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My Kaiser Experience

Started by katie Brennan, January 08, 2017, 07:35:49 AM

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katie Brennan

After finding out in August of 2014 that Kaiser covered SRS now names GCS, I contacted the Coordinator at the time Anna Pitinyan who called me back a few days later.  We went over my transition history and status, including HRT and RTL.  At the time I had been on HRT for about three months (pills) and had been known at work as a female.

However, I made a mistake of admitting, that I had not yet legally changed my name, and was still afraid of taking public transportation dressed.  This sent a red flag to Kaiser, and though I had mostly been living as a woman nearly 100% of the time, my comments had been recorded and had resulted in a requirement that I be put on a one-year RLE (Real Life Experience) list, and would not be considered a candidate for GCS until the end of that year.

However, Kaiser did refer me for a Mental Health assessment to begin HRT with them, which I successfully passed.  After that assessment, I started with my twice per month injection and 50 mg. Spiro. twice per day, which was reduced to once per day due to increased Creat. levels.  I also began seeing my therapist monthly.

My therapist agreed with me that the fear of dressing on the bus was a safety concern and not evidence that I was not ready for surgery.  But she could not change Kaiser's mandate that I undergo a 12 month RLE.

About six months into my new RLE, I went through the process of legally changing my name, which took about 7 months to get everything changed (Court order, Birth Certif. and all ID documents).

At the end of the first year, I was surprised to learn that, I would be put on a waiting list to get a consultation with Dr. Meltzer, which took another 8 months.  During this time, I underwent Six months of Genital Electrolysis with Layla's in West LA.  She had such a busy schedule, that I could only see here once per month as best.  However Kaiser would only authorize Electrolysis during a Six-Month period and 3 months prior to surgery.

After my consultation with Dr. Meltzer in May of last year I was approved to be a candidate for GCS and was given a surgery date for March 2018 with Dr. Meltzer.  However it would be a lot sooner if I would be willing to have my surgery done by Dr. Ellie Ley, who was not yet approved by Kaiser.

A few months later, Dr. Ley was certified by Kaiser and my new GCS date was moved to 02/14/17.  At that time my therapist asked me if I would like to see a speech therapist, and be referred to a trake. shave surgery.  I did not have a visible adams apple, so I didn't do the trake, but did begin speech.

In September, I contacted Anna Pitinyan to request authorization for the remainder of my genital electrolysis and was told that I could not be authorized until 3 months prior to my scheduled surg. and to wait for an authorization, which never came.

There was so much back and forth and confusion about my authorization for facial elec. and genital elec., which to this day (37 days to my surg. date) has not been resolved.  However I have been seeing my new selected electrolysis Beverly Hills Hair Free and paying for it from my own pocket.  Very Expensive.

Also, it appears that Anna Pitinyan had left Kaiser on 12/23/16 and was replaced by a new coordinator Annie L. Peatross, which I have left dozens of phone messages during the past two weeks without response.

Beyond getting authorized for the remainder of my genital electrolysis, I had learned that despite having a surgery date, my GCS has not been approved and must be reviewed by a committee, which I have just learned requires seeing my PCP, Endo, and Mental Health doctors within 3 months prior to surg.  I knew that I did need to see my therapist within 30 of my surg. but was not told that I needed to see the other 2.  What made it worse, was that the review does not start until all visits are done and takes 30 days to complete.  So in fact, I need to see all of these doctors, this coming week, which would leave 30 days before my surg, on the day. 

Though I did make appointments with all  my doctors, who kept telling me they weren't necessary, my surgery still may be canceled and rescheduled for up to another year, because Kaiser's Transgender Care department did not, despite many emails, several months prior to my surg. date asking if there was anything I needed to do, communicate with me.  This is very depressing and sad for me.

The main reason for this post is not to complain but inform all that, in the end, it is the patients responsibility to get the care and information they need to have their surgery.  Even if that means not trusting what you are told or promised and doing your own work, by writing daily if necessary and making appointments with your all of you doctors even when they tell you that they are not necessary.
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Michelle_P

Yeah, they don't communicate well. I'm starting to doubt that I'll actually get any transition care from Kaiser. All promises and no action.

Fortunately my older daughter is a women's rights litigator (including trans rights, of course), so I have that to fall back on.

I've been busting my butt to make sure Kaiser knows my status and has my requests. They haven't actually covered anything beyond HRT so far, and on a high deductible individual plan that doesn't mean much. I pay out of pocket the first 6500 dollars each year in exchange for a very low insurance cost. A better plan would actually cost me MORE in terms of total insurance costs plus out of pocket charges. Remember this is an individual plan, no corporation kicking in benefits or retirement funds.

I am setting up backup plans to take a couple of overseas vacations for when Kaiser doesn't come through.


Sent from my iPhone using Tapatalk
Earth my body, water my blood, air my breath and fire my spirit.

My personal transition path included medical changes.  The path others take may require no medical intervention, or different care.  We each find our own path. I provide these dates for the curious.
Electrolysis - Hours in The Chair: 238 (8.5 were preparing for GCS, five clearings); On estradiol patch June 2016; Full-time Oct 22, 2016; GCS Oct 20, 2017; FFS Aug 28, 2018; Stage 2 labiaplasty revision and BA Feb 26, 2019
Michelle's personal blog and biography
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katie Brennan

I have been on this journey with Kaiser for about 2 1/2 years, and they, besides a few problems in the beginning have been there with me.  They had authorized my HRT, first six months of genital electr., speech therepy, and consultation with Dr. Meltzer.  Now that I am just a little more than a month away from finally having my surgery, they are no where to be found.

Is this normal for others going through the process with Kaiser?

Katie
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jentay1367

My goodness, if you received that same care for heart disease, you'd probably be dead. I hate extorsion er.....I mean, Insurance. ;)
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Michelle_P

I think the next step with Kaiser is to file a grievance.  The Member Services office in the nearest Kaiser complex/hospital would be a good place to start. 

In California there are processes in place to help with denied or unresponsive care from HMOs.  You'd escalate through these:

http://www.opa.ca.gov/Pages/ProblemsAndComplaints_HowToFileAComplaint.aspx

The grievance should be enough to kick their butts into gear.  (Fingers crossed...)


Sent from my iPad using Tapatalk
Earth my body, water my blood, air my breath and fire my spirit.

My personal transition path included medical changes.  The path others take may require no medical intervention, or different care.  We each find our own path. I provide these dates for the curious.
Electrolysis - Hours in The Chair: 238 (8.5 were preparing for GCS, five clearings); On estradiol patch June 2016; Full-time Oct 22, 2016; GCS Oct 20, 2017; FFS Aug 28, 2018; Stage 2 labiaplasty revision and BA Feb 26, 2019
Michelle's personal blog and biography
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katie Brennan

I just received a call from my Transgender Care Nurse Coordinator last night to tell me that my surgery for 02/14/17 was approved by the committee at Kaiser.  Wow, more of a relief then anything.

I was so wonderfully shocked that, as soon as I found out that it was approved, I didn't seem to remember much of what was said after the news, I even had written down some questions that I forgot to ask.  So I will have to give her another call.  Also have many, many other people to call. :D

Katie
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AnxietyDisord3r

Sorry about all the red tape you are going through. That sounds exhausting. >:(
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katie Brennan

Thank you, it's been quite the experience.

When I complete this process, I think I should post all the A-Z things that need to be done, so other's with Kaiser Southern California will not have to go through the same last minute craziness.

Katie
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