Dr. Christine McGinn vs Dr. Suporn SRS?

[Brooke]

Has this been superseded with new policy?

https://gendertrender.wordpress.com/2016/08/31/medicare-denies-national-coverage-for-gender-reassignment-surgery-no-evidence-of-therapeutic-outcome/


update...apparently they do on a case by case basis. My question would be what criteria they're using this week and what kind of percentages are being covered? It would be tragic to count on this and have it dismissed and denied out of hand after having counted on it. Seems like all government programs, it does more harm than good.

From Medicare:
"Based on a thorough review of the clinical evidence available at this time, there is not enough evidence to determine whether gender reassignment surgery improves health outcomes for Medicare beneficiaries with gender dysphoria. There were conflicting (inconsistent) study results – of the best designed studies, some reported benefits while others reported harms."

Medicare uses "Best Evidence-" or should be.

Looks like the right hand is not talking to the left.

The 2014 decision that removed blanket ban won as evidence prior to 1981 that determined srs was experimental was ruled as not relevant and thrown out.

A national coverage decision (ncd) was triggered by this decision.

The decision summery recommendation that is quoted does indeed state that their was not enough evidence for the Medicare population.

But... they never took the 2014 decision into account, and that the "experimental evidence prior to 1981" was dismissed. In their meta(like)-analysis they used all studies that matched their search criteria from pubmed, including all of the evidence that was dismissed in 1981. Their results then of course were determined to be inconclusive.

Because there is no NCD, there is also no set reimbursement amount a surgeon can look up. This is a biggie, and then because of the seeming misinformation with the local MACs coverage is denied.

Currently best evidence is of course wpath. In their revised statements of medical necessity they argue that care (and procedures) must be customized to the patient.

I am working through a Medicare Appeal for hair removal that I imagine is going to end up in front of an Administrative Law Judge. I am also building up a case for the NCD recommendation based on "best evidence, and wpaths SOC/necessity statements".

If we can get a NCD, we then have a far better chance of finding surgeons willing to work with us.

Because Medicare does not have a prior auth system it's currently a huge gamble if it will be covered.


~Brooke~

[jentay1367]

I hope these people snap out of it and take care of those of us that need this life saving procedure. I'll cross my fingers for some civilized decisions to be made. Thanks for that great info, Brooke!

[Gail20]

I am working through a Medicare Appeal for hair removal that I imagine is going to end up in front of an Administrative Law Judge. I am also building up a case for the NCD recommendation based on "best evidence, and wpaths SOC/necessity statements".

If we can get a NCD, we then have a far better chance of finding surgeons willing to work with us.

Because Medicare does not have a prior auth system it's currently a huge gamble if it will be covered.

~Brooke~ 

Thank you so much for your summary and activism!!

[Ellemrob]

Hi Gail, I too am planning on using Medicare.

Is Dr. Mcginn currently accepting Medicare patients? If you are planning on going elsewhere may I ask where? Also is there any particular contact person I should try and reach?
I could really use the feedback and information. If you'd rather not post it on this thread, I would highly appreciate a PM.

Thanks!


~Brooke~

I had surgery with Dr. Mcginn on 4/1/17.

She'll "accept" any patient because Dr. McGinn requires payment up front in the form of a money order/certified check, and then her office will work with your insurance to get approval. Her office was SOO helpful getting approval, but they do make it clear at the end of the day, it is the patient's financial responsibility.

I paid up front for her surgery fee and the anesthesia fee, and then I had to submit a reimbursement form to my insurance company after the procedure was completed. The hospital fee was billed directly to my insurance (Tufts PPO in Massachusetts).

[Gail20]

I had surgery with Dr. Mcginn on 4/1/17.

She'll "accept" any patient because Dr. McGinn requires payment up front in the form of a money order/certified check, and then her office will work with your insurance to get approval. Her office was SOO helpful getting approval, but they do make it clear at the end of the day, it is the patient's financial responsibility.

I paid up front for her surgery fee and the anesthesia fee, and then I had to submit a reimbursement form to my insurance company after the procedure was completed. The hospital fee was billed directly to my insurance (Tufts PPO in Massachusetts).

I don't have the money for GRS.  If Medicare doesn't pay I'm out of luck so McGinn is not an option for me at all. . . My first choice was Dr Satterwhite. I had all my documentation in with them and made an impassioned plea but they said no to Medicare. That's when I realized the impact of taking just one Medicare patient was to a practice.  It just does not make good business sense for them. . . I'm now just looking at University or Hospital based programs. . . .

[Brooke]

I had surgery with Dr. Mcginn on 4/1/17.

She'll "accept" any patient because Dr. McGinn requires payment up front in the form of a money order/certified check, and then her office will work with your insurance to get approval. Her office was SOO helpful getting approval, but they do make it clear at the end of the day, it is the patient's financial responsibility.

I paid up front for her surgery fee and the anesthesia fee, and then I had to submit a reimbursement form to my insurance company after the procedure was completed. The hospital fee was billed directly to my insurance (Tufts PPO in Massachusetts).

Good to know. I'm actually a patient at Tuff's already- for corneal issues. In any case I go to Boston once a year for that. A trip is coming up this summer, may just have to book a consult while I'm there.


~Brooke~