Susan's Place Transgender Resources

Does anybody know of any surgeons who will accept medicare?

Rarer than unicorns, I'm afraid.

Marci Bowers filed a claim with medicare in August 2014.  I haven't heard how that worked out.


http://marcibowers.com/ftm/victory-medicare-to-cover-transgender-services/

Not a single one. I have E-mailed and called all in the United States. I am stuck with this myself. If anyone says they do, um, they don't. No one is more interested or concerned of this than me I guarantee!  :)

Quote from: Randi on October 14, 2014, 06:27:31 PM
Marci Bowers filed a claim with medicare in August 2014.  I haven't heard how that worked out.


http://marcibowers.com/ftm/victory-medicare-to-cover-transgender-services/

Her reimbursement was not enough from Medicare, so it will probably never be a reality.  :(

I assume that a surgeon has to agree to accept what Medicare offers as payment in full.

There's no way to make up the difference?

Quote from: Jessica Merriman on October 14, 2014, 06:28:59 PM
Her reimbursement was not enough from Medicare, so it will probably never be a reality.  :(

Quote from: Randi on October 14, 2014, 06:56:06 PM
There's no way to make up the difference?

Not legally. They just have to accept what they give. The thing that bothers me is she takes Medicare in her OB/Gyn practice. Why discriminate or choose one type of patient over the other for coverage? That is my question to Medicare. I have not gotten an answer yet. ???

Quote from: Jessica Merriman on October 14, 2014, 06:28:59 PM
Her reimbursement was not enough from Medicare, so it will probably never be a reality.  :(

Do you know how much is medicare willing to pay?

How much will Medicare pay? From what I see on Addendum B for (If I'm reading this right) HCPCS Codes 57291 Construction of Vagina or 57292 Construct Vagina with Graft both pay $2,522.58 - with a minimum unadjusted co-payment of $504.52. This is the Physician Fee only. This does not include the hospitalization which would be covered under Part A Medicare.

Also, quoted reimbursement does not include Orchi or any other procedure removal of testis 54520 is $2,599.64 - minimum co-pay $519.93.

Quote from: traci_k on October 15, 2014, 06:58:55 AM
How much will Medicare pay? From what I see on Addendum B for (If I'm reading this right) HCPCS Codes 57291 Construction of Vagina or 57292 Construct Vagina with Graft both pay $2,522.58 - with a minimum unadjusted co-payment of $504.52. This is the Physician Fee only. This does not include the hospitalization which would be covered under Part A Medicare.

Also, quoted reimbursement does not include Orchi or any other procedure removal of testis 54520 is $2,599.64 - minimum co-pay $519.93.

Thank you Traci !

So that is why they do not accept it...

The lifting of the trans care exclusions is just  pre election strategy to get trans supporters who do not know the details to vote for the incumbent party, that's all. Nothing has changed at all. People are so easily distracted. I figure after the general elections Medicare will reverse because of lack of people using the provisions even though there are none or "public" outcry over funding it will succeed in also getting a reversal. I would not expect it to stand. :(

The only trans related care I have had covered is HRT under the drug plan. 90 days of Spiro, "E", "P" and syringes/needles is only $13.00  a refill.

Quote from: Jessica Merriman on October 15, 2014, 06:43:21 PM
The lifting of the trans care exclusions is just  pre election strategy to get trans supporters who do not know the details to vote for the incumbent party, that's all. Nothing has changed at all. People are so easily distracted. I figure after the general elections Medicare will reverse because of lack of people using the provisions even though there are none or "public" outcry over funding it will succeed in also getting a reversal. I would not expect it to stand. :(

The only trans related care I have had covered is HRT under the drug plan. 90 days of Spiro, "E", "P" and syringes/needles is only $13.00  a refill.

Yup.  Lip service.  That's all we get.  I guess it's better than outright hatred, but at the end of the day we're still the same turds stuck to the bottom of society's shoes no matter who is running the show.  Politicians are there to serve their corporate masters' shareholders interests, not justice... and clearly not us.

/bitterness

I share your bitterness Jill!  >:(

I have to respectfully disagree about coverage being reversed. The coverage came about on an appeal for coverage, I believe in Arizona. The government lost on the appeal by board that recognized that SRS and other related care is not experimental, has proven effective and does meet a real need. Reimbursement amounts are another issue we in the hospital industry face. The fact is that there is a limited number of physicians who do provide these services and therefore can charge what the market will bear. I would love to find a physician who does quality SRS and introduce them to our hospital management. As we see greater acceptance of transsexual individuals by society, we are also seeing greater numbers coming out of the closet in the older years and we are seeing many more younger people, with the support of their parents seeking trans-related care. I think we are going to see a greater need for physicians providing these surgeries. I believe there are now 5 states that mandate insurance coverage and I'm going to guess that as with the growing number of states with Same Sex Marriage, more states, as the recognize the need for trans-gender health services, will mandate expansion of coverage. Again, this will fuel the need for more physicians.

What can we do? The chances of getting Medicare to increase rates is unlikely as quite a bit of Medicare money was moved to fund expansion of Obamacare. We can gather the facts much as we do here about the numbers of suicide attempts, 41% as we seen reported here, explain the pain and suffering that those who suffer from GD endure and lobby the state governors and insurance boards to expand coverage. Yes many would like to transition and go stealth, there are others like Kate Bornstein and others who are activists for transgender rights. We also need to educate the public that transgender health services, SRS and FFS, while seemingly cosmetic surgeries, can be needed life saving interventions.

I'll get off my soapbox now but hopefully there a few ideas that might inspire some people to action. The only reason I found out about the Medicare change was that I was trying to get a petition going on the We the People White House website and unfortunately I couldn't get more than a few people to sign on, even from the other forum I used to frequent. I had put it out in May and found that Medicare had just lost the appeal and the Trans-woman in Arizona, I believe, was going to have her surgery covered. Now, who did the surgery, or was there a doctor who accepted the Medicare reimbursement? I don't know.

Well it's disheartening to hear that no surgeons accept medicare, but i don't give up easily. I am going to whine and fight and put up the biggest stink that I can until they do. Even if I have to camp out on a surgeon's front lawn, someone's taking my medicare!!!

File a petition on the White House web page and get the word out, I think it is 50 k signatures then the President's office has to officially comment on it. It might not result in any changes but at least they can't hide behind an intern sending responses.

Ehhh just something to think about:

Let's assume a surgeon will accept Medicare.
Appointment is set.
You get everything in order.
You come in.
The procedure is done.
You wake up.
The results are not as good as you have thought. You've seen pictures and the results were MUCH better than what you seen in a consultation.
You can sue, make a news story of it and raise hell to get a settlement but the damage has been done.

I don't know, I feel like if they accept it that won't stop them from doing a less than desirable job on you.

Quote from: Marcellow on October 17, 2014, 09:46:46 AM
Ehhh just something to think about:

Let's assume a surgeon will accept Medicare.
Appointment is set.
You get everything in order.
You come in.
The procedure is done.
You wake up.
The results are not as good as you have thought. You've seen pictures and the results were MUCH better than what you seen in a consultation.
You can sue, make a news story of it and raise hell to get a settlement but the damage has been done.

I don't know, I feel like if they accept it that won't stop them from doing a less than desirable job on you.

I just noticed your ticker , congrats

White Rabbit,

That's what I did. I forget how many signatures were needed to get it open to the public, something like 50 to 100 or so. Unfortunately could only get about 20. Not to mention the thousands to get a response from the WH. If anybody else is up for starting another one asking for Medicare Reimbursement to be enough to induce surgeons to start accepting Medicare for SRS, let me know, I'll sign and re-publicize. That's what we need to do, keep networking and gather some momentum.

Hugs,

 Put the link up. I haven't seen it.

Sorry Kate,

The link has expired, it had until mid July to get the requisite number of signatures to get it to go public.

It was   http://wh.gov/lHsnA but all you get now is that the petition has expired.

The National Center for Lesbian Rights along with the ACLU, Gay & Lesbian Advocates & Defenders (GLAD), and a New Mexico civil rights attorney filed the successful challenge to Medicare's ban. For more information on what is happening now and how to find a doctor, you can contact Amy Whelan at NCLR at 1-800-528-6257.

My therapist told me in our last session she signed off on for surgery for someone that has found a surgeon in Indiana that accepted medicare.  I will check with her for clarification to make sure she not meant medicade but she said medicare.  I'll post an update when I get a response from her about the doctor.  So don't get high hopes yet, as I am some what in this boat too.

Medicaid does not yet cover SRS so I would guess she meant medicare. It does not mean this doctor will accept more medicare patients though.

I become eligible for Medicare on Jan 1 so I will be calling the above line for Amy Whelan at NCLR later today.

I know there was some talk earlier about Dr Rumner possibly accepting it, but I never saw either way.

She said it was Dr. Matthew Mellon of Indianapolis that accepted medicare for SRS.  Let me know if you have any success.  It appears he is out of IU University Health.

As an update do not call Ms. Whelan directly.  They have to check for conflict of interest first so you need to go through the helpdesk.

Can we please have a topic on insurance instead of these posts, everywhere. I am looking keep update with what is going on as well and I am having to hunt these posts down.  ;D I hope more doctors will take medicare. Right now as I have read Washington state and Oregon will have medicaid provide services for HRT, and SRS. I do hope these states will take medicare. ;D

Staci - there is a fundamental difference between Medicare and Medicaid - Medicare is federally provided insurance for seniors 65yo and over - guidelines and standards are enforced nationally - Medicaid is a combined state/federal program for low income families - quidelines and standards are determined by each state with the majority of funding being supplied by federal government - the few states that do provide Medicaid funds for transgender procedures is no indication of when/if the federal government will ever get around to fully endorsing them

be well
jenifer

Never heard back from NCLR.  Been busy with a move so haven't followed up on my end yet.


Just to clarify the above post, Medicare is NOT just for seniors.  It is a program administrated by the Social Security Administration.  Yes, it covers seniors, it also covers those of use with SSA approved disabilities receiving SSDI after a year.

I tried calling the 1-800-528-6257 number on a previous post here. As anybody had any success with that number or any more resources?

2 years later, just wondering if anyone has a list of SRS/GRS (Vaginoplasty) surgeons who accept Medicare in the US?

The trans Healthcare has a tool to search for this kind of information. Select the operation, select the state, and select the coverage ie insurance medicaid or medicare and submit. That is all there is to it. Surgeons that  meet the criteria are listed.

http://www.transhealthcare.org/find-surgeon/

Hope this helps,
   Laurie

Medicare 101 for the Trans Community. . .

First, Medicare does not pay as much for surgical procedures. In some cases it pays quite a bit less. Surgical Practices that have long waiting lists have absolutely no incentive to take Medicare patients that they will make a lot less money on, for doing the exact same procedure.

Once a Practice accepts a single Medicare patient the Practice then has to accept ALL Medicare patients in the future. Again, successful practices would not want to be deluged with a lot of low profit Medicare patients so they wont take the first one. Also, its against the law for you to offer to pay the difference.

Medicare uses regional "Medicare Administrative Contractors" to work with local Healthcare providers.  These Contractors decide what procedures will get paid for in their areas. This is a very important bit of information.  It means that what is paid for by Medicare in one part of the country may not be readily paid for in another part of the country. These contractors work first with the Healthcare providers in their region. So you may live in a Region that is governed by one Contractor but could travel to a Region for a procedure that will be handled/governed by a different Contractor.

Soooo . . .what does all this mean to us. . .here's my thoughts and what I've done . .

Look to the Surgical practices and programs associated with University Hospitals.  They already take Medicare and theoretically have to take Medicare patients for our surgeries. Regional Medicare Administrative Contractors are going to be less likely to question or turn down a major university medical center looking for reimbursement.

For friendly Medicare Administrative Contractors look to the more gender friendly areas of the country. Look to the East and West coasts. . . .

All this info is what I discovered over the last 6 months as I sought to get Medicare to pay for my GCS next week which it appears they will . . . .

So if I lived in Central USA, and have Medicare, I could still fly out to either coast and get the surgery there and get Medicare to cover it?  Mind sharing which hospital / surgeon you are going with?

Thanks for the tips.

Quote from: LadyStaci on October 28, 2014, 09:27:29 AM
Can we please have a topic on insurance instead of these posts, everywhere. I am looking keep update with what is going on as well and I am having to hunt these posts down.  ;D I hope more doctors will take medicare. Right now as I have read Washington state and Oregon will have medicaid provide services for HRT, and SRS. I do hope these states will take medicare. ;D

Kaiser in WA, OR and CA does. I am on medicare and they have offered me counseling, voice and mentoring, orchi if I want it. and other surgeries if you medically qualify that usually takes a couple approvals. You are required to join their Transgender program before any solutions are administered. They also supplied a social worker to help with id's, finding support groups etc.  https://thrive.kaiserpermanente.org/care-near-you/southern-california/transgender/

Quote from: JennJenn on August 05, 2017, 12:10:24 AM
2 years later, just wondering if anyone has a list of SRS/GRS (Vaginoplasty) surgeons who accept Medicare in the US?

After I did a fairly thorough search to no avail,I had my primary care doctor's office do a search. There are no doctors in the US willing to perform vaginoplasty for medicare patients, as Medicare will only pay about 20% of what they want. You might be able to get everything except the surgeon paid for through medicare, but you would still be responsible for paying your surgeon out of pocket.

Using the forum search feature, I found three threads of interest but there might be more. This isn't a recommendation as I am not studying surgery for myself and I don't know the detail of the surgeons.

https://www.susans.org/forums/index.php/topic,213990.msg1895130.html#msg1895130
https://www.susans.org/forums/index.php/topic,178561.msg1875978.html#msg1875978
https://www.susans.org/forums/index.php/topic,203419.msg1809693.html#msg1809693

Quote from: JennJenn on August 05, 2017, 02:55:32 PM
So if I lived in Central USA, and have Medicare, I could still fly out to either coast and get the surgery there and get Medicare to cover it?  Mind sharing which hospital / surgeon you are going with? Thanks for the tips.

I live in the Central USA and that's exactly what I'm doing . . .  I'm also logging in comments about my experience on the GCS Forum here   https://www.susans.org/forums/index.php/topic,226115.0.html

There are 2 surgeons that I know of that do accept Medicare for GRS surgery here in Los Angeles, California. The first is Dr. Garcia at Cedar Sinai Hospital and Dr. Josef Hadeed at Plastic Surgery Center.