Susan's Place Transgender Resources

I've been planning my top surgery in my head lately, and my insurance covers top surgery. My question is how soon is too soon to schedule a consult? I don't qualify for insurance to cover it until next fall, and my intention is to have it over winter break 2015.
Should I wait until summer or winter or would now be an OK time? Should I get insurance preapproval (I know the surgery is covered, but I don't know if the surgeon needs to be in network or whatever) before contacting the surgeon?
People say that survey dates tend to fill up quickly, and I just want this to be done really badly at that specific time because of school. I worry about waiting too long and all the days being booked by June or whatever.
The surgeon I want to go to is Rockmore, if that makes any difference. :/

I would say get started now, why the heck not? It would suck if you put off the first appointment, and then there was a complication (etc) and your goal date got delayed because of it. I need to find out about my insurance and everything, but I'm trying to move forward on mine ASAP for the same reason. I don't want to wait any longer than I have to.
P.S. I am just starting as far as looking into mine, and would love to hear feedback on how you went about finding Doctors, insurance info, anything. I'm open to P.M.s, but I'm not sure I set up my profile correctly to receive them...
-Bear

I would start with your insurance company and find out all of the details of what they will cover/what the circumstances have to be in order for them to cover the surgery.

For example, for some insurance plans you have to have been on T for one year before they will pay for it.  There are all different types of rules.  Start there and then move forward with the task of setting up consults and such. 

Right, on mine I have to have 1 year  HRT and 1 year rle "without returning to birth gender", which will be in September of 2015.
I'm really more worried about them approving the surgeon. I was thinking something along the lines of "provided I'm still on male hormones/get contraindicated out of them in September of next year, will this surgeon be covered. "

I'm a bit shocked how specific the insurance companies you guys are talking about are being - you have to be on T for a certain amount of time, etc.?  Is this is in the US?

That aside, some surgeons can have ridiculously long waiting lists even to get an initial consult booked.  So yes, go ahead and try to get the ball rolling.

Yup. There's a mile-long list of it. Really annoying. I'm just imagining them saying to a cancer patient, "Well, we know you HAVE a tumor, but we just need to be sure you want it removed, so we'll wait a year."
Seriously? Like, I understand the reasoning, kinda, but I'd kill for it to just be six months or once you get your name changed, if they need to gatekeep like that.
So frustrating.

QuoteBased on our criteria and assessment of peer-reviewed literature, sex reassignment surgery is considered medically
appropriate when ALL of the following criteria are met:
A. The patient is at least 18 years of age;
B. The patient has been diagnosed with the gender dysphoria, including all of the following:
1. The desire to live and be accepted as a member of the opposite sex, usually accompanied by the wish to make
his or her body as congruent as possible with the preferred sex through surgery and hormone treatment; and
2. The transsexual identity has been present persistently for at least two years; and
3. The condition is not a symptom of another mental disorder or a chromosomal abnormality; and
4. The condition causes clinically significant distress or impairment in social, occupational, or other important
areas of functioning; and
C. The patient is an active participant in a recognized gender dysphoria treatment program; and
D. The patient has undergone a minimum of 12 months of continuous hormonal therapy (unless contraindicated)
when recommended by a mental health professional and provided under the supervision of a physician; and
E. The patient has completed a minimum of 12 months of successful continuous full time real-life experience in
their new gender, with no returning to their original gender, including one or more of the following:
1. Maintain part- or full-time employment; or
2. Function as a student in an academic setting; or
3. Function in a community-based volunteer activity; and
F. Two qualified mental health professionals recommend sex reassignment surgery

ETA: I tried to contact them to update my name, as well, but no one ever got back to me, and this was like three weeks ago. Just tried to log into my account...and forgot the password enough times to get locked out. Their help desk is closed until Monday. I AM MORE THAN SLIGHTLY ANNOYED.

Quote from: devention on October 17, 2014, 07:06:25 PM
Yup. There's a mile-long list of it. Really annoying. I'm just imagining them saying to a cancer patient, "Well, we know you HAVE a tumor, but we just need to be sure you want it removed, so we'll wait a year."
Seriously? Like, I understand the reasoning, kinda, but I'd kill for it to just be six months or once you get your name changed, if they need to gatekeep like that.
So frustrating.ETA: I tried to contact them to update my name, as well, but no one ever got back to me, and this was like three weeks ago. Just tried to log into my account...and forgot the password enough times to get locked out. Their help desk is closed until Monday. I AM MORE THAN SLIGHTLY ANNOYED.

Wow that is quite a list!! I wouldn't meet several of these!! Sad to see this list of semi-unobtainable things (how many cities have "recognized gender clinics"? perhaps just some large cities like Philly and Chicago). I think that may be the way various insurance providers go, sad to say. It's also very binary with requirements like taking HRT and "living as the opposite sex" for some period.

What insurance company is this and what city? I want the trans center here to see a copy of this thing.




--Jay

Quote from: devention on October 17, 2014, 07:06:25 PM
Yup. There's a mile-long list of it. Really annoying. I'm just imagining them saying to a cancer patient, "Well, we know you HAVE a tumor, but we just need to be sure you want it removed, so we'll wait a year."
Seriously? Like, I understand the reasoning, kinda, but I'd kill for it to just be six months or once you get your name changed, if they need to gatekeep like that.
So frustrating.ETA: I tried to contact them to update my name, as well, but no one ever got back to me, and this was like three weeks ago. Just tried to log into my account...and forgot the password enough times to get locked out. Their help desk is closed until Monday. I AM MORE THAN SLIGHTLY ANNOYED.

This is just a bit much.  What a laugh.

It honestly seems like a massive step backwards to me - that this kind of gatekeeping is happening in a country like the U.S. 

It's not enough to have a diagnosis of Gender Dysphoria from a qualified mental health specialist who can attest to whether or not the other outdated and ridiculous criteria even apply to the patient?  IMHO it's the MHP's job to assess the readiness of the candidate for surgery, not the insurance company.

My insurance list is nearly as bad as yours. Do you know if Rockmore accepts insurance?

I have been talking to my insurance a lot. With mine, the pre-approval for the surgeon is only good for 6 months. So you might want to ask insurance about that. I am currently working on the form and it's confusing. My doctor doesn't understand it either. And if anything is done wrong, they won't pre-approve so add in time for that.

As Jay said, insurance doesn't want to pay for surgery. They are going to deny it if at all possible and then you have to resubmit so plan on that.

Quote from: chipper on October 18, 2014, 11:36:35 AM
Rockmore's office is really great when it comes to working with their patient's schedules. I had a consult in January and when I walked out I was scheduled for surgery in February. I even called to change the date several times, without issue.
Rockmore definitely takes insurance. I know this because I went to Rockmore and paid out of pocket- to pay out of pocket I had to sign all these waivers acknowledging that I didn't want to use insurance. I also had a friend who used insurance to pay for his surgery with Rockmore.

What surgery was done and how much was it all?

Quote from: chipper on October 18, 2014, 12:11:18 PM
I had a "bilateral subcutaneous mastectomy with free nipple grafts for gender transformation." Grand total was $6,479.

Uhhhh aside from medical terms...*looks at pics* Double incision, correct?

Yup!

Quote from: aleon515 on October 17, 2014, 11:59:43 PM
Wow that is quite a list!! I wouldn't meet several of these!! Sad to see this list of semi-unobtainable things (how many cities have "recognized gender clinics"? perhaps just some large cities like Philly and Chicago). I think that may be the way various insurance providers go, sad to say. It's also very binary with requirements like taking HRT and "living as the opposite sex" for some period.

What insurance company is this and what city? I want the trans center here to see a copy of this thing.




--Jay

My insurance is through blue Cross blue shield of Rochester (excellus).
Is that what the "recognized treatment program" is? I thought it just meant I had to be in therapy (which I am).

Quote from: devention on October 18, 2014, 12:54:23 PM
Yup! My insurance is through blue Cross blue shield of Rochester (excellus).
Is that what the "recognized treatment program" is? I thought it just meant I had to be in therapy (which I am).

Thanks. I don't know what they are defining as a "recognized treatment center". I saw my PA and a mental health counselor. The counselor was out of the transgender resource center. But that's not a treatment center.  I'm pretty sure that's not what they mean. Something like Mazzoni (in Philly) but there are very few of those in the country.

--Jay

Quote from: aleon515 on October 18, 2014, 02:24:44 PM
Thanks. I don't know what they are defining as a "recognized treatment center". I saw my PA and a mental health counselor. The counselor was out of the transgender resource center. But that's not a treatment center.  I'm pretty sure that's not what they mean. Something like Mazzoni (in Philly) but there are very few of those in the country.

--Jay

I'll check with them when I talk to them about everything else. I'm not tremendously far from Philly (like six hours). I could go there for a long weekend or something, if need be.
http://tinyurl.com/BCBSPolicy here is the whole policy if you're interested.

Thanks. Wow, very restrictive as well. Seems like a step back except they are paying, but as others mentioned quite a lot of gatekeeping. Perhaps is going to be inevitable. I'm guessing Dr Garramone and other doctors who don't want to take insurance will be able to as long as they want.

--Jay

Quote from: aleon515 on October 18, 2014, 05:54:07 PM
Thanks. Wow, very restrictive as well. Seems like a step back except they are paying, but as others mentioned quite a lot of gatekeeping. Perhaps is going to be inevitable. I'm guessing Dr Garramone and other doctors who don't want to take insurance will be able to as long as they want.

--Jay

Oh, I have no doubts about that. I'd give it at least five to seven years before we see reform on the "standards of care" related to trans health care, if not ten.
I was really surprised they covered it at all, to be honest. And if it's necessary, phone calls and a ride down to Philly are WAY less expensive than seven grand for surgery. The only tax is my mental health and I don't have a reliable price scale for that lol

Quote from: Kreuzfidel on October 18, 2014, 04:21:24 AM
This is just a bit much.  What a laugh.

It honestly seems like a massive step backwards to me - that this kind of gatekeeping is happening in a country like the U.S. 

It's not enough to have a diagnosis of Gender Dysphoria from a qualified mental health specialist who can attest to whether or not the other outdated and ridiculous criteria even apply to the patient?  IMHO it's the MHP's job to assess the readiness of the candidate for surgery, not the insurance company.

Actually, Kreuzfidel, he is pretty lucky that he has insurance that covers it at all.  That is pretty new here in the U.S. and it is a very small percentage of companies covering the surgery (or any trans health care).

What jumped out for me with that criteria list is the vocation part.  What about the person who is disabled or is simply a homemaker (clearly the policy holder's spouse/partner)?  It says someone at least has to be volunteering with a recognizable group.  I think the motivation behind the list of working, volunteering, etc., is to show that the person is active outside their home...as if the only gender dysphoria one has is social dysphoria (because you know when we are alone we don't mind our boobs! <eye roll>).  I can't think of any other reason for that piece of criteria.

But, yes, bottom line is that the companies want to boast that they pay for trans related care, but really they don't want to pay for it.

Quote from: Brett on October 18, 2014, 08:10:03 PM
Actually, Kreuzfidel, he is pretty lucky that he has insurance that covers it at all.  That is pretty new here in the U.S. and it is a very small percentage of companies covering the surgery (or any trans health care).

What jumped out for me with that criteria list is the vocation part.  What about the person who is disabled or is simply a homemaker (clearly the policy holder's spouse/partner)?  It says someone at least has to be volunteering with a recognizable group.  I think the motivation behind the list of working, volunteering, etc., is to show that the person is active outside their home...as if the only gender dysphoria one has is social dysphoria (because you know when we are alone we don't mind our boobs! <eye roll>).  I can't think of any other reason for that piece of criteria.

But, yes, bottom line is that the companies want to boast that they pay for trans related care, but really they don't want to pay for it.

I was thinking it was just to prove that you're trying to pass in public or something? IDK. I'm a college student and I will hopefully have a job tomorrow, so.
I think the thing that bugs me the most is "successful". Like. Folks, if you don't pass, you don't get the surgery...that will help you pass.
ugh.

Yeah that one did too, and was one of the reasons I said I wouldn't qualify. I'm retired, of course, I'm now on Medicare which started covering this.(I guess I'm volunteering, but still...) But there are reasons that maybe someone would not be working. However, you are right it's a start, but it seems they are working on ways to refuse someone in a more "legitimate way". I'm pretty sure they realize the handwriting is on the wall of them refusing outright. It's not going to be allowed too much longer.

The place I minded them the most was in front of my mirror!!

--Jay

Quote from: Brett on October 18, 2014, 08:10:03 PM



Actually, Kreuzfidel, he is pretty lucky that he has insurance that covers it at all.  That is pretty new here in the U.S. and it is a very small percentage of companies covering the surgery (or any trans health care).

What jumped out for me with that criteria list is the vocation part.  What about the person who is disabled or is simply a homemaker (clearly the policy holder's spouse/partner)?  It says someone at least has to be volunteering with a recognizable group.  I think the motivation behind the list of working, volunteering, etc., is to show that the person is active outside their home...as if the only gender dysphoria one has is social dysphoria (because you know when we are alone we don't mind our boobs! <eye roll>).  I can't think of any other reason for that piece of criteria.

But, yes, bottom line is that the companies want to boast that they pay for trans related care, but really they don't want to pay for it.

Quote from: aleon515 on October 18, 2014, 10:43:35 PM
Yeah that one did too, and was one of the reasons I said I wouldn't qualify. I'm retired, of course, I'm now on Medicare which started covering this.(I guess I'm volunteering, but still...) But there are reasons that maybe someone would not be working. However, you are right it's a start, but it seems they are working on ways to refuse someone in a more "legitimate way". I'm pretty sure they realize the handwriting is on the wall of them refusing outright. It's not going to be allowed too much longer.

The place I minded them the most was in front of my mirror!!

--Jay

No kidding!

Quote from: devention on October 18, 2014, 09:30:40 PM
I was thinking it was just to prove that you're trying to pass in public or something? IDK. I'm a college student and I will hopefully have a job tomorrow, so.
I think the thing that bugs me the most is "successful". Like. Folks, if you don't pass, you don't get the surgery...that will help you pass.
ugh.

Nah, you're alright, student is on the list.  Maybe you are right about it being that the person is trying to pass in public.

Also, wanted to follow up my comment about it being still rare that insurance companies cover it...I am not including the states that now require companies to cover it (CA, for example).  I also wonder if it is because CA covers trans health care that Crane is so busy with bottom surgeries.  I bet his numbers went up when Medicaid started paying for it.

Quote from: Brett on October 19, 2014, 08:44:33 AM
Nah, you're alright, student is on the list.  Maybe you are right about it being that the person is trying to pass in public.

Also, wanted to follow up my comment about it being still rare that insurance companies cover it...I am not including the states that now require companies to cover it (CA, for example).  I also wonder if it is because CA covers trans health care that Crane is so busy with bottom surgeries.  I bet his numbers went up when Medicaid started paying for it.

Yeah, I'd love to see the numbers on that one.

Yeah, I was just saying that I passed that particular qualification lol. This whole thing is frustrating. On the one hand, I'm immensely grateful that my insurance covers GCS, given that where I live, it's not required. On the other, it's so frustrating that I have to wait for so long. Yet I'd have to wait longer if insurance didn't cover it, because I'm on enough debt from school already, and that debt is only going to get deeper from here.
Still. It's something.