Requirement of gender affirming surgery letters for a revision and labiaplasty

[mistyjensen]

Hi,

I am miffed. About a hour ago, I spoke with Dr. Bluebond Lagner's secretary to schedule a consultation with Dr. Bluebond-Lagner at NYU Langone Medical Center for a vaginoplasty revision and labiaplasty. The secretary surprised me by saying that I need three gender affirming surgery letters, even though I told her that I had my vaginoplasty surgery in October 24, 2016 and want to have a revision. I don't have readily access to my letters. Moreover, I no longer work with the psychiatrist and mental health therapist who wrote my letters. I don't want to have to see another psychiatrist and psychologist to get new letters just so I can have a revision. Obtaining new letters would be an extra hurtle for me and could pose a problem as a requirement for other transgender persons as well who want revisions. Say, hypothetically, if insurance companies covered the cost of labiaplasty for cis women, would they have to have surgery approval letters as well? I hate being treated like a second class person because of who I am and having to deal with more gatekeeping.

[FTMax]

Hi Caitlyn,

When I was working with Dr. Bluebond-Langner, I just needed 2 mental health referrals and a letter from the doctor that does my HRT.

You can contact the doctor that originally performed your vaginoplasty to obtain your patient record which should have those letters in it. If Dr. BL didn't do your vaginoplasty initially, she may like to have access to those files anyway.

[mistyjensen]

Hi Caitlyn,

When I was working with Dr. Bluebond-Langner, I just needed 2 mental health referrals and a letter from the doctor that does my HRT.

You can contact the doctor that originally performed your vaginoplasty to obtain your patient record which should have those letters in it. If Dr. BL didn't do your vaginoplasty initially, she may like to have access to those files anyway.

Hi,

Thank you for sharing your experience with Dr. Bluebond Lagner. Her secretary told me the same guideline. I don't believe that three letters should be a requirement for revisions and labiaplasty. I am questioning if Dr. Bluebond Lagner indeed requires letters for those procedures.

[FTMax]

Are you paying with insurance or out of pocket?

My understanding was that insurance is more likely to cover with all of those referrals, and that is why most surgeons request that many. I understand it's not your first stage of GCS, but it seems like it's your first stage with Dr. Bluebond-Langner, so it would make sense to me that her office would want to cover all the bases in terms of making sure it can be approved.

[mistyjensen]

I am paying with my health insurance.

I am not totally invested in Dr. Bluebond-Lagner performing my vaginoplasty revision, specifically clitoral reduction and labiaplasty. I want to have a consultation with her to learn more about these procedures and to discuss her experience with performing them. Clitoral reduction and labiaplasty aren't necessarily gender affirming surgical procedures for transgender women. Cis women get clitoral reduction and labiaplasty that health insurance companies sometimes cover.

Dr. Bluebond-Lagner's secretary sent me a list of requirements for gender affirming surgery pursuant to WPATH Standards of Care. As you may know, WPATH doesn't have letter standards for transgender patients wanting revisions. Moreover, none of the other surgeons that I have consulted with require transgender patients to have letters for revisions. Another point is that surgeons do not require letters of cis women wanting labiaplasty and vaginoplasty revisions

On a matter of principle, I believe that a three letter requirement for revisions of gender affirming surgeries  places an extra hurtle for transgender patients, such as myself, who already had gender affirming surgeries and want revisions. Bearing that in mind, I will not provide access to my letters - once I get them - unless I decide to have a doctor perform my surgery only after my consultation and my health insurance company requires them. I am seeking a cosmetic revision, not necessary gender affirming surgery. My gender affirming surgery letters are confidential. Moreover, I don't want to share them for a consultation about a procedure that isn't gender affirming. I am unwavering on this point, even if it costs me from having Dr. Bluebond-Lagner performing my surgery. As mentioned, I will share the letters if my insurance requires them for revisions. The requirement of submission of three gender affirming surgery letters for a cosmetic revision that cis women have is highly out of the ordinary and makes transgender women do more work.

If Dr. Bluebond-Lagner's office wants to have greater chance that my insurance company will cover the cost of my consultation, then I'm willing to ask my primary care provider for a referral to Dr. Bluebond- Lagner. Moreover, Dr. Bluebond-Lagner's office is welcome to submit a preauthorization to my insurance to cover the cost of the consultation.

[AnonyMs]

I'd hope that its a misunderstanding by the secretary, because its an absurd requirement. If she really wants it then I see it as a bit of a red flag.

I'd have thought the only issue would be in convincing the insurance company that the its not simply a cosmetic improvement, but actually necessary medical procedure, and letters have nothing to do with that.

[mistyjensen]

Hi,

Yesterday, a supervisor in Dr. Bluebond-Lagner's office contacted me and told me that I do not need three gender affirming surgery letters for a revision. The supervisor apologized for the miscommunication.

[ainsley]

I had my GRS in Montreal with Brassard in August 2015 and I contacted Dr. Marci Bowers about a revision/labiaplasty because my insurance added coverage for it this year.  They told me I did not need letters...and if they had told me I needed them I would tell them to jump in a lake, even if it were at the behest of my insurance.  I have had a vaginoplasty; no need for further letters, for fugg sakes...