The Story of Lori

[Paulie]

We now have about four inches of snow on the ground. On the bright side, it looks like Christmas outside.

Our neighbor wished us Merry Easter in light of the Christmas look outside.

Paulie

[LoriDee]

@Paulie

That's great! Merry Easter, everyone.
Does Santa Bunny wrap the eggs, or just hide the presents?

[LoriDee]

I am all for a good prank or practical joke on April Fool's Day, but I think a line has been crossed.
I have contacted the Pennsylvania Department of Fish & Game and applied for a Groundhog Hunting license. I wonder how many assassination attempts have been made against old Punxsutawney Phil over the years.


It is still snowing. This is really putting a damper on my outdoor activities. I live in Rapid City, not even up in the mountains.

Tomorrow's forecast calls for sunny and 53. If true, we will have to deal with flooding when all this crap melts. On the plus side, flood waters in the creeks dislodge gold. Maybe this is just a set up for me to have a banner year. If not, I can spend my summer in Pennsylvania hunting a certain groundhog. 

[Northern Star Girl]

@LoriDee
Dear LoriDee:

Unseasonably cold this Spring for me too.

Welcome to my world !!!!
Temperature is 7 deg(f)  [-14C)

[REM.1126]

It is beautiful in Alabama.

[LoriDee]

@Northern Star Girl

I don't know how you do it. I would love to do some prospecting up there, but the ground only thaws out for about fifteen minutes a year. 

@REM.1126

In my senior year of high school, I lived in Crestview, Florida. I loved the South! The Gulf's clear ocean water and the white sand beaches. That was the first time I ever saw pine trees growing on a beach not far from sea oats. We would skip across the border into Alabama to buy beer. When I joined the Army I told the recruiter I wanted to be stationed in Florida. The closest he could get me was Fort Polk, LA. Many years later, both my children went to college in Pensacola. I seriously considered moving back many times.

[LoriDee]

I should also mention that we hit 60 degrees today and the snow is gone. And no flooding so far.

[imallie]

I should also mention that we hit 60 degrees today and the snow is gone. And no flooding so far.

Tuesday we were at a baseball game (albeit a chilly one) - right now it's snowing and we're due to get anywhere from 3-6 inches tomorrow.  *deep sigh*

[LoriDee]

It looks like the start of my mining season might still be another month away. Our so-called "Early Spring" has yet to manifest. Today and tomorrow will be rain/snow and everything in between mix.

In 1972, we had a flood here that destroyed part of Rapid City. Google can show you pictures. It was devastating. In response, the US Geological Survey installed stream gauges along waterways from up in the mountains out to the flatlands as an early warning system. The ones in higher elevations measure precipitation, water depth, and water volume. Further downstream they monitor just water depth and flow.

Their website has access to live data coming from these gauges. The one that I watch is shown below. It is quite a ways downstream from my mining area, but over the years I have learned how to extrapolate the data.



As you can see, our recent precipitation has had a significant impact on the creek. The water level has only risen about one foot. The gauge reads a water depth (not shown) of 5.2 feet. I know that at my location that means the water will be about three feet deep. That is ideal for my uses.

However, the discharge amount (shown above) shows the creek is flowing at over 61 cubic feet per second. That is dangerously fast and I won't venture out into that. To give you a visual, one cubic foot is about the size of a bowling ball. American bowling, not Bocci. Imagine standing on the bank of a creek and 61 bowling balls go past you every second. That's fast-moving water.

Since it takes me about 20 minutes to drive up to my site, I check the gauge to see what is happening and if it is worth making the trip. Since the weather is crap and the water is unsafe, I will stay in PJs and fuzzy socks and make jewelry today.

[davina61]

It was dry yesterday and today here but so Wiiiiinnnnnnnnnnddddddddddddddyyyyyyyyyyy. I was hoping to get on the veg patch but looks like it will be okay next weekend. Might get up to 20C as well.

[LoriDee]

Now this I think we can all relate to. I just saw a meme (I won't post it here) that went something like this.

Doctor to you: "You need this medication."
Doctor to Pharmacy: "She needs this medication."
Pharmacy to Insurance: "She needs this medication."
Insurance Company: "Does she though? Let's ask her doctor."

I've been going through this (as you know) concerning electrolysis. My Psychologist submitted a consult to Minneapolis VA who have a non-VA electrolysis provider where they send their veteran patients. My Psychologist asked if it is possible to send me to that provider, or possibly to send me to Minneapolis VA so they can send me to their provider. Simple, right?

Without even looking at my records, Minneapolis had a team of not less than three people respond. They all stated that my records need to have documented that this is not cosmetic, but "medically necessary". The provider in Minneapolis does laser only, not electrolysis. The VA (the largest healthcare provider in the United States) has no one that does electrolysis in-house. And since the VA will cover electrolysis for pre-op genital surgery, it is automatically considered "medically necessary".

So my Psychologist (God bless her) did a deep dive, combing through my medical records. She quoted various provider notes going back to 2019 that show a determination of "medically necessary" no less than three times each year. The providers making that determination include my Primary Care Physician, three Psychologists, two Endocrinologists, a Gynecologist, and the Medical Chief of Staff for the Black Hills Healthcare System.

So now, we have firmly established the need (mental health), and the medical necessity. The next obstacle is a provider. Every provider that I have contacted (over 20 in all) demands payment at the time of service, cash or credit. The VA pays their bills like an insurance company. And there are none in the immediate area.

I found a provider that I am interested in. I won't post a link, but Clear4Life in Williams Bay, WI does electrolysis on any body part, including for gender-affirming surgery. I am trying to get the VA to cover the costs of travel, service, food, and lodging for an overnight stay if needed, or give me written approval guaranteeing reimbursement if I pay for it all myself on a credit card. I could just get it done, but the VA likes to take months to reimburse expenses. That won't work for me. Electrolysis requires multiple sessions and I will be paying credit card interest rates. I need to be reimbursed within 60 days or else I will quickly max out my credit limit.

I am continuing to standby to standby in case I need to standby to hurry up and wait. 

[ChrissyRyan]

Now this I think we can all relate to. I just saw a meme (I won't post it here) that went something like this.

Doctor to you: "You need this medication."
Doctor to Pharmacy: "She needs this medication."
Pharmacy to Insurance: "She needs this medication."
Insurance Company: "Does she though? Let's ask her doctor."

I've been going through this (as you know) concerning electrolysis. My Psychologist submitted a consult to Minneapolis VA who have a non-VA electrolysis provider where they send their veteran patients. My Psychologist asked if it is possible to send me to that provider, or possibly to send me to Minneapolis VA so they can send me to their provider. Simple, right?

Without even looking at my records, Minneapolis had a team of not less than three people respond. They all stated that my records need to have documented that this is not cosmetic, but "medically necessary". The provider in Minneapolis does laser only, not electrolysis. The VA (the largest healthcare provider in the United States) has no one that does electrolysis in-house. And since the VA will cover electrolysis for pre-op genital surgery, it is automatically considered "medically necessary".

So my Psychologist (God bless her) did a deep dive, combing through my medical records. She quoted various provider notes going back to 2019 that show a determination of "medically necessary" no less than three times each year. The providers making that determination include my Primary Care Physician, three Psychologists, two Endocrinologists, a Gynecologist, and the Medical Chief of Staff for the Black Hills Healthcare System.

So now, we have firmly established the need (mental health), and the medical necessity. The next obstacle is a provider. Every provider that I have contacted (over 20 in all) demands payment at the time of service, cash or credit. The VA pays their bills like an insurance company. And there are none in the immediate area.

I found a provider that I am interested in. I won't post a link, but Clear4Life in Williams Bay, WI does electrolysis on any body part, including for gender-affirming surgery. I am trying to get the VA to cover the costs of travel, service, food, and lodging for an overnight stay if needed, or give me written approval guaranteeing reimbursement if I pay for it all myself on a credit card. I could just get it done, but the VA likes to take months to reimburse expenses. That won't work for me. Electrolysis requires multiple sessions and I will be paying credit card interest rates. I need to be reimbursed within 60 days or else I will quickly max out my credit limit.

I am continuing to standby to standby in case I need to standby to hurry up and wait. 

I do not have any VA coverage or know how they operate. The best situation seems to be is for the VA to pay the provider directly (and reasonably quickly) but you know that!  This would avoid any heartbreak if you paid the provider and later find the VA will not pay after all.

I wish you the best results Lori.  I realize that this is a tough financial situation.

Another option to consider is that you can get some services cheaper with discount offers like a Groupon deal.  You will pay it all but at a lower fee.  Maybe you can get a few initial sessions this way to see how it is like for you.

I would not expect anyone to pay for my lodging but I do not know how the VA works.
If it is an entitlement, try to obtain it.  It would be another way for the country to compensate you for your long military service.  Thank you for serving.

Chrissy

[LoriDee]

@ChrissyRyan

Thanks, Chrissy! And thank you for your support!

Because I am a disabled veteran all of my medical care is covered within the limits of government regulations. I pay a reduced copay for meds, but that is all. Anything covered means all expenses are covered, including travel and related expenses to get that care.

The VA will not cover anything considered "cosmetic". Hence the need to establish "medically necessary" care. Hormone Therapy is medically necessary, as are various "cosmetic" prosthetics such as wigs, breast forms, binders, gaffs, and packers. The other glitch is that the VA does not pay providers directly. They use an insurance company. In the midwest it is Optum. Out west it is Tri-Care.

Insurance companies never pay on demand, even if a procedure is medically necessary and pre-approved. And electrolysis providers demand "payment at the time of service". Somewhere in the country, there are a few providers that have agreed to treat veterans and accept the VA's insurance payments. Most of them are still in the process of getting state licenses, and certifications, and signing the contracts. So there is movement in this area.

The next big hurdle is gender-affirming surgery. Currently, government regulations prohibit "gender-altering" surgeries of any kind. So that includes genitals, facial feminization, voice surgery, tracheal shaves, etc. A complaint was filed against the VA in 2016 claiming that this was discriminatory in that it discriminates against transgender veterans and only transgender veterans. The VA said they agreed and would change their policy. In 2018, the VA said they had to change the Federal Regulations in order to change their policy. In 2021, the VA said they were changing the regulations, but it would take about two years to implement since they needed equipment and trained personnel. In 2024, TAVA (Transgender American Veterans Association) filed a lawsuit against the VA to get a court order for the VA to change the regulations immediately and stop stalling. That case is still pending.

There is another option that I am looking into. I don't recall where I saw it, but there are organizations that provide grants for gender-affirming care. The funds are limited and they receive many applications each year. I fear that I would apply, receive the funds, and then the VA would start covering the care as promised. I don't want to take funds that could be available for someone else who may need care immediately if my care is going to be covered.

There is progress being made and I don't mind waiting in line, but I don't want to try to get all this done when I am 70 (in three years). I'd like to start living MY life. 

[ChrissyRyan]

Lori,

Go to jimcollinsfoundation.org

The 2025 grant cycle will open on June 1, 2024 and will close on August 15, 2024.


Chrissy

[LoriDee]

I will check it out, thanks!

The one I was thinking of applications had to be in by November.

[ChrissyRyan]

@ChrissyRyan

Thanks, Chrissy! And thank you for your support!

Because I am a disabled veteran all of my medical care is covered within the limits of government regulations. I pay a reduced copay for meds, but that is all. Anything covered means all expenses are covered, including travel and related expenses to get that care.

The VA will not cover anything considered "cosmetic". Hence the need to establish "medically necessary" care. Hormone Therapy is medically necessary, as are various "cosmetic" prosthetics such as wigs, breast forms, binders, gaffs, and packers. The other glitch is that the VA does not pay providers directly. They use an insurance company. In the midwest it is Optum. Out west it is Tri-Care.

Insurance companies never pay on demand, even if a procedure is medically necessary and pre-approved. And electrolysis providers demand "payment at the time of service". Somewhere in the country, there are a few providers that have agreed to treat veterans and accept the VA's insurance payments. Most of them are still in the process of getting state licenses, and certifications, and signing the contracts. So there is movement in this area.

The next big hurdle is gender-affirming surgery. Currently, government regulations prohibit "gender-altering" surgeries of any kind. So that includes genitals, facial feminization, voice surgery, tracheal shaves, etc. A complaint was filed against the VA in 2016 claiming that this was discriminatory in that it discriminates against transgender veterans and only transgender veterans. The VA said they agreed and would change their policy. In 2018, the VA said they had to change the Federal Regulations in order to change their policy. In 2021, the VA said they were changing the regulations, but it would take about two years to implement since they needed equipment and trained personnel. In 2024, TAVA (Transgender American Veterans Association) filed a lawsuit against the VA to get a court order for the VA to change the regulations immediately and stop stalling. That case is still pending.

There is another option that I am looking into. I don't recall where I saw it, but there are organizations that provide grants for gender-affirming care. The funds are limited and they receive many applications each year. I fear that I would apply, receive the funds, and then the VA would start covering the care as promised. I don't want to take funds that could be available for someone else who may need care immediately if my care is going to be covered.

There is progress being made and I don't mind waiting in line, but I don't want to try to get all this done when I am 70 (in three years). I'd like to start living MY life. 

I hope you all of this taken care of. You seem thoughtful and you are nice looking.

Thank you again for serving our country with your military service.

I wonder if Admiral Rachel Levine could help you with the VA.  She is transgender, and she is a four star admiral, and she is a MD.

Chrissy

[LoriDee]

She is the Assistant Secretary of Health. Maybe some influence but the VA is like its own animal. Also, Dr. Levine's rank is in the United States Public Health Service Commissioned Corps. Same government but a different agency. But then again, if I'm going on a letter-writing crusade, I can always include Mr. Biden. I have responses from Reagan and Obama from previous crusades.    Not that anything got done. Hard to expect action from a politician.

[davina61]

Yup not unless it wins votes or puts $/£s in their pockets (cynical me?!)

[imallie]

Hey Lori -

Just a suggestion based on what I know from my son's experiences working within the Federal government:

I know you're in PA - and I believe there your districts are pretty well split between dems/rep in terms of congress members. So I'm not sure who your member is. But if you've got a dem representing you, I think you might want to try contacting your rep's office.

They are (well, the good offices any way) EXCELLENT at negotiating the red tape of the VA, Social Security, etc... whatever constituent issues arise. And if you get lucky you might find an advocate in the office who can open some doors for you and might know who to call and make things happen for you.

If you happen to not have a friendly congress member, you could reach out to your senator — but their constituent service game is not as tight, but again... might be worth a call/email.

Love,
Allie

[LoriDee]

Thanks, Allie

But I am in South Dakota, one of the reddest of the red states. I was born in PA but only lived there for six months. (I was six months old when our family moved to CA.)

I have contacted our congressman, Governor, and Senator on several occasions unrelated to this. You are correct in that they have some pull with government agencies. When I was in the service, one thing that our commanders absolutely dreaded was a Congressional Investigation. They usually ended with people resigning or going to jail.

As always, I do appreciate your advice.

Hugs!