Grrr, why is this so complicated?

[amberwaves]

So in a change from my initial plans when deciding to transition, a few months ago I realized that I desire to fully transition, including GCS.  I wasn't in too big of a rush, but lately I've become impatient.  This is partly due to a change in financial circumstances and the realization of just how much trans related care my health insurance covers.

So I began to look into surgeons and all the hoops that I will need to run through to make this happen.  I am unable to privately afford this so insurance is a must.  I downloaded a copy of my policies transgender care requirements.  Ostensibly they are derived from WPATH v7.  However, there are a few vaguely worded sections that I have been trying to receive answers for.

First, electrolysis of the vaginoplasty donor site is covered.  However, it does not state if I have to have locked down both of the therapist letters first.  Fine, I call and the lady (who was very clueless) basically just read the policy back to me verbatim.

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[Jailyn]

Well knowing how sales go in general. You got a minion of the company phone lines that is not one the underwriter or the manager. I would ask for one of those 2 people to explain it or clarify their policy better. Also you could ask a lawyer  to read over it see if he sees anything about it in there. I am not a policy expert so that is where I would try myself. Or find a doctor to see if they know whether your insurance will cover it or what you will have to do. Doctors are generally well versed in how insurances work and what hoops they have to go through as well. Good luck!!!

[amberwaves]

Well knowing how sales go in general. You got a minion of the company phone lines that is not one the underwriter or the manager. I would ask for one of those 2 people to explain it or clarify their policy better. Also you could ask a lawyer  to read over it see if he sees anything about it in there. I am not a policy expert so that is where I would try myself. Or find a doctor to see if they know whether your insurance will cover it or what you will have to do. Doctors are generally well versed in how insurances work and what hoops they have to go through as well. Good luck!!!

Yeah, I understand that I'm speaking with the lowest level of support.  It's just frustrating because I am suddenly very impatient to start the process.  I was very "meh" about my transition for a long while as hormones did their thing.  Now, it seems like it's "do everything now".  I understand that everything is still quite a ways off, but I would prefer to be actually doing something other than phone tag sorting details.

A lawyer would be overkill in this scenario.  I understand technical and policy writing pretty well.  Honestly, that familiarity is how I was able to discern this was a particular concern that I should verify first.  A doctor would likely be as uncertain as I am, since this policy change is only a year old, they likely haven't dealt with this particular nuance yet.  I am just trying to verify their interpretation of the unclear language rather than getting saddled fighting a bill later.  It's a patience thing, and getting to speak to the correct  person(s) at this point.  Patience has never been my strong suit.

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[amberwaves]

Okay so this is getting ridiculous.  Last week the lady took my question and told me she would get back to me with an answer.  All week passes with no response.  I called back today and basically started over.  No one can give me a freaking answer apparently.  I understand that the policy is relatively new.  I understand almost no one understands crap about LGBT. Holy crap am I getting sick of explaining everything.  I would think you would have at least heard the term LGBT and I wouldn't have to explain it.

The question isn't even that complicated.  The policy states that two referrals from mental health providers are required.  What it doesn't state is whether one from a masters level therapist and one from a doctoral level is fine.  It shouldn't be a hard question to answer.  Also, whether or not I started this process with my GP is irrelevant.  I have an endocrinologist who treats me and is qualified.  This is not relevant to the question at hand.  I am getting so sick of banging my head against a wall talking to people who don't even understand basic medical terminology.  So frustrating.

Why is it that, every time I try to go through proper channels to make sure everything is in order, it seems I get stymied.  This isn't limited to trans care.  Even to deal with my frickin ADHD that I've dealt with my whole life I ran into the same crap for 6 months.  This is why I chose to pay out of pocket to see my endo.  A specialist who focuses on LGBT issues.  God I can just imagine how messed up everything would be had I tried to remain in network.  If I was independently wealthy I would just pay for this too, but I am not.  I hate bureaucracy and the morons who fill their ranks so damn much.  Very frustrating and demoralizing.



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[Roll]

You think that's bad, I've been trying to get ahold of Medicaid to ask about what they do and do not cover regarding gender issues and it's just an endless cycle between two automated numbers, I can't even get to the point they don't call me back. Literally I call the number on my card, it has no menu options that go to a person, then says "for all other issues call 1-888-whatever" super quickly and hangs up. So I had to go back through it, being quick to grab the number. I call that number, it goes through a few other menu options that don't lead to a person and then does the same thing for the first number! I then called social security and they said they can't answer any questions about medicaid, and the only numbers they had were the ones I already tried. At this point if I could just get through to an overseas call center I'd be happy.

[amberwaves]

You think that's bad, I've been trying to get ahold of Medicaid to ask about what they do and do not cover regarding gender issues and it's just an endless cycle between two automated numbers, I can't even get to the point they don't call me back. Literally I call the number on my card, it has no menu options that go to a person, then says "for all other issues call 1-888-whatever" super quickly and hangs up. So I had to go back through it, being quick to grab the number. I call that number, it goes through a few other menu options that don't lead to a person and then does the same thing for the first number! I then called social security and they said they can't answer any questions about medicaid, and the only numbers they had were the ones I already tried. At this point if I could just get through to an overseas call center I'd be happy.

Yeah that is terrible.  My situation isn't the end of the world, obviously.  I just needed to vent.  There does need to be serious reform in how health care is managed in this country.  By and large it is just flat out inaccessible.  I hope you find a way to get ahold of someone soon.  Do you have anything like a county assistance office or something you can go to?

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[Roll]

Yeah that is terrible.  My situation isn't the end of the world, obviously.  I just needed to vent.

Oh, mine isn't the end of the world either, I just thought the medicaid looping thing was pretty funny honestly and thought I'd share. (And vent some too myself!)

The only county place is SS, which don't seem to have any insight. Which is really, really weird. You'd think that social security and medicaid would be more in tune with one another. Isn't bureaucracy grand?

[HappyMoni]

Amber,
   The insurance thing is ridiculous. I think they make it purposely hard to get people to give up and save them money. As for your change in urgency, I totally relate. Once we see the real possibility is out there our brains kick in to overdrive and demand it get done. The only time I could remotely relax pre-surgery was to get stuff arranged to make it happen.
I was such a mess before surgery. It is so cool after. I don't know how others feel but for me, it removed that giant dysphoric itch I have always had. You will get there Girl. I had tried to get pre approval for surgery myself. It was too soon and the doctor had to initiate the process, but they ended up assigning a nurse to help with my questions. She was a good  source of info for me. Don't know if that is a possible for you. I used Aetna.
Moni

[amberwaves]

Thanks for chiming in Moni!   Yes indeed the system certainly seems designed to be inaccessible.  I severely doubt it is due to malicious intent, more likely it is decades of bureaucratic and regulatory bloat.

I am, or at least seem to be, in a hurry.  However, it's not about the destination per see.  That is a long ways off and I will wait until it's closer to get impatient about it.  I am mostly impatient about getting started and getting everything in order.  Historically, I have been a "fly by the seat of my pants" type of person.  I am trying to be a reasonable adult about things and plan things out.  For the most part, my transition has been a carefully measured endeavour.  This stands in stark contrast to my life in general. 

Also, my luck is terrible and I'm trying as best I can to hedge my bets so as not to get smacked around by reality.  The longer and more drawn out the situation becomes the more I can just feel the window of opportunity creeping closed.  For a while, GCS was far off in the nebulous future.  Then it just so happened that I saw the stars and planets align into a potential. Suddenly, the future was not some nebulous thing, but a distinct path that could be planned for with contingencies galore.  All it would take is some self righteous jerks in power to sunder that path.  Another chance would be unlikely until a long time in the future.

I did finally get my response.  Yes, a masters level therapist is fine.  They just couldn't seem to understand why I was so concerned to get verification.  If I just assumed and moved forward to be wrong it would legitimately screw over me, my wife, and our three young children.  I have already screwed things up enough over the years that our margin for error is tiny.  As it is I'm going to have to go about certain things in an untypical manner timing wise.

I would like to thank everyone has listened to me rant and vent.  I'm most assuredly not done doing it.  I am only done with it regarding this matter.

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[Roll]

They just couldn't seem to understand why I was so concerned to get verification.  If I just assumed and moved forward to be wrong it would legitimately screw over me, my wife, and our three young children.

Oh god, I hate it when people act like you're crazy for seeking clarification before moving ahead on something. I run into all the time, particularly when dealing with academics. Like planning ahead and getting things right is a bad thing.

[HappyMoni]

Thanks for chiming in Moni!   Yes indeed the system certainly seems designed to be inaccessible.  I severely doubt it is due to malicious intent, more likely it is decades of bureaucratic and regulatory bloat.

I am, or at least seem to be, in a hurry.  However, it's not about the destination per see.  That is a long ways off and I will wait until it's closer to get impatient about it.  I am mostly impatient about getting started and getting everything in order.  Historically, I have been a "fly by the seat of my pants" type of person.  I am trying to be a reasonable adult about things and plan things out.  For the most part, my transition has been a carefully measured endeavour.  This stands in stark contrast to my life in general. 

Also, my luck is terrible and I'm trying as best I can to hedge my bets so as not to get smacked around by reality.  The longer and more drawn out the situation becomes the more I can just feel the window of opportunity creeping closed.  For a while, GCS was far off in the nebulous future.  Then it just so happened that I saw the stars and planets align into a potential. Suddenly, the future was not some nebulous thing, but a distinct path that could be planned for with contingencies galore.  All it would take is some self righteous jerks in power to sunder that path.  Another chance would be unlikely until a long time in the future.

I did finally get my response.  Yes, a masters level therapist is fine.  They just couldn't seem to understand why I was so concerned to get verification.  If I just assumed and moved forward to be wrong it would legitimately screw over me, my wife, and our three young children.  I have already screwed things up enough over the years that our margin for error is tiny.  As it is I'm going to have to go about certain things in an untypical manner timing wise.

I would like to thank everyone has listened to me rant and vent.  I'm most assuredly not done doing it.  I am only done with it regarding this matter.

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Amber,
   You know you can rant to me any time, Hon. Now venting, well we will have to see. lol You have your style of transition and that is fine. Everyone has to find their path. I think it is smart to hurry for things that hostile politicians can effect. The sand could be shifting under our feet. If I read you correctly, the further you get, the better you are feeling. I have recently gotten restless to finish my transition. I am definitely more comfortable in my own skin since GCS. It is a big leap for me. Only three months and I have to strain to remember what the old anatomy was like. Hope you are smiling these days.
Moni

[amberwaves]

Amber,
   You know you can rant to me any time, Hon. Now venting, well we will have to see. lol You have your style of transition and that is fine. Everyone has to find their path. I think it is smart to hurry for things that hostile politicians can effect. The sand could be shifting under our feet. If I read you correctly, the further you get, the better you are feeling. I have recently gotten restless to finish my transition. I am definitely more comfortable in my own skin since GCS. It is a big leap for me. Only three months and I have to strain to remember what the old anatomy was like. Hope you are smiling these days.
Moni

It's amazing how quickly you can adapt to things sometimes.  That's awesome Moni.  I am happier the farther along I get.  I was hopeful that would be the case, but honestly I had very little idea of what happiness was to begin with that it far exceeded my expectations.

Switching jobs to where no one knows the former me was incredibly useful.  However, it did a lot to make me accelerate the pace of my transition.  I'm finally internalizing that others see me as a woman.  I had assumed my voice, mannerisms, etc were give away, but it truly does not seem to be the case.

I never had strong genital dysphoria, but living as a woman and being accepted as such just makes it seem wrong now.  I have noticed that things seem to happen in spurts.  A big flurry of activity at the beginning, coming out, hormones, etc.  Then almost a year of not much.  Now it's another burst with the name change, electrolysis, and planning surgery.  It's a wild ride.  This all is happening as I fix other problems undealt with such as finally getting treated for ADHD.  So much positive growth.  Its hard to sit back and let it all sink in sometimes.

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[amberwaves]

It occurs to me that since others kind of have a thread for themselves that they generally post to, I guess this one can be mine.

I mentioned before about life closing opportunities, well it does certainly seem like that is happening.  Not for GCS, not yet, anyway.  Lately my hours have been cut back at work for no discernable reason.  This comes at a time when I went ahead and booked lots of other things that cost money such as electrolysis, therapy, etc.  So those plans are probably boned. Once again it feels like banging my head against a brick wall.  I must be terrible at planning.  The reality is that all of these factors are mostly out of my control.  I should have known better than to try to move forward with anything.

It's not transition that is getting me down, but my complete inability to ever move forward in life in general.  Transition related take just happen to be the things I want to do at the moment.  Substitute in any number of goals and you have the past.  I am so tired of trying to be better.  Right now I am just going to accept feeling miserable. I really would like to cry over this crap, but unfortunately when I feel like this Abraham takes over and prevents that.  Sometimes I really wish he would go ahead and die off already.  (I know that's hyperbole, but it's an effective metaphor for the moment)

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[JoanneB]

Amber,
   The insurance thing is ridiculous. I think they make it purposely hard to get people to give up and save them money....

My brother in-law got a job at Blue Cross. Their training essentially consisted of the same advice a lawyer gives his client. Deny, Deny, Deny. Most times people just give up.

For the past 3 years Horizon BCBS rejected my prescription for E under the infamous "Age and Gender" rule. After a lot of back and forth with the doctors office ending with a Peer to Peer review, it finally gets approved. Of course this is always a good month or more AFTER I run out. 

Rule #1  Insurance Companies are in business to make money, not to give it away

[amberwaves]

I don't talk much about all the negative things I've endured in life, but perhaps sharing will be helpful.  For those who don't know, I suffer from Borderline Personality Disorder and ADHD.  I'm finally starting to get treatment for ADHD, but aside from therapy I am not being treated for BPD.  BPD is a terrible thing and it arises from a life time of abuse.  For me it was extreme emotional abuse and some physical abuse in every facet of my life, home school and social.  There is a fascinating interplay between all of this and my gender dysphoria.

I had a very rough therapy session yesterday.  I went in quite depressed because due to work schedules I only see my family about 1 hour most days.  The previously mentioned problems with my hours and expenses have been weighing on me heavily as well.  I was discussing all of these things and my therapist kept bring it back to why am I blaming myself for all of these things.  That is a chronic pattern.  I don't have a good answer for it other than it's a patterned response.  I have always failed to live up to my potential (that's the ADHD part) and was always made to believe that I am to blame for almost everything.  I broke down crying discussing the past and why this is.  I explained that before starting hormones I had only cried 4 times in my adult life and one of those was the birth of my first child, so not relevant.  I was never allowed to cry or even have emotions.  My sisters were allowed to and consoled for it.  I was always forced to "man up".  In addition, emotions were used as a weapon against you in my household.  The extreme (read unrealistic) standards I was held to shattered me in many ways.  All because I was a boy.  Thrust into a competition with an unachievable male ideal and not one shred of support.

I was a sweet child until around the age of five.  Pictures show me smiling and being a kid.  After that every photo I have ever seen of me looks bleak.  Even the ones where I am smiling it never reached my eyes.  My life could almost be a case study in brinksmanship.  How to crush a soul without pushing them over the edge (though there were attempts).  The world was given a diamond, but decided to crush it to pieces before it could ever shine.

I was hopelessly unsettled all day.  On the walk to the car I started crying.  In the car I cried.  At home talking with my wife I cried.  I slept for a bit and later that evening I cried.  I had to call off work because there was no way to be functional.  Before going to bed I cried.  This was more tears in one day than in all of the previous 20 years.

I am better today.  One blessing for me of being on Estrogen is that these moods don't last like they used to.  Before I would be off for 3 days.  I am getting there, but it's terrible sometimes.

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[HappyMoni]

Maybe the water comes from breaking the damn of pent up emotions. I only hope you can find some peace with the past. I can't imagine how hard it is to revisit painful events, but maybe it is a way to move on. I'm rooting for you, Amber.
Moni

[amberwaves]

Maybe the water comes from breaking the damn of pent up emotions. I only hope you can find some peace with the past. I can't imagine how hard it is to revisit painful events, but maybe it is a way to move on. I'm rooting for you, Amber.
Moni

Thanks Moni.  I really appreciate you responding.  Many times it feels like when I post things that I am merely screaming futilely into the aether.  It's comforting to know that others even read my ramblings.  The waterworks was interesting.  I have cried some over the past few months, but I was always able to regain my composure relatively quickly and then it was done.  This was a whole different ballgame.

I won't say it has been easy.  Some days it is, others not so much.  I have spent so long hiding the fact that I am broken from the world that it is really hard to actually talk about it.  There is a term called apparent competence.  This describes how an individual can seem outwardly to be completely well adjusted and capable, but the truth is they are not even remotely close to it.  When a meltdown or outburst inevitably occurs others are incredibly confused by it.  This is me to a T.  To most people I appear very capable and charming.  However, inside I am incredibly dysfunctional and stumble my way from one crisis to the next.

I have been working to get better, but it is a life long struggle.  Surprisingly, transition has been incredibly helpful in that.  I had no idea how badly Testosterone was exacerbating the emotional problems.  All it did was mask the pain with rage.  This past session was a bit of an eye opener for my therapist as to the extent of my problems.  I had spoken in general terms of the pain and the nature of my behaviors and problems.  However, to experience me when I am actually feeling like that is truly a whole different beast.  I hate having that side of me exposed.

I actually told my wife this morning that I think she has to be the strong one moving forward.  I've been the strong one for so long, but I just don't seem to have it in me any more.  I was the consummate actor putting on a show for the world.  In reality, I was just breaking myself little by little.  I dear that change and the vulnerability it brings, but I truly believe that it is necessary. I was always a scared little boy. Then, I became an angry man.  It's time to cast that aside to become who I should have been allowed to be.

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[HappyMoni]

Amber,
   I hear you on the "is anyone out there" sometimes. As far as the anger goes, I lost an awful lot of that going on HRT. The T was poison to my system. You are wise to face the things that have haunted you. It is painful for sure, but running or in your case putting up the stone wall of strength, doesn't solve anything. If one is not at peace with themselves, it is pretty hard to find that crazy state of mind people call happiness. I always wonder how many people who seem to have it all together,are actually struggling. I suspect a fair amount. Hugs to you.
Moni

[Roll]

I know that I, and I'd wager many others just starting out, am definitely reading/listening to pretty much everything on these forums, but unfortunately often don't feel qualified to offer advice or anything besides what I worry would just come across as little more than pleasantries. What I mean is that you definitely aren't screaming into the aether if nothing else! And reading these stories, yours and others, of both trials and successes also definitely goes a long way in helping those like myself who are looking for something to connect to, and hopefully finding solace within, a community whose shared experiences provide us with the knowledge that we are not alone, each individually screaming into the aether. (I hope that last bit didn't sound too corny, just sort of happened to come back around to your original phrase as I was typing.  )

[amberwaves]

I know that I, and I'd wager many others just starting out, am definitely reading/listening to pretty much everything on these forums, but unfortunately often don't feel qualified to offer advice or anything besides what I worry would just come across as little more than pleasantries. What I mean is that you definitely aren't screaming into the aether if nothing else! And reading these stories, yours and others, of both trials and successes also definitely goes a long way in helping those like myself who are looking for something to connect to, and hopefully finding solace within, a community whose shared experiences provide us with the knowledge that we are not alone, each individually screaming into the aether. (I hope that last bit didn't sound too corny, just sort of happened to come back around to your original phrase as I was typing.  )

Hi roll.  I did a lot of lurking in the beginning too.  I am still not a prolific poster.  I typically have little to add to extant conversations anyway.  I don't feel ignored here at Susan's terribly much.  Mostly it's stupid Facebook.  Because of how fb chooses what to show on feeds, and the fact that most people have lots of friends and the fact that I don't post often, things I say there are very much like that.  I don't even think my wife sees what I post without having to scroll down for minutes on end.

There does also seem to be something about how I phrase things that seems to not invite comment.  It's funny because irl I am a very good conversationalist.

That feeling is particularly problematic due to my condition.  A large part of BPD is a strong fear of perceived rejection tied into critically absent self worth.  Online, there is no way to really know if others read or care.  In person, there are lots of subtle nonverbal cues.  It's hard to put my thoughts and feelings out there.  That's mostly why I avoid the negative things in posts.  I have shared some of my journey in an attempt to show that transition is not always a negative journey full of struggle.  As far as my transition goes it has been largely headache free.  I know for many this isn't the case.  For me it has been almost every other aspect of life that has been hell.  Perhaps, that fact alone has skewed my perspective on things.

I love all you ladies and the support you give.  I'm terrible at seeking support for myself.  Especially on a transgender forum when my issues are not tg related.  Anyway, off to my very first electrolysis session [emoji4] !  Have a good day ladies (and gentlemen if any of you are reading too)

Amber

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