Quote from: Steph2.0 on June 08, 2018, 08:46:27 AM
It was from Dr. Gallagher's office in Indianapolis, informing me that they'd verified that GCS is covered by my insurance at their clinic, and requesting my letters. I had them ready to go, and sent them off yesterday afternoon.
The only hang up is apparently the insurance company requires 18 months of therapy before they cover it. Since my first visit to the gender clinic was May 19th last year, that puts me out to November 19th. If the clinic is willing to get all the ducks in a row so when the clock ticks over we're ready to go, it's still possible to meet my goal of getting it done this year. I'm waiting now for word that the documents are sufficient, and then it'll be time to set a consultation date.
Well, this is not going well, and is contributing to my depressed mood.
A couple of the letters I sent weren't sufficient, so over the last week and a half I got new ones. I've complained about this before, but the clinic I go to - which specializes in LGBT, and especially T issues - has the most bizarre and annoying policies regarding any letters they write. First of all, a letter - even just to change name of the person to whom it's addressed - costs $25. And they categorically will
not let you have a copy. They fax it directly to the doctor, and if you want a copy you have to get it from them. I have no idea why, but it feels like gatekeeping. So the two letters I had to get cost me another $50, and I don't even know what one of them says.
That's annoying, but it gets a lot worse. The 18 month therapy requirement is imposed by the insurance company (Blue Cross Blue Shield of Florida), and Dr. Gallagher's office will not even allow a consultation to schedule surgery until that requirement is met. Since my18 month date is November 19, they have told me that there is no way they would have time to schedule surgery this year. This has absolutely destroyed me. I'm completely convinced that by the end of the year, our government is going to remove the mandate that insurance companies cover GCS, and I won't have coverage next year. I hope I'm wrong, but the current record is not encouraging.
My only course of action is to see if the insurance company will change its mind. I wanted to see if I could arrange a Patient Care Coordinator, which I was told the company would set up - someone who acts as a personal liaison as you go through the process. To that end I started with an online support chat with BCBS. That was a waste of time.
From there I went to a BCBS office and outed myself to them to see if they could set up a PCC. They had no idea what I was talking about. We did have a frank conversation, but the upshot of it all was first, it was doubtful that they would be willing to change the policy, and two, they agreed with my assessment that if the mandate was removed, the company would drop GCS coverage like a hot rock. In the nurse's words, "Well, they're a for-profit organization." She then corrected herself with, "Well, they're actually a non-profit, but still..." They recommended calling the headquarters. So that visit was also useless.
So today, I got out the hammer to beat myself on the head with, and made the call. Over the next hour Roger transferred me to Juan who transferred me to Eva who transferred me to an unnamed "Care Consultant" who, after I explained for the fourth time what I wanted, was unceremoniously disconnected. So I got to start all over. It was finally made clear that Florida Blue does not have Patient Care Coordinators, and you have to take your chances and explain the situation every time you call and talk to someone new. The best I could get was the suggestion to have my doctor write a letter explaining why it was necessary to ask for a waiver on the time requirements, and send it to their grievance and appeals board.
My next step, then, is to get an appointment with my therapist and see what she's willing to do for me. I have been trying to get an appointment with her for three weeks on a day when I will be in town, and so far no luck. I may have to try a Skype appointment, though I much prefer in-person meetings. I have also asked if my liaison at Dr. Gallagher's office would be willing to go to bat for me. I'm not hopeful, but I have to ask.
What's really upsetting about it all is the WPATH Standard of Care, which the insurance company says it follows, has nothing more than a "recommendation" for ongoing therapy. The exact wording of their requirements:
1. Persistent, well documented gender dysphoria;
2. Capacity to make a fully informed decision and to consent for treatment;
3. Age of majority in a given country;
4. If significant medical or mental health concerns are present, they must be well controlled;
5. 12 continuous months of hormone therapy as appropriate to the patient's gender goals (un- less the patient has a medical contraindication or is otherwise unable or unwilling to take hormones).
6. 12 continuous months of living in a gender role that is congruent with their gender identity;
Although not an explicit criterion, it is recommended that these patients also have regular visits with a mental health or other medical professional.So the insurance company is imposing requirements far beyond what the true experts recommend. That, along with what the nurse reminded me of - that BCBS of Florida advertises themselves as being very LGBT friendly - may be the only things working in my favor.
So the stresses are building, but I'm doing the best I can to move forward. I'm limited in what I can do, but I have to try.
Stephanie
