Advice anyone??

[friendhelp]

Hello everyone!!
One of my best friends is transgendered and has been having a lot of health problems lately. Pretty much what has been going on is that he needs to get a hysterectomy but his insurance is calling it an "elective surgery", meaning they won't cover the expenses. Being a college student,  he doesn't have the money to pay for this himself. For the last few months he has been having intense abdominal pain and bleeding, and the doctors have tried alternatives but they've pretty much come to the conclusion that he needs this surgery. He has not been able to work and is going to take a semester off school until he gets this figured out. I would love to try and help him but can't think of anything I can do. I came across this website today and was just wondering if anybody had any advice or ideas; I would love to hear from any of you!
Thanks!

[Flan]

as an issue that is part medical, part transition, the best thing the surgeon can do for him is to code it as such so the bastards insurance company can't deny benefits. that basically means gather up the labs (blood work, ultrasound, and whatever else) and get a diagnosis other then GID.

hope that helped

[Arch]

I assume that the insurance company is saying that your friend is faking or that he must have brought this on himself. The first is ridiculous if he has severe observable symptoms and if his doctor will attest to his health. The second...well, insurance companies treat cancer patients who are lifelong smokers, they cover ER services for drug overdoses, and they approve treatment for PWAs who admit that they contracted the virus through unprotected anal sex with a stranger. Why are trans people always exceptions to the usual policy?

I have never seen an insurance exclusion for cancer, drug overdoses, or AIDS. Go figure.

Flan is right. The physician has to code the condition properly. But I wonder what other factors are at work here. Is your friend listed as male or as female with the insurance company? I'm assuming female. If he is identified as male, that's a whole different issue, I think. I assume that his insurance provider knows he is trans, and that's why they are denying him. Is he on testosterone? Is this a trans issue?

If it is clearly a trans issue, and if working with the doctors and appropriate coding doesn't work, I suggest that your friend google trans law sites (like the Transgender Law Center, which operates in California) and start looking into patient advocacy groups. There is also a trans health conference that has been running for a couple of years--their site might provide some useful references. http://conference.transadvocacy.com/.

He probably needs to make a big stink about this. I'm glad you're on his side. We need more folks like you.

[tekla]

they cover ER services for drug overdoses

Anymore, just one.  After which it's a 'pre-exiting condition'.  Same in many states for domestic violence, you knew what would happen if you went back (or did drugs in that amount again), you assume all the risks of such behavior.

[Arch]

Anymore, just one.  After which it's a 'pre-exiting condition'.  Same in many states for domestic violence, you knew what would happen if you went back (or did drugs in that amount again), you assume all the risks of such behavior.

Interesting. But most guys I know have only one set of "female" organs that need removing, anyway.

[tekla]

But most guys I know have only one set of "female" organs that need removing, anyway.

Right, and once it's done, it's done - so that's good on that pre-existing deal.

[Arch]

Tekla, was that a joke or a typo a little while back--a near-fatal drug overdose as a pre-exiting condition? Well, whether it was accidental or intentional, it was funny as hell and wonderfully appropriate. I laughed my ass off. Even more perfect would be an insurance company that coded a fatal overdose as a pre-exiting condition...

[tekla]

Yeah, a near-fatal (I love insurance talk, it really makes me all moist) 'drug event' would be treated as a first case, every other 'drug-related event' that required emergency assistance there-after would not be covered, as the drug-related event condition, vis-a-via the use of illegal drugs, is now 'pre-existing', i.e. they know that you know, that everybody knows about it now.