WPATh-SOC timeline & Insurance

[Brooke]

We are all probably familiar with the one year of HRT and RLE being a requirement and prerequisite to GCS.

I am in a situation that I have not read about.

I changed my legal name in May of this year. At my last visit with my HRT doctor she asked if I had my gender marker changed, and if not we need to get that done before the next presidential term starts. She wrote two letters. One for Social Security and one for motor vehicle division, license.

Over the past 48 hours I have gotten my gender marker changed to F for both social security and my driver's license.

I am only about 6 months into both hormones and RLE (have had male fail most of my adult life). I believe the point of the one year of HRT and RLE is to make sure that the transition is right for you, and you're able to navigate society, friends and family.

In order to get my gender marker changed here in Arizona, you need a letter from a doctor saying that you are irrevocably commuted to the gender transition, and receiving appropriate care.  Similar for social security.

Has anyone been in this position, of not meeting the 1 year requirements and yet have your doctor on board and willing to help change your gender marker. If so, with that paper trail will insurance still require a full year of RLE and HRT in order to begin prior authorization for GCS?

I'm wondering if it's worth trying to get that auth going, or if it's a futile venture even with all the legal changes.

For the record I'm on SSDI and receive Medicare. Who at this point show my gender as Female, as it is directly connected to Social Security.

Any thoughts?
Brooke

PS mods, if this should be in a different sub forum please move it. Thanks!

[Michelle_P]

Hi, Brooke!

I'm at 5 1/2 months of HTR right now, and just got my letters for marker change from the endocrinologist last week.  She HAD been reluctant to write letters for me before i had a year of HRT, but that has changed very recently.  I am living full time as myself and am engaged in a variety of public activities, though.

I don't think this will affect the timeline for SRS at all, and I'd bet the insurers and more importantly, the doctors will just look at the evidence for time elapsed, following the WPATH SOC.  I think it has been pretty common for folks to do their name and marker change well before they are actually eligible for surgery.   At least one surgeon checks for the real life experience time by asking for a year old document with our new name.

My court date for both name and marker change is January 13.  I have all the paperwork ready to attach the court orders to and submit before the 20th comes along.  I'm keeping my fingers crossed...

[Brooke]

I can understand doctors checking for RLE.

I was thinking  considering that Medicare shows me as Female at this point. Since each case for GCS is reviewed independently, I might be able to start the prior authorization and by the time we actually have a surgery date, it will have been a full year.

I also know that wpath has changed in their wording from requirements to guidelines.

And Michellle, good luck on the name and gender marker changes. Still feels surreal seeing that F on my (temporary) ID


Sent from my iPhone using Tapatalk

[HappyMoni]

Brooke,
My understanding is that the driver's license depends on the state you are in. Each may be different. In Maryland, I needed a letter from my therapist and hormone doctor to change gender on license. Then I had to send it in to the medical advisory board for approval. Check the rules in your state. Soc sec. is federal so the state shouldn't matter. You need a letter from your medical person in charge of your trans care to change gender. You can google it. The clock for surgery (RLE) is based on what your two letters say. If the primary and secondary letters say you started RLE in May, then that is where the clock starts. The surgeons go by the letters which are written to WPATH standards.
Monica

[Brooke]

Hi Monica,
I may not have been clear. I already changed the gender marker for both license and Social Security.

Basically I'm wondering if now that my gender is legally changed, and Medicare recognizes that my legal gender is Female, is that enough to bypass the year of RLE to start a prior authorization for GCS that would be performed after the one year mark.


Sent from my iPhone using Tapatalk

[KathyLauren]

If your surgeon and insurance adhere to the WPATH SOC, then the one year will not be affected by gender change on your official documents.  One year will still be one year.  The documents make useful evidence that the one-year clock has started.

On the other hand, some doctors will do "informed consent", meaning that they will bypass the SOC on request.  Whether or not your surgeon will do this, and whether or not your insurance will cover it is something that you will need to inquire with them.

[Dena]

With the surgeon wait list, you should be able to start your discussions before the year mark. You won't be able to have surgery until after the year mark and possibly deposits may need to be paid out of pocket but if the insurance covers the procedure, any excessive deposits should be returned to you.

[FTMax]

As I understand it, RLE is as much an insurance requirement as a surgeon requirement. My insurance required that I have a letter from my primary doctor detailing the extent of my transition and all of the milestones in it (starting hormones, changing my name/gender marker, having chest surgery, having a hysterectomy) before they would pre-approve my SRS. My surgeon required that same letter as well as the two letters from mental health folks. Both required that I had been transitioning for a year before I could move forward with any kind of scheduling, and my surgeon required the letter from my doctor before I could schedule a consultation.

[Brooke]

Thanks for everyone's response. It sounds like it probably wouldn't happen- to start prior auth sooner than a year.

I have submitted claims for hair removal- still pending. I don't expect that reimbursement to happen, however if they do end up covering it, the claim will leave a great paper trail.

Thanks again everyone!
Brooke

[Maybebaby56]

I may not have been clear. I already changed the gender marker for both license and Social Security.

Basically I'm wondering if now that my gender is legally changed, and Medicare recognizes that my legal gender is Female, is that enough to bypass the year of RLE to start a prior authorization for GCS that would be performed after the one year mark.

Hi Brooke,

The fundamental problem with WPATH guidelines is that they do not take into account that I am not the only one transitioning.  My family, friends, and coworkers have to transition as well, and it can't always be done at the same time.  I can get new friends (and I have), but jobs are harder to replace, and family cannot be replaced at all.  I have had to negotiate my transition with all of them at different rates. I always think of myself as female.  It's other people's perceptions of me that's the problem, and I can't control that.

So, I approached this the other way around.  I changed by gender marker on my driver's license, social security, passport, etc. and used that as proof that my one year of RLE has started.  My reasoning was that if you are legally female, you are female all the time, regardless of how you dress. When it comes time to get my letters for SRS, I will point to the date that my driver's license was issued and say, "Here's proof when I started doing RLE." There's no one following me around to check if I am wearing a dress and lipstick all the time, and it's absurd to think your clothes or physical appearance define your gender in the first place.

Sorry for the rant,

Terri

[Brooke]

Hi Terri,

I approached the transition in a similar fashion to you. Got my name changed in May of this year, gender marker this week.

I had been out to family and friends for a decade at this point. I'm also on SSDI, in recovery from a misdiagnosed epilepsy and nerve damage.

In any case the workplace is a non issue. I actually have a timeline for returning to work that is independent from my transition timeline.  By the time I return to work I hope to be finished with any medical aspects of my transition.


Sent from my iPhone using Tapatalk

[JoanneB]

If you are expecting someone else to pay for GCS, Their Ball, Their Rules. The actual surgeon is the ultimate arbitrator. He only cares about covering his but, and making money.

As stated by others earlier, between the waiting list and hoops you need to jump through being a few months out from the 1 year RLE mark is not a bad time to "Start the conversation" But then again, if you are expecting your insurance carrier to pay for the consults and whatever else, it's their rules you need to follow