Susan's Place Transgender Resources

So I'm almost ready to schedule a consultation with Dr. Garramone for surgery, and I'm trying to make sure I've calculated everything out financially. I believe you have to get labwork prior to surgery, and I'm worried about the cost. If my insurance isn't going to cover the surgery, will it cover getting that done? I have insurance through medicare so I have no idea. I'm just trying to be prepared in case it's like $500 or something. Did any of you pay out of pocket for getting labwork done (in the US) and approximately how much did it cost?

Hey sbx,

I'm not an ftm nor do I know anything about top surgery, but I can share my labwork experiences with you.  I've had to pay out of pocket for bills that were quite insane (one was almost $3,000 and the other was around $700) but that's mainly because of the cost of estradiol/testosterone testing and choosing a hospital branch for one.   Mainly the high cost is a result of some labs sending their speciality testing (like estradiol and testorone) to other labs (I know this because it's happened to me and have seen this happen with others).  For general labwork, like a Complete Metabolic Panel, you probably won't pay too much.  Actually, my $700 bill has a CMP down for $53 alone, so it's not bad.  As long as they are just testing basic things for general medical clearance and not doing speciality testing the costs probably won't be a lot, likely well under 500 depending on the lab you go to.  You can check this by looking at the blood work script itself and finding out the cost of each specific test, just in case. 

Have you used the medicare policy for bloodwork before?  How about for bloodwork for your endocrinoligist, if you have one.  It may give you a better sense of your policy and whether you will need to code it a certain way.

By the way, take what I say with a grain of salt.  This is only my experience, but it's been backed up by what I've seen through working in a medical office.  In any case, I hope it helped somewhat.

Quote from: sbx on May 22, 2014, 07:47:58 PM
So I'm almost ready to schedule a consultation with Dr. Garramone for surgery, and I'm trying to make sure I've calculated everything out financially. I believe you have to get labwork prior to surgery, and I'm worried about the cost. If my insurance isn't going to cover the surgery, will it cover getting that done? I have insurance through medicare so I have no idea. I'm just trying to be prepared in case it's like $500 or something. Did any of you pay out of pocket for getting labwork done (in the US) and approximately how much did it cost?

My insurance paid, no problems.  It is mainly just the standard blood work people get.  He just wants to make sure you are healthy.  It shouldn't be a problem.   

As an aside, I thought that the government just changed it to Medicare paying for top surgery...or they are in the process of making that happen.  Definitely find out about that.  Google it.  It would suck if you scheduled your surgery only to find out that Medicare starts paying for surgeries beginning one month after you got yours done!

A lot of it (I am on Medicare as well) is HOW the doctor codes it. If you can get him to code it as a Hormone Imbalance you are good to go. Mine did this and it was covered.  :)

Quote from: Jessica Merriman on May 22, 2014, 08:21:24 PM
A lot of it (I am on Medicare as well) is HOW the doctor codes it. If you can get him to code it as a Hormone Imbalance you are good to go. Mine did this and it was covered.  :)

Hey, Jessica.  He is asking about blood work for top surgery with Garramone, specifically, not hormone levels.

EDIT:  sbx, I realized I didn't answer your question.  I think it was $280 or something like that billed to my insurance

Quote from: Brett on May 22, 2014, 08:44:53 PM
Hey, Jessica.  He is asking about blood work for top surgery with Garramone, specifically, not hormone levels.

I had Gall Bladder removal surgery and Medicare paid for the blood work up. Sorry, blonde moment! ::)

Thanks for your replies everyone. I think I'm just going to go ahead and schedule the consultation since waiting is driving me crazy.

Quote from: learningtolive on May 22, 2014, 08:14:43 PM

Have you used the medicare policy for bloodwork before?  How about for bloodwork for your endocrinoligist, if you have one.  It may give you a better sense of your policy and whether you will need to code it a certain way.

No, I actually just started going to a trans-friendly clinic, and I'm supposed to get bloodwork to check my T levels done next week. I can always ask my doctor about it, but I don't see him again until mid-June. The clinic takes medicare, and they have their own lab, so maybe I can get it done through there. Unless Garramone requires that you get it done at a specific place?

Quote from: Brett on May 22, 2014, 08:19:09 PM

As an aside, I thought that the government just changed it to Medicare paying for top surgery...or they are in the process of making that happen.  Definitely find out about that.  Google it.  It would suck if you scheduled your surgery only to find out that Medicare starts paying for surgeries beginning one month after you got yours done!

I know they're currently reviewing the topic, but who knows when it will actually happen. I really can't wait any longer and I'm not sure I'll qualify for medicare next year anyway.

Quote from: sbx on May 22, 2014, 09:22:19 PM
Thanks for your replies everyone. I think I'm just going to go ahead and schedule the consultation since waiting is driving me crazy.

No, I actually just started going to a trans-friendly clinic, and I'm supposed to get bloodwork to check my T levels done next week. I can always ask my doctor about it, but I don't see him again until mid-June. The clinic takes medicare, and they have their own lab, so maybe I can get it done through there. Unless Garramone requires that you get it done at a specific place?

I know they're currently reviewing the topic, but who knows when it will actually happen. I really can't wait any longer and I'm not sure I'll qualify for medicare next year anyway.

Most doctors don't have you go to a specific place.  They would want to make sure that you get accurate results from a reputable lab.  At my job, we just give patients a script for bloodwork and they can go to the lab of their choice.  For a medical clearance, they just want to get an overall sense of your health and whether you can be cleared for surgery.  While I don't know this doctor and his requirements, I would be surprised if he only lets you get it done at one place.

A lot of things with insurance depends on your policy.  My insurance covers all of my medical things related to trans things, but I once had an insurance company that denied me doctor's visits, prescriptions, and lab work.  The reason was the way my endo codes my treatment as gender dysphoria.  IF you aren't sure if trans related care is covered by your policy, see if you can get everything coded differently.  For example, if you get a script for bloodwork and it's coded for gender dysphoria, you want to be sure the insurance covers things for that reason.  If not, and you have a nice doctor, they can code things differently as Jess said above.  Bllodwork for surgical clearance probably won't be an issue if coded right, but I would recommend you make sure of it to be safe because just having insurance doesn't always guarantee coverage.

Again, I should note that I'm not a transmale nor do I know anything about top surgery. I just know what I've experienced in my own experiences and from speaking with patients that get bloodwork done on a frequent basis. 

I went to Dr. Gary Lawton and before top surgery he requires two tests done, I think it was a CBC and a CMP, not sure. I went to a place called Any Lab Test Now and it cost me $98. There are other discount labwork places too, definitely worth looking into as it can be much cheaper than getting it done at a doctor's office.

I had a *lot* of blood tests for Dr G. Some of them might have been my age, but here's the list I had:
CBC, electrolyte panel, BUN, CR, CA, Phos, PT, PTT, INR.  (Btw, I copied that from my script.) I had no trouble getting my insurance to pay up. My personal doctor wrote it up. I think she might have said pre-surgery but not sure. They didn't ask *what surgery*.

--Jay

That's good to hear, Jay. I'm pretty sure my doctor will be willing to write it up so that it's covered. If that's not possible for some reason, I'll check out a discount labwork place. Thanks.

Quote from: aleon515 on May 23, 2014, 12:18:55 PM
I had a *lot* of blood tests for Dr G. Some of them might have been my age, but here's the list I had:
CBC, electrolyte panel, BUN, CR, CA, Phos, PT, PTT, INR.  (Btw, I copied that from my script.) I had no trouble getting my insurance to pay up. My personal doctor wrote it up. I think she might have said pre-surgery but not sure. They didn't ask *what surgery*.

--Jay

Interesting.  Garramone sent it to me by email.  I had 3 scripts.  One for bloodwork.  One for my mammogram.  And one for medical clearance.

sbx, you have to get "medical clearance" for surgery from your PCP.  They will know what that means.  Garramone does not require an EKG.  If you are age 35 or over, Garramone requires a mammogram.

Quote from: Brett on May 23, 2014, 09:08:46 PM
Interesting.  Garramone sent it to me by email.  I had 3 scripts.  One for bloodwork.  One for my mammogram.  And one for medical clearance.

sbx, you have to get "medical clearance" for surgery from your PCP.  They will know what that means.  Garramone does not require an EKG.  If you are age 35 or over, Garramone requires a mammogram.

Yes that info was off the script he sent me by email. But my doctor just "rewrote" it. Dr G doesn't require an EKG, my doctor had me have one though as part of the medical clearance thing. I am not sure if it is age, or if she'd require anybody to have one. I think it is dubious what they'd show, but that's just what I read.

--Jay