Quote from: mac1 on March 29, 2017, 09:21:02 PM
You are correct with respect to medicare. Most doctors consider transsexual surgeries to be elective surgeries and will be reluctant to perform them on people who are over 65. Thus there would be very few claims for coverage under medicare even if the surgeries were covered.
We are also in a weird grey area with Medicare. The blanket ban has been for GCS coverage has been lifted, as of 2014. This triggered a review by CMS for a national coverage determination. It appears the left hand wasn't talking to the right in this case. The review memo did not even mention the 2014 decision, (and the fact that all data pointed toward or whose conclusion deemed GCS "experimental" before 1981 was discarded). However the current CMS review and recommendation uses both all data sets and because the outdated studies were used they deemed it a wash as to the efficacy and benefits to the Medicare population. The current official status is that Medicare Does cover GCS, however it is approved and reimbursed on a case by case basis. CMS has also suggested that a study be completed on the Medicare Community to determine what procedures are effective and should be covered on a national level.
I'm an odd case in this regard as I am in the minority of Medicare beneficiaries that receive Medicare after becoming disabled mid life/career. I also have several extremely rare conditions that has consequently resulted in an intimate knowledge of our current healthcare system.
In any case CMS is asking for data where it is impossible to get a sample size large enough for accurate analysis. The sample size simply isn't large enough.
All of this makes this concerning on a coverage level. How are studies supposed to be completed if they don't even know the population size. It in a sense puts this coverage into a stalemate.
