Kaiser Permanente and SRS

[Janet_Girl]

I am going to be sending a letter to Kaiser Permanente regarding to SRS.  I am quoting the AMA Resolution 122 in an attempt to persuade them into covering SRS, even if it on a case by case basis.

I don't know if it will be worth the pain and headache of fighting for my medical rights, but maybe it will pave the way for others behind me.  But if they cover my SRS, then it will be worth it.

Wish me luck.

Janet

[NicholeW.]

Have you thought yet to check with your medical insurance policy and see if it expressly enumerates SRs as a possibility or an exclusion? If it's an exclusion it's prolly because your company has declined to include it in your medical benefit and the company will, consequently, not cover it either.

If you haven't check with your employer's HR dept, the medical insurance side, and work through them first.

To go direct to the insurance may not only be a waste of time, but if you're getting hrt meds through them they could start disallowing that as well if your medical insurance doesn't expressly cover them for both designated sexes.

You don't want to get into a position vis-a-vis your insurance where not only do you out yourself, but get hurt in the process. And insurance companies share info with each other as well.

Nichole

[Janet_Girl]

I have not check with my HR as of yet.  That is on the schedule to do before sending my letter.  That will be Monday.

But you do have a very good point about my HRT.

[NicholeW.]

I have not check with my HR as of yet.  That is on the schedule to do before sending my letter.  That will be Monday.

But you do have a very good point about my HRT.

Uh-huh, I knew I did. There are wheels within wheels, especially in dealing with insurance. Most insurance companies will prolly write riders to cover even SRS if the company is willing to pay for the freight. Most companies are not willing to do so.

But, yes, you don't want to screw things up with your meds just to be told no SRS, No HRT, no nothing that a "male" isn't normally covered for.

Take care of you, Janet.

Nichole

[Janet_Girl]

However Kaiser does have me as Female on my records.  And I posted this to get other ideas before begin a long battle that could result in having my insurance canceled for any reason.

And I understand all about the wheels within wheels.  But thank you for you concern, Nichole.   

Janet

[MeghanAndrews]

Yeah, Kaiser will code you as female if you ask. They are definitely very trans-friendly. Getting orchi covered hasn't been an issue for anyone I know. I don't know anyone who has gotten SRS through them. Even if you convince them to let you get it covered, they will most likely use one of their urologists or plastic surgeons and I'm not sure you want to go down that path Janet. The other option would be getting them to cover (probably slim chance but go for it!) and finding out their share of cost, then going to the surgeon you want, letting them accept the Kaiser fee which will hardly be anywhere near the cost the doctor charges, then you pay for the difference. That way you get the procedure partially covered AND you get your choice in doctor. Keep us posted 🙂 In California, Medical covers SRS after lengthy battles but again, I don't believe you are going to be going to a main surgeon. The reimbursement rate for insurance on those kinds of procedures is probably really low. Med-Cal (Medicaid in other states) only pays 20% of what Medicare doesn't cover, which is really, really low.

[seks4me]

Hi Janet-
I'm Mike. I'm an FTM and I also am interested in getting Kaiser to cover the costs of my SRS. Would you keep me in the loop as things progress with you,please? I won't have benefits for 5 mos,but,the only reason I'm waiting till then is in case I can get it covered..If I am refused,at least I'll be able to file an appeal and pursue it on a discrimination suit on the part of the insurance company if necessary.

Thanks,Good Luck!
Mike

[sarahb]

Hey Janet, I have Kaiser as well and was wondering if you ended up pursuing this? Did anything good come out of it?

~Sarah

[Janet_Girl]

Actually I have lost my insurance, because they fired me.  But a good point is that I am now getting unemployment, which helps.


Janet

[sarahb]

Oh shoot, I'm sorry Janet! Well, I'm thinking I might pick up your efforts where you left off and see if I can get them to cover it. Wish me luck!

~Sarah

[Janet_Girl]

best of luck, Sarah.  I hope you succeed! 


Janet