Some good news with the cost of my SRS

[Steph]

When I first approached my insurance company about covering the cost of my SRS they told me that it isn't covered, but I should get a cost breakdown from the surgeon (Dr Brassard) and submit it to their office.  I did, and they told me that they may cover certain costs but not everything and that I should submit an appeal to the head office for a ruling.

So I collected all the information I had, letters from therapists, Dr's, endo's etc. and guess what, they are going to allow my claim, well up to 80% of the total, which is great considering I wasn't expecting anything.

So it always pays to pursue the insurance companies - what do we have to loose.

Steph

[Dennis]

That's awesome, Steph. Good work.

Dennis

[Melissa]

Congratulations Steph.  That's great.

So it always pays to pursue the insurance companies - what do we have to loose.

Coverage of non-related services perhaps.    That's my fear at least.

Melissa

[Owen]

Steph that is great news way to go. It sure does pay to pursue insurance.


Linda Ann

Love being female

[Jillieann Rose]

Wow!
Way to go Steph.

Jillieann

[HelenW]

The isurance is covering 80%?     WOW!

I hope you bought a lottery ticket or two the day you found out!!

That is just awsome news.  My health insurance is self-funded, all claims are paid directly by my employer, and they have a specific exclusion of all services related to GID.    I'm hoping I can appeal that if (when?) New York State finally passes a gender nondescrimination law but I ain't holding my breath.

I guess this means you and Gill will have some extra $$ to go out to dinner or maybe a trip to England?

hugs & smiles
helen

[cindianna_jones]

Wow.... I only get 80 percent of "normal" charges to begin with!  I think that you should always file, just in case. 

This is terrific news Steph.  Now whatchya gonna do with all that money?

Cindi

[Steph]

I wish I had all that money.  I had to pay up front for the SRS so I'm still out 20%

Steph

[BrandiOK]

  That's fantastic Steph   <sigh> Maybe I need to move back to Canada.

  I have AETNA and I kept hearing reports that they were one of the few US insurance companies that will cover SRS so I did a little research.  It seems that, yes, they will cover SRS but ONLY if the company you work for has specifically allowed a particular rider on the policy that allows it.  Of course being here in the bible belt my policy specifically details that ANY procedures that have to do with sex changes or associated medical care will not be covered (no big shocker there).  Gotta love conservative corporate America.....

 

[Melissa]

  I have AETNA and I kept hearing reports that they were one of the few US insurance companies that will cover SRS so I did a little research.  It seems that, yes, they will cover SRS but ONLY if the company you work for has specifically allowed a particular rider on the policy that allows it.  Of course being here in the bible belt my policy specifically details that ANY procedures that have to do with sex changes or associated medical care will not be covered (no big shocker there).  Gotta love conservative corporate America.....

I actually have aetna too, but somehow I doubt they have the rider, as they said I was the first TS they've had transition.

Melissa

[ssindysmith]

Blue cross and blue shield will only cover my hospital stay......... the surgeon I am on my own, there catch all being they will only cover the hospital provided the surgeon is on staff, finding a staff surgeon to preform the surgery is just about a lost cause. Not that I haven't asked, we had a new resident female surgeon, I asked her a question about SRS she sounded knowledgeable about the subject, she told me she would need to speak to the patient before recommending which procedure would suit the best out come. I giggled and told her it was me, she raised her eye brow looked me over shook her head and said lets have a look. She examined me and told me I would be a excellent candidate for a colon segment because my donor tissue was so lacking (5 years HRT flaccid and atrophied) but she was not comfortable doing the procedure.

[Chrissyts41]

My therapist told me that one of her other patients had SRS in Trinidad w/ Dr. Bowers and Blue Cross/Blue Shield was a major disappointment for her when all was said and done.  She had to pay up front (of course), but then when she submitted it to ins., they responded w/ very little coverage.  That's the insurance that I have, but I think I'll do what Steph said and discuss it w/ them in depth ahead of time to get a clear idea of what the I can expect from them instead of waiting until after surgery when I feel more vulnerable.
Good thread!

[LostInTime]

Melissa, you should check.  I know of one or two transsexuals who had their surgery covered because it was not excluded.  The companies just never really thought about it.

My insurance will not cover a thing and submitting something like surgery will cause the insurance to go away and possibly lead to me being fired.  Yes, gotta love the south, usa.

[Melissa]

Melissa, you should check.  I know of one or two transsexuals who had their surgery covered because it was not excluded.  The companies just never really thought about it.

Oh yeah, I did check and there was an exclusion.

Melissa

[HerJeepness]

you should move your butt to alberta steph!!! i think we are one of the last provinces to pay for it (part of the reason i moved here). the province paid for everything, airfare, food, meds, the surgery, my stay in St Eustache, aftercare, etc etc. kind of strange when you think about it, all of the more liberal provinces squashed funding for SRS but the most backwards/redneck province of them all will gladly pay for it.

i even managed to get my date bumped up by a year and 2 days (took everyone by surprise here i can assure you!! lol) they called me to say they had a few cancellations and wanted to know if i could handle having my date bumped up by a year... uhm DUH!!! "of course, i'll start walking now" i said LOL she got a laugh out of that, anyway, i get there and i'm not even unpacked yet and Mr Brassard pops in and asks if he can get me to move my date ahead again (he came across very appolgetic) i blushed and hugged him, LOL (he hugs very gently)

and check this out... they get me all prepped with the IV and get me situated on the gurney in the OR and the orderly leaves me alone, I FELL ASLEEP ON THE TABLE!! before they even had a chance to give me any medication or anything...  i mustve been rather relaxed and very at peace with it all because afterwards when the morphine cleared he asked me what had happened, i shrugged and said i felt safe and relaxed so i had a nap and when i woke up i was a woman!!! 

you'll love your trip steph i'm sure of it!

just dont go outside tanning 2 days after surgery or you will get sun stroke due to the anti biotics (i guess the sun affects it? ) and the staff at the house will get very worried and mad at you.. not that i would know first hand or anything 

[Steph]

...

you'll love your trip steph i'm sure of it!

just dont go outside tanning 2 days after surgery or you will get sun stroke due to the anti biotics (i guess the sun affects it? ) and the staff at the house will get very worried and mad at you.. not that i would know first hand or anything 

Too late hon my srs was on Dec 11th 2006

Steph

[Dennis]

...and suntanning in December in Ontario isn't an option.

Dennis

[HerJeepness]

lol, sorry bout that steph... my bad...

i hope you had a good trip anyway:)

[LostInTime]

...and suntanning in December in Ontario isn't an option.

Dennis

Well, it is but you just might not enjoy it as much as one might during the warmer parts of the year.   

[Steph]

...and suntanning in December in Ontario isn't an option.

Dennis

Well, it is but you just might not enjoy it as much as one might during the warmer parts of the year.   

Very true, it was -25 today brrrrrrrrr.

Steph