Questions about SRS and insurance

[Amelia Phoenix]

It's one day short of a year since I last posted here, and wow, a whole lot has changed in my life in that time. At that time, I had just received my letter for HRT, and now a year later I'm approaching my first HRT anniversary and looking at how to best tackle the next steps in transition.

So, I received some super good news last week, I have been offered employment with a great company that offers health insurance that covers SRS. I start at the beginning of the month and my insurance will go into effect 60 days after that. By that time (April/May), I will have passed my one year mark for HRT/RLE, and I'm wondering if I would then be able to pursue surgery.

I guess my concerns range mostly around whether it is appropriate to use your insurance for SRS immediately after being given the insurance, and whether or not that would be looked down upon by the company. I also figure no matter where I go, I will be on a waiting list of probably at least 9 months, maybe even up to 18 months, so by then we would be far into a Trump presidency and the ACA would likely be completely repealed by that point.

This is a super progressive, pro-LGBTQ company (received a 100% on HRC's LGBTQ equality index), so I know they would like to continue to provide things like this for their trans employees, but is it likely that even LGBTQ-friendly companies may have to gut their pro-trans insurance benefits in order to make their healthcare plans economical after the ACA is gone?

Also, Is it even possible that a non-American based surgeon, such as Dr. Brassard, is covered under insurance, or would I need to see a surgeon in the United States?

Also, if I was approved for surgery, would I have to use vacation/sick days for my recovery, or would that fall under temporary disability or something such as that. How long does recovery generally take before I could go back to work?


Questions; in summary:

1. Is it improper/would a company be upset if I immediately scheduled SRS the moment I received their company-healthcare benefits?
2. What is like likelihood of LGBTQ-friendly companies continuing to offer SRS-inclusive health insurance in a post-ACA insurance marketplace?
3. Assuming no complications, what is the average amount of recovery time for SRS before you can return to work?
4. Could a non-American based surgeon, such as Dr. Brassard, be covered under insurance, or would I need to see a surgeon in the United States?
5. Would vacation/sick days need to be used for surgery/recovery time, or would that qualify under something like temporary disability?

Thanks in advance for the help. Even though surgery is probably still at least 2 years down the road, it's important for me to start planning now, so I appreciate any and all advice.

[Dena]

Sick leave or vacation time would depend on company policy but it would be best to have vacation time available should you need it. The doctors the insurance policy covers will depend on the policy and you would need to discuss that with the insurance company. As your surgery is two years off, you aren't going to be using the insurance policy for a couple of years yet so that's not exactly rushing it. Besides that, I assume your company is aware of your status and that you will be wanting surgery some time in the future.

[FTMax]

1. Probably not. You may want to look into when benefits are doled out though. For a lot of companies I've noticed, health insurance kicks in somewhere within the first 90 days, but there may be stipulations on when you begin to accrue vacation/sick leave or when you can take it. So I'd be sure to ask HR about all that.

2. Fairly likely. Most of the companies on the HRC's list opted to cover before the ACA and I don't see them opting out after the fact. Likewise, many states that have made it illegal to exclude transgender healthcare coverage aren't likely to roll back those protections.

3. Not sure for the ladies. For me, I'm taking 6 weeks off work total.

4. Most likely no. You would need a US based surgeon. Your specific insurance policy would be what you'd need to look at to see if surgery abroad would be covered. Most policies that I've seen will pay for emergencies that happen overseas, but that's it. Not a scheduled surgery.

5. Would depend on your short term disability policy. Some would allow benefits for time off after a pre-planned surgery, but others would not since it was a planned for event. Your company may also require that you utilize any available sick/vacation time before they will allow short term disability to be taken.

[Amelia Phoenix]

Sick leave or vacation time would depend on company policy but it would be best to have vacation time available should you need it. The doctors the insurance policy covers will depend on the policy and you would need to discuss that with the insurance company. As your surgery is two years off, you aren't going to be using the insurance policy for a couple of years yet so that's not exactly rushing it. Besides that, I assume your company is aware of your status and that you will be wanting surgery some time in the future.

My manager is aware of my status, not sure about HR, but it's something I'm going to have to speak with them about anyways so I'm sure they'll know within the next few months anyways.

1. Probably not. You may want to look into when benefits are doled out though. For a lot of companies I've noticed, health insurance kicks in somewhere within the first 90 days, but there may be stipulations on when you begin to accrue vacation/sick leave or when you can take it. So I'd be sure to ask HR about all that.

2. Fairly likely. Most of the companies on the HRC's list opted to cover before the ACA and I don't see them opting out after the fact. Likewise, many states that have made it illegal to exclude transgender healthcare coverage aren't likely to roll back those protections.

3. Not sure for the ladies. For me, I'm taking 6 weeks off work total.

4. Most likely no. You would need a US based surgeon. Your specific insurance policy would be what you'd need to look at to see if surgery abroad would be covered. Most policies that I've seen will pay for emergencies that happen overseas, but that's it. Not a scheduled surgery.

5. Would depend on your short term disability policy. Some would allow benefits for time off after a pre-planned surgery, but others would not since it was a planned for event. Your company may also require that you utilize any available sick/vacation time before they will allow short term disability to be taken.

1. Mine kicks in on the next 1st of the month after a 60 day period. So, considering my unfortunate start time of February (being only 28 days), I will be waiting almost 90 days even though the policy is 60ish days.

2. That's good to know. Like I said, this is a super LGBTQ-friendly company, so I would be surprised if they did get rid of those benefits. So, fingers crossed, but I think I'll still be covered in a post-ACA America, which is super fortunate.

3. Did a little bit of research and was hearing the figures 3 - 6 weeks depending on how active your job is. So... Probably 4 - 5 weeks for me.

4. Gotcha. I was just wondering because my friend went to Brassard and she had great results, so he was definitely first on my list. I'll have to ask her more about whether or not she paid out of pocket, I know she worked for Starbucks, which has SRS-inclusive insurance, but I'm not sure exactly how she went about that.

5. Okay. My company has awesome vacation/sick day time. Assuming I get surgery within the first 2 years of my employment, I would have 4 weeks paid time off a year, and ~5 days of sick days. If the company would be willing to qualify it as a temporary disability, however, I would have 4 weeks of 100% paid disability time, plus 16 weeks of 50% paid, and I imagine I would only need 4 - 6 weeks at the very latest.


Will definitely have to do some more research, but I'm cautiously optimistic that everything is going to work out. Pretty excited!

[FTMax]

It sounds like it should!

Re: Brassard, I know my insurance company is willing to have people make a case as to why benefits should be applied to surgeons outside the network. I have never heard of anyone trying this with a surgeon outside the US, but I have seen people get coverage for their preferred surgeons inside the country even though those surgeons weren't originally covered by their policy. Generally there has to be some kind of difference between who your insurance is willing to pay for here versus who you want to go to. So if their methods are unique, if their complication rate is reduced, if their experience level is vastly different, etc.

I am attempting to get my overseas surgery covered on the basis that paying for it would be cheaper for my insurance company overall, and that there is no one in the US currently performing the exactly combination of things I'm getting in a single stage. I'm not super optimistic about it, but it would be nice