cover it so I might just have to wait until next year to begin the process.

They had told me when we spoke earlier that the total cost for gcs would be roughly $80,000 usd counting the surgery itself, hospital stay and anaesthesia if I were to have it without insurance, which might as well be a million for me, I'll never be able to come up with that much.  Does this sound right or is that an extremely high number?  I've always heard between 20 and 30 thousand....

[Dena]

The number sounds hight to me BUT if you have medical insurance, that number is often negotiated lower by the insurance company so the total will be much less. Even my crummy Blue Cross has resulted in some out of pocket reductions while the insurance covered nothing so the insurance prevented me from paying full price.

[Sspar]

My GCS is this October with Dr.Rumer in the Philly area... its going to run about 21k.. ( hopefully covered by Aetna insurance )  and BA at the same time is about 5k..
I signed up for Aetna just for this  Surgery.. but so far they have been a bit difficult to deal with overall.. We will see how this all Plays out..

[EmilyMK03]

$80,000 USD isn't right.  I have always heard that the cost is $20,000 - $30,000 for surgeons in the USA.  That is of course if you pay for the entire thing out of your own pocket, with no insurance coverage whatsoever.

[Barb99]

That's WAY out of line. I'm scheduled with Dr. Rumer in November, it's only going to be about 26K with a triac shave. I had quotes from 3 other USA surgeons, all were in the 21-30K range.

[Jenna Marie]

Yeah, that may be what they'd charge an insurance company, but out of pocket it's ridiculous.

I went to Brassard, and it was $18K Canadian; the dollar was about 1:1 at the time, but right now, that price would be around $15K US.

[Emjay]

Thanks for the replies everyone, I was thinking it was a LOT high too.

They said the surgery itself was around 21K.  The expensive part being the hospital stay at somewhere around 60K, which I don't understand.

They are in clinic on Wednesdays so they can't take calls today but I'm going to call back tomorrow to get clarification and make sure they know that I live in town and won't require staying in the hospital that long if it's not necessary.  Maybe I missed something when we spoke yesterday.

At any rate I'm looking into picking up insurance from my employer too, if I did it would go into effect in January so I should have coverage then either way.

[TinaVane]

Yeah, that may be what they'd charge an insurance company, but out of pocket it's ridiculous.

I went to Brassard, and it was $18K Canadian; the dollar was about 1:1 at the time, but right now, that price would be around $15K US.

Brassard is 15k [emoji15][emoji15][emoji15][emoji15][emoji15][emoji15]? Never knew that thought he was a arm and a leg


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[Jenna Marie]

TinaVane: Well, like I said, that's a factor of the exchange rate. I believe his price is about $19K in Canadian dollars right now, but because the US dollar is worth more than the Canadian dollar, that is only around $15K in US dollars. (I have a friend who's going to him in about a week, so I'm actually in a position to know what someone paid him within the last month or so.)

When I did it, I paid about $18K in US dollars, although that's still fairly cheap by North American standards - and it included 2 days in the hospital and another 8 days under 24/7 nurse supervision in his recovery residence. (I actually liked that better than staying in a hospital for longer; by day 3, I was ready to be out of the "critical care" environment but not ready to be on my own yet.)

[Brooke]

I believe many insurance companies will cover the hospital stay/expenses even if they will not pay for the actual procedure. Definitely something to look into as well.


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