Top Surgery + way to mess with insurance?

[eliz]

Hi,

I learned a couple of months back that my friend is ftm. He is now on T and the next step would be top surgery. He's trying to do this on the cheap and so far, so good. Got a hormone letter from the great Dr Peveller (gendertherapist.com), he is very knowledgable and nice. For those of you who don't know - he does online therapy and charges 110 dollars for 4 sessions. I highly recommend him.  Anyway, then my friend found this place outside of Chicago that is willing to mess with insurance and say he has a hormone defiency so that it covers everything. You can private message me if you live in the area and want to know the name of the place.

So, I'm wondering if you know of ANY transfriendly surgeons who would be able to go along with messing with the insurance people? The thing is, my friend has a history of breast cancer in his family, so there could be a way to write the top surgery off as a preventive procedure to avoid cancer. Any idea? I'm willing to call just about anyone who you'd think would be up for it, anywhere in the country. Flying a ways away will still end up being cheaper than paying like 6000 for someone close by. Oh, also, if the first plan doesn't work out - know a good surgeon in the chicago/n IL/Wisconsin area who does a good job and doesn't charge too much? And maybe someone who would do top surgery without a letter from a psychologist?

Thank you for reading, I appreciate any and all info on this subject.

/ eliz

[myles]

Sorry don't know anyone who will do it with insurance or without a letter from a therapist.
Myles/Andrew

[Radar]

I've heard of guys getting their insurance to cover top surgery, but I have no idea how they pull it off. Just make sure your friend doesn't have the medical procedure put under a male condition (like gynecomastia) if he's listed as female on his insurance (or visa-versa). Insurance could catch it after the fact and slap him with insurance fraud.

I've wondered too if insurance would cover the nipple reconstruction part of the surgery. I know they do if the patient has breast cancer, but our situation is different.

[CodyJess]

A lot of medical professionals are willing to work around insurance, because they can charge more of insurance than they would if the customer/patient were paying cash. Try to find a better way to say it than 'messing with insurance', though. I can't imagine a single professional worth their weight being willing to flirt with insurance fraud.

Some can list it under 'breast reduction'. If the breasts are large enough or can be claimed to cause back problems, insurance will usually cover 'breast reduction'.

I'm sure there's other ways it can be done.

[FlorDeLuna]

If you have a serious history of breast cancer in your family you can request, and sometimes insurance will cover, a Prophylactic Double Mastectomy.  Most women who undergo this procedure also have reconstruction of the breasts, but that is an optional secondary procedure.

But again, for insurance to even think about covering this, you'll need for basically every female in your family to have gotten breast cancer.

[Alexmakenoise]

If you have a serious history of breast cancer in your family you can request, and sometimes insurance will cover, a Prophylactic Double Mastectomy.  Most women who undergo this procedure also have reconstruction of the breasts, but that is an optional secondary procedure.

But again, for insurance to even think about covering this, you'll need for basically every female in your family to have gotten breast cancer.

Ugh, too bad.  I was planning on seeing if insurance might cover it as "breast cancer prevention".  But I have only 1 family member who's had it, and she's been alive and well since her mastectomy (which she had about 40 years ago) - fortunately.   

Maybe there's an insurance company out there that will cover it due to the high rate of breast cancer in general?

Also, I wonder about the fact that having heavy breasts can cause back problems and such?  I've heard of women getting breast reduction surgery for this.

[Nero]

As others have said, I think this is most likely to happen if you have large breasts and can claim back problems. Course, I'd assume the minimum for this would be if you wear at least a DD bra.

[FlorDeLuna]

I am actually considering a breast reduction, which would be covered by my insurance (I'm a 38E) but it's a lot of risk and I've read that in almost 50% of cases the breast tissue gradually comes back. Then you've still got huge boobs and big scars to go with them. :sigh:

I think it's highly unlikely that an insurance company would fund a top surgery disguised as a breast reduction. I actually work in the insurance field, and I just can't see a way that a benefit analyst would not pick up on that.  Don't get me wrong, I think that top surgery should absolutely be covered. If GID is a medical diagnosis then it follows that medical treatment up to and including surgery should be covered.

Then again... infertility is also a medical problem but damn if the insurance companies will pay for any treatment for that either. It's all a bunch of bull.

[Radar]

Some insurances will cover a breast reduction but you have to be large and usually show proof of stress to the back. Insurance companies don't want to pay out anything so they'll find any reason to not cover something. As for them covering a mastectomy just because your family has a history of breast cancer, I doubt it. It wasn't that long ago in the U.S. when insurance companies would even deny covering a mastectomy for a breast cancer patient. And that's cancer! A law even had to be made for insurance companies to cover it. Welcome to the awesome healthcare system of the U.S.

[Alexmakenoise]

I am actually considering a breast reduction, which would be covered by my insurance (I'm a 38E) but it's a lot of risk and I've read that in almost 50% of cases the breast tissue gradually comes back. Then you've still got huge boobs and big scars to go with them. :sigh:

So, in theory, they should cover a full double mastectomy because some people might prefer this option in case the tissue grows back.

Some insurances will cover a breast reduction but you have to be large and usually show proof of stress to the back. Insurance companies don't want to pay out anything so they'll find any reason to not cover something. As for them covering a mastectomy just because your family has a history of breast cancer, I doubt it. It wasn't that long ago in the U.S. when insurance companies would even deny covering a mastectomy for a breast cancer patient. And that's cancer! A law even had to be made for insurance companies to cover it. Welcome to the awesome healthcare system of the U.S.

This is reminding me of how much I prefer living in Australia and want to move there and never live in the US again (but, sigh, immigration is expensive and takes a long time).  Even if you're not part of their nearly-free healthcare system and have no insurance, a doctor's visit costs about $50 - total.  And prescription drugs cost about the same as otc ones, even when you're paying out of pocket as a foreigner without insurance.  Plus, things like therapy are free for everyone who's there for any length of time, as long as you go to the right organization and have a good reason to request it.  Plus the QUALITY of the care you get is a lot higher, a lot more consistently. 

So, even though I doubt their healthcare system covers transition-related stuff (although who knows - it's a very progressive country), I have reason to suspect the cost is a lot lower and the quality is a lot higher.

I was hoping to transition AFTER immigrating.  Makes more sense on the surface.  But, having tried once and failed, I think they'll prefer a well-educated ftm with a really solid professional track-record to a fresh-out-of-grad-school female without much professional experience in my chosen field.

And, in case anyone else out there is considering the same thing, I found Melbourne to be very lgbt-friendly (plus it has one of the best music & arts scenes in the world, imo), and I have heard that Sydney is queer-friendly too.

[tekla]

I think they'll Everyone prefers a well-educated ftm person with a really solid professional track-record to a fresh-out-of-grad-school female ex-student without much professional experience in my chosen field.

FIFY

[Alexmakenoise]

I think they'll Everyone prefers a well-educated ftm person with a really solid professional track-record to a fresh-out-of-grad-school female ex-student without much professional experience in my chosen field.

FIFY

Thanks.  Good to know I'm going about things the right way now!

[tekla]

All the grad school in the world does not match one day's worth of the real experience.  Two stories, both of them true.

One - A band I know (well known, famous, at least in their genre, which is as good as it gets these days) needed a new drummer for an upcoming tour as the bands real drummer was too busy doing drummer stuff (drugs) to be bothered (wake up enough) to tour.  Having nothing better to do that day (other than smoke their pot and drink their beer) I sat in on the auditions.  In the end it came down (as it almost always does) to TWO outstanding choices, and everyone else who showed up.  ONE was a highly trained (Boston, some music place that sounds like a major university in the Bay Area) and one street punk who had drummed in several (largely unsuccessful) local bands. They went with the punk.  I asked why they would pass on a professionally trained and educated person in favor of a street punk and the response was (wait for it, it's worth it)...
We want someone who we know can tour, not someone who thinks they can.
I said: How can you pass up someone who has a degree from Berklee?
The reply: Where do you think the last moron came from?
True story.

Second Story, also true.
I had to hire someone.  Which I hate.  But, it comes down (as it always does) to two people.  One with a Masters degree in Tech Theatre from a really good school.  The other, a gutter punk who had done two years as a professional painter and had some carpentry experience.  Number two had also driven to the interview on some cannibal corpse type motorcycle.  I asked him about it and he told me he had put it together with spare parts from friends and few parts he had to buy.  I asked how much he spent.  He said $300.  I hired him on the spot.

[Alexmakenoise]

We want someone who we know can tour, not someone who thinks they can.
I said: How can you pass up someone who has a degree from Berklee?
The reply: Where do you think the last moron came from?
True story.

Haha!  Good stories.

Yeah, the importance of the pieces of paper can be a bit over-estimated these days.  I just got mine because they're required for the techier stuff that I do, according to the professional organization that over-sees everything.

[Radar]

I just got mine because they're required for the techier stuff that I do, according to the professional organization that over-sees everything.

Yeah, some fields and companies won't give you the time of day without a degree. I know me and a guy I worked with at the time applied for the same position at one company. I had two phone interviews and one in-person interview with them. He asked them if they got his resume, too. They did but told him it was corporate policy to not hire anybody without a degree so to forget it. This man had 20 years more experience than me! I was shocked. So sometimes it does work the other way around. Of course, who usually gets more priority is someone with a degree in their field and much experience. It's a good way to go. 😉

[eliz]

Hi again,

Thanks for your replies. It seems as though the thread took on a life of its own. 😉

Anyway, I guess most of you are right, getting insurance to cover top surgery disguised as whatever is not very likely to happen. Now I guess I'll try to look into good surgeons. There is this famous one in Ohio that is supposed to be good. I think I saw him mentioned in a thread before but can't remember his name. For my friend it's really important to find a dr who won't be very... intrusive? My friend is very private and with a sky-high level of dysphoria. the fact that drs usually take photos before the procedure really makes him crinch. So, yeah, any ideas on good doctors who would be "extra" careful and understanding of the persons concerns?

And in response to a topic that got going on here - I'm just now getting used to the American way of health care. I didn't know it was so bad... I'm from Sweden and here everything's basically free/low cost and here being transgender is seen for what it is - a medical condition, whereas in the u.s. they call it "plastic surgery". pssh. anyway, so everything that has to do with transitioning is practically free in Sweden. But, first you have to go through a process lasting 2 years, and i think the process means just talking to therapists and "presenting as the desired gender", whatever the hell that means. I saw a documentary about it, and this one person had to wait 5 years for the government to believe him and grant him the go-ahead to start hormones. SO, it might be free, but I'd honestly rather do it the American way if i were transgender. it doesn't make sense to have to wait 2 years to even get started. i would say that's equivalent to torture.

[Radar]

There are pros and cons to transitioning through the American healthcare. You can usually get on T faster if you have insurance. If not (or they're not covered under your insurance) then you have to pay for each therapy session, psychological tests, endo visits blood tests and eventually the T each time. The endo visits, blood tests and T will be an on-going expense. Then, to get any SRS surgery done you have to pay out of pocket. We're talking thousands and thousands of dollars here. Some guys never get it done due to costing so much.

So, if I had the choice of using the U.S. system (even with insurance) or wait two years for everything to be paid for I'd do the two years. It's a longer wait- but think of all the money saved and guys being able to get the surgery we need but can't afford. My hang up is the real life experience (presenting as the desired gender) requirement. Some guys just can't pass at all before T. So how is he supposed to pass when everyone sees him as female instead of male- no matter what he does? That just sounds unreasonable.

[eliz]

There are pros and cons to transitioning through the American healthcare. You can usually get on T faster if you have insurance. If not (or they're not covered under your insurance) then you have to pay for each therapy session, psychological tests, endo visits blood tests and eventually the T each time. The endo visits, blood tests and T will be an on-going expense. Then, to get any SRS surgery done you have to pay out of pocket. We're talking thousands and thousands of dollars here. Some guys never get it done due to costing so much.

So, if I had the choice of using the U.S. system (even with insurance) or wait two years for everything to be paid for I'd do the two years. It's a longer wait- but think of all the money saved and guys being able to get the surgery we need but can't afford. My hang up is the real life experience (presenting as the desired gender) requirement. Some guys just can't pass at all before T. So how is he supposed to pass when everyone sees him as female instead of male- no matter what he does? That just sounds unreasonable.

Well, for sure the American healthcare system is ->-bleeped-<-, but then again I don't think my friend would be able to take 2 years of waiting, he'd be dead soon before. And I'd rather be alive and in debt than dead. I understand that some people would be able to put up with the wait. it takes about 3 years to become a swedish citizen i heard, so if youre up for waiting 5 years and dont mind moving to a foreign country then it could be free for you as well. but then there are some people whose dysphoria and depression are just too much to handle. That the swedish gov decided that there will be a 2 year wait is ridiculous.  Whenever you hear something is free it doesn't really mean that. Everyone seems to think Sweden is so great when I tell them about our healthcare, but then stuff like this comes up. The whole process sounds really demeaning and awkward. "experts" are supposed to tell you if you're crazy or not, and then more often than not they will decide that you are. And then you have to wait a while before you can start the process again.

[emoglassesenvy]

yeah, i guess technically it is possible to get top surgery with insurance but as others said, it depends on how strong your case is for reasons other than transy issues.

if he's got a large chest, maybe that could be an option

if he's got a smaller chest, might i suggest surgery in thailand?? cheaper than america and the doctors have more experience. that's where my boyfriend went and he was really impressed by the price, results, and post-op care.

[xACEx]

i got top surgery done 9 days ago and my insurance covered every bit of it. i had to pay 50$ copay for my consultation and $100 copay for the day of the procedure....i was very large chested tho, i put DD on my paperwork...but anyway, my doc removed every bit of breast tissue and made my nipples smaller...i live in tn and got it done locally by a dr here...

as far as my endo and my therapist, ins covers that too and my T is 10$ a month for generic and 20$ for brand name...yea insurance