First appt. w/ Endocrinology! :O

[Wolf Man]

So, it all began with me asking my PCP if my insurance covered HRT. After a month, he responded saying they do and that he referred me to Endocrinology. That was yesterday.

Today I made my first appointment and it's going to be on the 14th! I'm so flippin' excited! I'm also a bit nervous which is the reason for my post. 

Seeing as this is my first time and all, what should I expect to happen and what happened with you? Should I ask questions? What questions?  I want to be prepared.

Thank you all for any responses and help. 

[Arch]

This is going to sound stupid, but what questions do you have? I would say that you should start actively thinking about questions and concerns. Whenever you think of something, write it down.

Even if you've done your homework and know a lot, you can and probably will still have questions--not necessarily about T in general but about how your HRT might affect you. So you might want to ask if he starts people on injections or something else, what concentration, what dosage. How often he wants to monitor you, what blood tests he will order, stuff like that. How much experience he has with trans folk. What your GP can handle and what your endo insists on handling.

My big question, which I was too keyed up to ask, was WILL I GET MY FIRST SHOT TODAY PLEASE PLEASE PLEASE I'LL DIE IF I DON'T GET IT.

Ahem. I was terrified that I wouldn't get the shot that day. I was even more terrified that I wouldn't be approved for HRT at all, even though I had the letter from my therapist and everything. That appointment was, without a doubt, the most stressful hour in my life. I felt as if my body would simply explode if I didn't get the shot.

Anyway...

[Wolf Man]

I guess that all makes sense. Thanks Arch.

Oh, and I had just gotten a referral to the Endo by my PCP. I never went to therapy, nor did I ever get a letter. Does this mean there'll be the possibility that I will be denied HRT by my insurance? 

[LordKAT]

You could be denied by your endo actually.

[Wolf Man]

Joy... Well, all it will mean is that I cannot have this covered by insurance. In that case, I know of an informed consent based clinic I can go to.

It's worth trying though.

[Arch]

I guess that all makes sense. Thanks Arch.

Oh, and I had just gotten a referral to the Endo by my PCP. I never went to therapy, nor did I ever get a letter. Does this mean there'll be the possibility that I will be denied HRT by my insurance? 

You had better look into this, just to be on the safe side. But you might need to be surreptitious about it. I mean, sometimes things would have gone smoothly if you hadn't brought it to someone's attention, if you know what I mean.

Okay, the first thing I would do...do you know where to find your insurance manual, the one that says what is covered and what isn't? There might be some useful information there about how to get certain things covered, but I doubt it. Usually it just lists what is covered and what isn't, not so much the procedure for getting specific treatments covered. Still, if there is a trans exclusion, that means your PCP is probably coding your referral in an interesting way, which also means that your endo has to be on board with that.

If there is no trans exclusion, then it's probably safe to make direct inquiries of the insurance company, but it might be easier to start with your existing doctor and his or her staff.

Does your PCP have experience with cases like yours? If so, s/he could already be following the procedure put in place by your insurance. If not, I would say that you should call your PCP and see if s/he (or someone on the staff) can make sure of the correct procedure.

Or call the endo's office, tell them you have a referral from your PCP, and make sure they are going to bill insurance.

Or both.

But first find out what your insurance policy says about trans stuff. Look in the table of contents for an entry like "exclusions. or "what your policy doesn't cover." The things that aren't covered are usually at the end of the document.

P.S. I didn't go through insurance, but when I called for my endo appointment, I told them I was a trans patient looking for HRT, and did they need a letter from my therapist? You can ask if a referral from your PCP is sufficient for you to start HRT and get it covered--don't mention a therapist or they might suddenly decide they want that!

[LordKAT]

I meant that your endo may refuse to prescribe T if you don't have a letter from a therapist. I wasn't thinking about insurance coverage.

[Wolf Man]

Well, I had contacted my insurace Member Services to ask about the coverage I had with HRT. All that was mentioned to was this: Your PCP needs to see it medically necessary for it to be covered.

I had originally asked my PCP, who told me to ask Member Services, who then told me my PCP had to okay it, I told my PCP this and he referred me, telling me to make my appointment today.

So my insurance says it's covered and I know a FTM irl who has my same insurance company who is getting ready to get T from them, covered. He, however, went to therapy and got a letter before switching to my insurance company. :/

I don't know what to really think anymore, but I'm going to go with what you said Arch. I'm just going to keep the therapy procedure to myself and see what happens. Maybe my PCPs referral is enough. If it's not, I'm not going to freak out. I'll be a bit bummed, but I know I can get it for sure somewhere else.

[Arch]

I don't know what to really think anymore, but I'm going to go with what you said Arch. I'm just going to keep the therapy procedure to myself and see what happens. Maybe my PCPs referral is enough. If it's not, I'm not going to freak out. I'll be a bit bummed, but I know I can get it for sure somewhere else.

Wolf Man, if you will only be "bummed," then maybe this isn't so urgent. For me it was absolutely imperative that I get the shot that day. I had built it up so much that after two decades of actively suppressing, I was a freaking time bomb.

Good luck to you. I know you'll update us the second you're out of there.

[Naturally Blonde]

What is the structure in the U.S.A regarding treatment? do you find a psychiatrist who then finds you an endocrinologist? and does you psychiatrist find you other treatment processes as well? Over here it's a bit more DIY!

[LordKAT]

In US it is all DIY. You may get lucky and find one who will refer you to another, the norm is you hunt on your own and go in any order.

[Arch]

In US it is all DIY. You may get lucky and find one who will refer you to another, the norm is you hunt on your own and go in any order.

Yeah, it's mostly DIY. But some insurance plans cover trans stuff and have a pretty specific procedure in place and specific health care providers that you have to use. For example, if I had sought an endo through the insurance at my old job, I would have had to follow their procedure and use someone from their list of endos. And one of my buddies at my undergrad alma mater is following a fairly specific path, although he has the option to go outside the system for top surgery if he is willing to pay some of the cost out of pocket.

I wasn't actually on the insurance policy through my old job (it wasn't worth it), so I did everything outside of insurance. Even so, some of mine was DIY and some wasn't. I found my therapist through my LGBT center because I knew that they would be knowledgeable to some degree. I didn't even ask my PCP; I doubt that he would have known where to start.

My therapist, however, directs his clients to one specific endo; they've had a professional relationship for years. (He also tells them about the informed consent clinic but doesn't know much about it.) Top surgery was entirely DIY. My therapist knew about the two major surgeons for chest surgery in the western U.S., but he did leave it up to me to do my research. He didn't recommend anyone in particular. I found a local guy who had done his first FTM top surgery five years earlier.

On the other hand, I've heard that some insurance companies cover trans stuff but have no set procedure or providers in place. It's all up to you.

P.S. Sorry to derail your thread, Wolf Man. Looks like you only have a couple of days left!

[Vanessa_yhvh]

I'm in the US, specifically Mississippi. Getting trans care in this state is... a special challenge.

I sent an email to a therapist in Louisiana and told her I wanted to set up an appointment with her for pre hormone replacement therapy evaluation.

When the appointment took place, I answered a bunch of questions on forms essentially boiling down to the fact that I wasn't in immediate danger of self-harm. Then we sat and had a long, pleasant chat about my life.

Then a couple of doctors came in, addressing me by my preferred name. We reviewed some of the particulars of HRT, and I left with a couple of prescriptions and an appointment for a month later (a few days from now).

To my knowledge, no endo is involved at this point, and I doubt that will change any time soon unless my bloodwork seems odd at some point.

They billed BCBS, which has covered some of the therapist cost. I haven't heard from BCBS yet regarding the meeting with the Family Medicine doc who prescribed the hormones, but the total cost on my Flex card at the pharmacy was only $20 for both the medications I'm taking.

I'm under the vague impression at this point that BCBS has one of the more progressive attitudes toward HRT coverage.

[Arch]

I'm under the vague impression at this point that BCBS has one of the more progressive attitudes toward HRT coverage.

With those premiums, I should hope so!!!

[Vanessa_yhvh]

I'm on a corporate plan, so it's not too bad compared with others I've seen. We had a different carrier for the longest time, but they were pretty spotty on coverage.

[Naturally Blonde]

I'm in the US, specifically Mississippi. Getting trans care in this state is... a special challenge.

I sent an email to a therapist in Louisiana and told her I wanted to set up an appointment with her for pre hormone replacement therapy evaluation.

When the appointment took place, I answered a bunch of questions on forms essentially boiling down to the fact that I wasn't in immediate danger of self-harm. Then we sat and had a long, pleasant chat about my life.

Then a couple of doctors came in, addressing me by my preferred name. We reviewed some of the particulars of HRT, and I left with a couple of prescriptions and an appointment for a month later (a few days from now).

It's sometimes very difficult in the U.K to get a prescription on a first visit. For me it took two years to try and get a prescription with the NHS. In the end I left the NHS and went with a private Psychiatrist and got a prescription on the first appointment.

[Arch]

I'm on a corporate plan, so it's not too bad compared with others I've seen.

Yeah, I don't think the federal government does such a great job with any plan. My ex had a choice of "self" or "self and family." No "self plus spouse" option. So we had to pay two and a half times as much when I was added to his policy. One of his coworkers covers himself, his wife, and FOUR children for the same premium we are paying. That sure isn't how my old job's insurance worked...

Of course, the BC/BS option offered by the feds doesn't cover trans stuff anyway, so we went with a cheaper option.

[Wolf Man]

I'm cancelling my appointment. 

I cannot make it the appointment first off, I have some family stuff, I'm preparing to move out and with this last one it means that I'll no longer be covered which would just make this pointless.

If I was even let to be without therapy, I'd have more appointments to make which I would not be able to keep because I'd have no insurance.

This is a disappointment, but it is probably for the better seeing the situation. I'll be attending that informed consent clinic by Summer, hopefully, and I should have my name change by then as well.

Eh, life is filled with many different courses, but I know everything will work out in the end.

[rexgsd]

thats stinks, Wolfman, but it seems like the best choice in your situation right now.
You'll have to keep us updated later on though!

[Vanessa_yhvh]

Bummer! But it's better to realize your situation before you find yourself saddled with a big, fat medical bill & no way to follow through, I guess.

But the disappointment must be intense.