Hi. New to the site, just joined, and this is my first post. I was okay with just lurking and reading but figured I had to join because of this thread, as I have some info to add.
I am insured under Kaiser in Northern California. And indeed SRS is covered, as it should be by now with most insurers in California as noted above by Colleen.
I transitioned 19 years ago and am just now getting around to the surgery. Imagine my surprise at learning that the procedure is now covered. Kaiser, of course, doesn't normally cover "out of network" services. You just get all services from Kaiser, period. But Kaiser does not have their own SRS surgeon. When services are not available "in-house", they contract with an outside provider, and provide coverage just as if the provider were in-house. The level of coverage (deductibles and co-pays and so on) should depend only on which Kaiser plan you have.
In this case the provider they contract with is Dr. Meltzer. At least, that's the case for MTF surgery, at least in the San Francisco area. I'm not sure how wide a geographical area that applies to, or who they use for FTM surgeries. I have already been to Scottsdale for a consult. Not only was I charged only a $10 copay (normal for the plan I'm on), but Kaiser covered the airfare and one night in a hotel near the clinic.
I have had a number of office visits locally at Kaiser. There was a general intake visit, a psych screening, a visit with a local Kaiser surgeon to authorize surgery, and so on. And each time, just the $10 copay, so by the time this is all said and done, I could have this whole thing for under $100, $200 max. (I don't remember whether my copay is higher for the actual inpatient stay, but I kind of think it isn't.) It's really rather astonishing.
The weird thing, though, is the idea that Kaiser now picks my surgeon for me. After all these years, it's pretty ingrained that I need to do my due diligence and research and choose the surgeon that's right for me. And now, poof! The decision has been made. At least, if I want insurance coverage, it has. As it happens, I've recently reached a point in my career where I actually have enough money that I could forego the insurance if I choose to, in order to use a different surgeon. And I'm thinking about it. I had been previously considering Dr. Bowers and so I have a consult with her this coming week. Just the consult alone will cost more than the entire treatment with Meltzer! If I choose her for the surgery... wow, that's a huge price difference, $23,000 minimum vs. $10.
I waited all these years (for reasons not solely related to money), I finally decided to move forward with SRS (the timing is partially because I could afford it, finally), then I had the pleasant surprise of finding out it's now covered; it would sure be ironic to just forego that and shell out for surgery with somebody else. But I feel I still need to go through this selection process, even though there's a huge financial incentive to stick with Meltzer. I need to know that I made that choice myself, rather than just leaving such a big decision to somebody else. The price differential will surely play a role in my decision. But I need to at least consider the possibility that this once-in-a-lifetime decision matters, and that it might be worth the cost to choose somebody else. It's a tough decision, given the inherent crap-shoot of it all. I'd be interested in any thoughts anybody has on that conundrum. (Though maybe that deserves its own thread.)
