Susan's Place Transgender Resources

Community Conversation => Transsexual talk => Female to male transsexual talk (FTM) => Topic started by: Nygeel on February 04, 2012, 10:59:37 PM

Title: Top Surgery Insurance Loop Hole
Post by: Nygeel on February 04, 2012, 10:59:37 PM
Somebody I spoke to said he had top surgery completely covered by insurance which was amazing to me. I'm not sure if this works, or who would be comfortable with it but free surgery? Sounds like a good thing to me!

Pretty much this guy had approached it with the intent of having a family history of breast cancer. He had to get mammograms and he had top surgery as a preventative measurement against breast cancer. Or at least, that's how it was coded on paperwork. It was really just getting top surgery.
Title: Re: Top Surgery Insurance Loop Hole
Post by: wheat thins are delicious on February 04, 2012, 11:10:07 PM
The only problem with that is you have to find a surgeon who is willing to construct your chest in a male fashion during the surgery.  There is also the "reduction" method, if you can find a surgeon who will take you all the way down and reconstruct your chest in a male manner.  I've definitely heard of both methods being used but you have to find the right surgeons.
Title: Re: Top Surgery Insurance Loop Hole
Post by: Nygeel on February 04, 2012, 11:20:36 PM
Quote from: Andy8715 on February 04, 2012, 11:10:07 PM
The only problem with that is you have to find a surgeon who is willing to construct your chest in a male fashion during the surgery.  There is also the "reduction" method, if you can find a surgeon who will take you all the way down and reconstruct your chest in a male manner.  I've definitely heard of both methods being used but you have to find the right surgeons.
Can't go to a top surgeon (ex: Garramore) and have them sign it off as preventing breast cancer?
Title: Re: Top Surgery Insurance Loop Hole
Post by: Epi on February 05, 2012, 12:31:55 AM
This would fall under health care fraud.  Yes, there are some understanding physicians out there, but this type of leniency is usually because the healthcare provider and administrators want to bill the insurance for more services and are even willing to bill non-covered services as visits/procedures that are covered in order to bring in more $$$.
Title: Re: Top Surgery Insurance Loop Hole
Post by: Adio on February 05, 2012, 12:55:57 AM
Hmm...I'm sure some might but probably not that many.  Garramone definitely does not though.  I don't think he messes with insurance at all.  Not sure about anyone else.
Title: Re: Top Surgery Insurance Loop Hole
Post by: wheat thins are delicious on February 05, 2012, 07:54:31 AM
Quote from: Epi on February 05, 2012, 12:31:55 AM
This would fall under health care fraud.  Yes, there are some understanding physicians out there, but this type of leniency is usually because the healthcare provider and administrators want to bill the insurance for more services and are even willing to bill non-covered services as visits/procedures that are covered in order to bring in more $$$.

I don't believe getting a legit reduction but having more tissue taken off than usual is fraud.  It's still a reduction.

Quote from: Nygeel on February 04, 2012, 11:20:36 PM
Can't go to a top surgeon (ex: Garramore) and have them sign it off as preventing breast cancer?

Garramone doesn't deal with insurance, but there are some surgeons out there who are known for top surgery who do, not sure the exact ones though.
Title: Re: Top Surgery Insurance Loop Hole
Post by: Epi on February 05, 2012, 05:12:47 PM
Quote from: Andy8715 on February 05, 2012, 07:54:31 AM
I don't believe getting a legit reduction but having more tissue taken off than usual is fraud.  It's still a reduction.

The intentional deception for personal gain is fraud.  Now, having one procedure performed under the "guise" of something else that is covered even though in actuality you are having a different procedure that isn't covered is fraud.   

If a patient had breast reduction to reduce back pain, etc after other options had failed, that would be covered.  Now, if a patient claimed back pain and found a physician/surgeon willing to "perform" a "reduction" but in reality it was a complete mastectomy with chest reconstruction, that would be fraud.  There's a lot of reasons medical insurance and billing policies are so screwed up, but committing fraud isn't the solution.
Title: Re: Top Surgery Insurance Loop Hole
Post by: Nygeel on February 05, 2012, 05:39:11 PM
Then don't most of us need some sort of health insurance fraud in order to get some coverage? Like marking on insurance male, and saying we have low testosterone to cover hormones...or anything like that? I know if you say "GID" then you tend to not get coverage.
Title: Re: Top Surgery Insurance Loop Hole
Post by: Adio on February 05, 2012, 06:02:09 PM
Quote from: Nygeel on February 05, 2012, 05:39:11 PM
Then don't most of us need some sort of health insurance fraud in order to get some coverage? Like marking on insurance male, and saying we have low testosterone to cover hormones...or anything like that? I know if you say "GID" then you tend to not get coverage.

I guess I see it a little differently.  How is putting "male" on insurance fraud?  I am a male, just an "atypical" one.  I'm not sure what my endo puts.  Either hypogonadism (which I've told her I wasn't comfortable using) or endocrine disorder NOS (which was my initial suggestion).  Low T was another one of her options.  I do have naturally low T, so why not put it?  I have a medical condition in which I have lower amounts of testosterone than the average male, but it's not exactly hypogonadism or another easily codable condition.  So to me endocrine disorder NOS fits.  Whatever she puts I'm sure that she can back it up legitimately.  This woman isn't about to risk her license over me. 

I know of another trans guy who used to help others get surgeries legally covered by insurance.  Sometimes even in cases where the policy excludes trans related surgeries.  Unfortunately he isn't offering those services anymore.  There are some of his tips on various yahoo groups though.  You may have already heard of him since you live in NY.  If you want, I can PM you info I have on him.
Title: Re: Top Surgery Insurance Loop Hole
Post by: wheat thins are delicious on February 05, 2012, 06:08:11 PM
Quote from: Nygeel on February 05, 2012, 05:39:11 PM
Then don't most of us need some sort of health insurance fraud in order to get some coverage? Like marking on insurance male, and saying we have low testosterone to cover hormones...or anything like that? I know if you say "GID" then you tend to not get coverage.

I think that a legal female can be prescribed testosterone if the doctor bills it as hypogonadism on the insurance or a hormone imbalance.

Quote from: Adio on February 05, 2012, 06:02:09 PM
I know of another trans guy who used to help others get surgeries legally covered by insurance.  Sometimes even in cases where the policy excludes trans related surgeries.  Unfortunately he isn't offering those services anymore.  There are some of his tips on various yahoo groups though.  You may have already heard of him since you live in NY.  If you want, I can PM you info I have on him.

He still does it but you have to go through his website, and he charges based on how thoroughly you want your insurance plan looked at and how many suggested doctors, etc you want.  That is, if you are talking about who I think you are.
Title: Re: Top Surgery Insurance Loop Hole
Post by: Epi on February 05, 2012, 06:21:11 PM
Quote from: Nygeel on February 05, 2012, 05:39:11 PM
Then don't most of us need some sort of health insurance fraud in order to get some coverage? Like marking on insurance male, and saying we have low testosterone to cover hormones...or anything like that? I know if you say "GID" then you tend to not get coverage.

Where's my red pen?!  I get what you're asking and while doing things the honest way can be more time consuming and frustrating, just because it's more difficult doesn't mean you need to resort to fraud.  There are plenty of other options that don't include fraud such as private insurance individuals can obtain, plenty of public (and private) university systems, public/private sector jobs, etc offer health insurance that also covers HRT/SRS.  There's also a lot of clinics aimed at providing medical care to low-income individuals at a signifncantly reduced cost that also provide a lot of services for transgender patients. 

Fraud is both a criminal and civil matter, in most states the statue of limitations is 7 to 10 years.  By committing fraud you run the risk of facing a whole gauntlet of legal consequences from jail time, to paying restitution, to forfeiture of assets (if they're not seized) to pay judgment.  You basically would mark yourself for life as un-insurable unless you were willing to pay a ridiculously high premium or had a damn good union job.

Committing medical insurance fraud only lines the doctors and medical insurance companies pockets with more money and puts individuals such as you and I at a great disadvantage. 

Title: Re: Top Surgery Insurance Loop Hole
Post by: Nygeel on February 05, 2012, 06:32:32 PM
Quote from: Epi on February 05, 2012, 06:21:11 PM
Where's my red pen?!  I get what you're asking and while doing things the honest way can be more time consuming and frustrating, just because it's more difficult doesn't mean you need to resort to fraud.  There are plenty of other options that don't include fraud such as private insurance individuals can obtain, plenty of public (and private) university systems, public/private sector jobs, etc offer health insurance that also covers HRT/SRS.  There's also a lot of clinics aimed at providing medical care to low-income individuals at a signifncantly reduced cost that also provide a lot of services for transgender patients. 

Fraud is both a criminal and civil matter, in most states the statue of limitations is 7 to 10 years.  By committing fraud you run the risk of facing a whole gauntlet of legal consequences from jail time, to paying restitution, to forfeiture of assets (if they're not seized) to pay judgment.  You basically would mark yourself for life as un-insurable unless you were willing to pay a ridiculously high premium or had a damn good union job.

Committing medical insurance fraud only lines the doctors and medical insurance companies pockets with more money and puts individuals such as you and I at a great disadvantage.
This is my situation...I get my health insurance from my parents. I have severe problems that make it hard to get a job (let alone a full time job). Trying to find a job that I'm able to do, and will hire me full time, and give me insurance that will cover everything is very very very hard to find. Places may provide medical care (Ex: hormones) to trans people at sliding scale if they don't have insurance where as if you do have insurance and the insurance doesn't cover it, you're out of luck. On top of that, there's almost no coverage for surgery.

Look, I get what you're saying but I think that it might be worth the risk for some people. I know getting enough money for surgery would end up taking me years upon years upon years. I also know that there are a lot more people out there in worse situations than I'm in that have way more extreme body discomfort. Whole health care system is in need of a fixin'. 'Cause the way it is now, we're all screwed.
Title: Re: Top Surgery Insurance Loop Hole
Post by: Bahzi on February 05, 2012, 07:04:40 PM
Quote from: Nygeel on February 05, 2012, 05:39:11 PM
Then don't most of us need some sort of health insurance fraud in order to get some coverage? Like marking on insurance male, and saying we have low testosterone to cover hormones...or anything like that? I know if you say "GID" then you tend to not get coverage.

Pretty much, and I don't feel guilty about it either.  I pay nearly $200 a month for my (high deductible) health insurance, only to have Humana deny my HRT blood work claims through my previous physician, because they were billed with the 'correct' codes, and my plan had trans-exclusions (which wasn't mentioned in my benefits description, either, mind you).

Now I go to Howard Brown Health Center in Chicago (a 10 hour round trip), and they bill it as an endocrine disorder, so it's covered.   Howard Brown does sliding scale for those without health insurance, but since I actually have health insurance, I don't qualify.   Dropping my health insurance to get into their low-income HRT program would be irresponsible due to my other health conditions.   For years I didn't have health insurance and the tax payers got to cover my ER visits.  I feel way worse about that than I do Howard Brown making Humana cover some blood work for a plan both my employer and I pay out the nose for.

Howard Brown has good lawyers, they can legitimize their diagnosis of endocrine disorder if need be (and certainly in my case since the T keeps my endometriosis symptoms almost non-existent after other treatments failed), but even if they couldn't, I wouldn't be the one in trouble for committing fraud.

It's a really nice, pie-in-the-sky idea that trans people should just look for jobs with insurance that cover their treatment, but logistically, most people aren't in a great position to be finding new jobs during transition.  It's a horrid job market for anyone right now, let alone if you don't pass or if your documents don't match up.  Private insurance is prohibitively expensive (and are great at crying 'pre-existing condition!' to avoid coverage), college is prohibitively expensive, and it's shocking how few LGBT clinics there are that actually provide HRT services.

The fact is, insurance companies should be covering these things anyways (actually, we should have socialized medicine, you can't claim to be the greatest country on earth when over a quarter of your citizens can't get antibiotics).  By all means, exhaust all the proper, legit channel methods first before resorting to 'creative billing' (I sure did), but if you're got a practitioner or surgeon who knows how to swing things in your favor, I certainly don't judge anyone for it.   
Title: Re: Top Surgery Insurance Loop Hole
Post by: Epi on February 05, 2012, 07:41:58 PM
Quote from: Nygeel on February 05, 2012, 06:32:32 PM
This is my situation...I get my health insurance from my parents. I have severe problems that make it hard to get a job (let alone a full time job). Trying to find a job that I'm able to do, and will hire me full time, and give me insurance that will cover everything is very very very hard to find. Places may provide medical care (Ex: hormones) to trans people at sliding scale if they don't have insurance where as if you do have insurance and the insurance doesn't cover it, you're out of luck. On top of that, there's almost no coverage for surgery.

Look, I get what you're saying but I think that it might be worth the risk for some people. I know getting enough money for surgery would end up taking me years upon years upon years. I also know that there are a lot more people out there in worse situations than I'm in that have way more extreme body discomfort. Whole health care system is in need of a fixin'. 'Cause the way it is now, we're all screwed.

I know a number of individuals whose grad schools insurance covered HRT/SRS.  That may be a very viable option for you.  Others volunteered at LGBT non-profits and eventually were offered paying positions that came with coverage.

It may be worth the risk now but later on what if you or someone on the policy has a major illness or suffers a serious injury?  The insurance company is going to look through everything with a fine tooth comb doing everything possible not to pay.  If you want to commit fraud move to Alabama, the statue of limitations is only 2 years so long as it's not tax evasion.




Quote from: Bahzi on February 05, 2012, 07:04:40 PM
Pretty much, and I don't feel guilty about it either.  I pay nearly $200 a month for my (high deductible) health insurance, only to have Humana deny my HRT blood work claims through my previous physician, because they were billed with the 'correct' codes, and my plan had trans-exclusions (which wasn't mentioned in my benefits description, either, mind you).

Now I go to Howard Brown Health Center in Chicago (a 10 hour round trip), and they bill it as an endocrine disorder, so it's covered.   Howard Brown does sliding scale for those without health insurance, but since I actually have health insurance, I don't qualify.   Dropping my health insurance to get into their low-income HRT program would be irresponsible due to my other health conditions.   For years I didn't have health insurance and the tax payers got to cover my ER visits.  I feel way worse about that than I do Howard Brown making Humana cover some blood work for a plan both my employer and I pay out the nose for.

Howard Brown has good lawyers, they can legitimize their diagnosis of endocrine disorder if need be (and certainly in my case since the T keeps my endometriosis symptoms almost non-existent after other treatments failed), but even if they couldn't, I wouldn't be the one in trouble for committing fraud.

It's a really nice, pie-in-the-sky idea that trans people should just look for jobs with insurance that cover their treatment, but logistically, most people aren't in a great position to be finding new jobs during transition.  It's a horrid job market for anyone right now, let alone if you don't pass or if your documents don't match up.  Private insurance is prohibitively expensive (and are great at crying 'pre-existing condition!' to avoid coverage), college is prohibitively expensive, and it's shocking how few LGBT clinics there are that actually provide HRT services.

The fact is, insurance companies should be covering these things anyways (actually, we should have socialized medicine, you can't claim to be the greatest country on earth when over a quarter of your citizens can't get antibiotics).  By all means, exhaust all the proper, legit channel methods first before resorting to 'creative billing' (I sure did), but if you're got a practitioner or surgeon who knows how to swing things in your favor, I certainly don't judge anyone for it.

Bahzi, I would have less of a problem with a physician billing for something else if the person barely could afford their sub-par medical coverage premium, but you can afford to pay your $200 premium.  While you may be saving some $$$, someone else is having to pay more to make up the difference and it's certainly not the doctors that are paying that.  Also, with recent healthcare reform you can't be denied based on a preexisting condition.  Even though some of these provisions of Obama's health care reform don't go into full effect until 2014, you still have other options.

While Howard Brown may have good malpractice lawyers, you as the patient are still responsible for your share of the coverage.  Later down the line say you're in a car accident and break your leg, requiring surgery and hospitalization.  They're going to nit pick everything and unless the another party was at fault don't expect your insurance provider to see what extra services they can provide you with, they're going to make sure you pay every cent.  You think $200 is high now, wait til your credit ruined and you have a collection agency after you.

Fraud isn't a joking matter and committing it doesn't fix any of the problems associated with medical coverage.  In the end, someone else, such as myself, pay more than their fair share because you won't and that's not right.  (Next the federal government will bail them out too!)

Planned Parenthood has HRT services for transgendered patients, as I recall, there are a lot of Planned Parenthoods.  Also, Bahzi is it absolutely necessary you take the insurance offered by your employer?  Is there an opt-out option so you can find your own coverage (possibly where your employer pays a percentage of it)?
Title: Re: Top Surgery Insurance Loop Hole
Post by: Nygeel on February 05, 2012, 08:01:15 PM
Quote from: Epi on February 05, 2012, 07:41:58 PM
I know a number of individuals whose grad schools insurance covered HRT/SRS.  That may be a very viable option for you.  Others volunteered at LGBT non-profits and eventually were offered paying positions that came with coverage.

It may be worth the risk now but later on what if you or someone on the policy has a major illness or suffers a serious injury?  The insurance company is going to look through everything with a fine tooth comb doing everything possible not to pay.  If you want to commit fraud move to Alabama, the statue of limitations is only 2 years so long as it's not tax evasion.

I don't go to school. I graduated from community college a year ago. I currently volunteer at an LGBT youth center but they only hire people with masters degrees and don't pay well.

If I could afford to move to Alabama I probably could afford transition expenses.
Title: Re: Top Surgery Insurance Loop Hole
Post by: Epi on February 05, 2012, 08:11:32 PM
Quote from: Nygeel on February 05, 2012, 08:01:15 PM
I don't go to school. I graduated from community college a year ago.

Well, this actually changes everything.  I was under the impression based on past postings that you had graduated from a 4-year.  Why not apply to a public 4-year university with medical student insurance that covers HRT/SRS and apply for FAFSA since you qualify?
Title: Re: Top Surgery Insurance Loop Hole
Post by: Nygeel on February 05, 2012, 08:24:50 PM
Quote from: Epi on February 05, 2012, 08:11:32 PM
Well, this actually changes everything.  I was under the impression based on past postings that you had graduated from a 4-year.  Why not apply to a public 4-year university with medical student insurance that covers HRT/SRS and apply for FAFSA since you qualify?
I don't qualify for FAFSA, and with what I have a degree in, going to a 4 year wouldn't exactly be a great choice.
Title: Re: Top Surgery Insurance Loop Hole
Post by: Epi on February 05, 2012, 08:27:39 PM
Quote from: Nygeel on February 05, 2012, 08:24:50 PM
I don't qualify for FAFSA, and with what I have a degree in, going to a 4 year wouldn't exactly be a great choice.

May I ask why you don't qualify for FAFSA?
Title: Re: Top Surgery Insurance Loop Hole
Post by: Nygeel on February 05, 2012, 08:31:17 PM
Quote from: Epi on February 05, 2012, 08:27:39 PM
May I ask why you don't qualify for FAFSA?
My parents, although together their combined income is barely enough to live where we are is too much for FAFSA. When it was myself, and my two younger brothers in school at the same time we didn't qualify while making the same income as we do now.
Title: Re: Top Surgery Insurance Loop Hole
Post by: Epi on February 05, 2012, 08:34:47 PM
Quote from: Nygeel on February 05, 2012, 08:31:17 PM
My parents, although together their combined income is barely enough to live where we are is too much for FAFSA. When it was myself, and my two younger brothers in school at the same time we didn't qualify while making the same income as we do now.

This was an issue for me too.  Even though I lived separately from my parents I was still considered dependent but by the time the year of my 24th birthday rolled around, that no longer applied.  Since you're 24 years old now Nygeel; even if you still live at home, you're now considered independent by FAFSA.  "Be 24 years of age or older by December 31 of the award year"  Your parents income is now irrelevant. 
Title: Re: Top Surgery Insurance Loop Hole
Post by: Nygeel on February 05, 2012, 08:38:42 PM
Quote from: Epi on February 05, 2012, 08:34:47 PM
This was an issue for me too.  Even though I lived separately from my parents I was still considered dependent but by the time the year of my 24th birthday rolled around, that no longer applied.  Since you're 24 years old now Nygeel; even if you still live at home, you're now considered independent by FAFSA.  "Be 24 years of age or older by December 31 of the award year"  Your parents income is now irrelevant.
Either way, it's still not practical.
Title: Re: Top Surgery Insurance Loop Hole
Post by: Epi on February 05, 2012, 09:48:26 PM
Quote from: Nygeel on February 05, 2012, 08:38:42 PM
Either way, it's still not practical.

I'm very confused Nygeel.  What exactly are you wanting, or for that matter, waiting to happen?  You've said going to a 4-year (even though you qualify for FAFSA and could attend a university that has insurance which covers HRT/SRS) isn't practical and wouldn't be a good idea with the 2-year degree you got.  Trying to find full-time employment is difficult; the place you volunteer only hires individuals with graduate degrees, but that requires normally you have a 4-year degree first.

What would be practical to you Nygeel?  Is committing insurance fraud really practical?  I'd say you have a lot of feasible options that don't involve fraud.
Title: Re: Top Surgery Insurance Loop Hole
Post by: MaxAloysius on February 06, 2012, 06:54:23 AM
With Medicare (Aussie national health) 75% of the 'scheduled fee' will be covered, and a private health fund can cover the rest, though my surgery will actually cost me several thousand more on top of that (twice! T.T). It is put down on the books as a 'subcutaneous bilateral mastectomy'.

It is perfectly legal, and from what I can gather all top surgery in Australia is put through the books this way. My surgeon told me that had I already had my gender changed through Medicare before the surgery, or before my second surgery/revisions, then it would be put through under gynecomastia and still be covered.
Title: Re: Top Surgery Insurance Loop Hole
Post by: Bahzi on February 06, 2012, 09:26:13 AM
Quote from: Epi on February 05, 2012, 07:41:58 PM

In the end, someone else, such as myself, pay more than their fair share because you won't and that's not right.  (Next the federal government will bail them out too!)

Planned Parenthood has HRT services for transgendered patients, as I recall, there are a lot of Planned Parenthoods.  Also, Bahzi is it absolutely necessary you take the insurance offered by your employer?  Is there an opt-out option so you can find your own coverage (possibly where your employer pays a percentage of it)?

I've paid my 'fair share', and then some, thank you.  I paid into this plan for 2 years and never used it until HRT, because unlike the other people at my work, I don't smoke and am not overweight/have a drinking problem.  They drive up the rates with their chronic, self-inflicted conditions,  and it costs way more than a few blood panels.  The only option for HRT in my city charged $380 after in-network discounts for blood work, and I had to have that done every 3 months for the first year and a half.  I can barely manage my $200 premium, I don't even make $10 an hour.  After moving soon, I'll probably have to go down to the basic plan next year when it's open enrollment again, for now I'm locked in through the year.

I and a few other co-workers researched dumping our employers plan and finding private coverage, but no, our employer wouldn't pay any of it, and the rates for anything approximating the same coverage were way higher than we'd be paying through the company, because they pay half.   I haven't looked into it again since the reform, but I didn't even qualify for most private policies last year because of my mental health history.  It would have involved a lot of lying to get covered, even though my hospitalizations were years and figuratively a lifetime ago.

Only some Planned Parenthood's offer HRT services, and none anywhere near me.  We're in talks with the local PP's about trans care right now, but PP recently lost a lot of funding, so it's unlikely they'll be able to offer that service here anytime soon.

My credit's already pretty crappy, and I've had collection agencies after me before, old hat.  I finally got out of debt and am rebuilding credit, but this is worth ruining it again for me, because this is what I need to do to function currently and to keep living.  If I get busted, I'll deal with the consequences, but I've had enough disadvantages in life that I don't feel guilty for how things are being billed.   *shrug*
Title: Re: Top Surgery Insurance Loop Hole
Post by: thefire on February 06, 2012, 11:26:40 AM
I've thought of a serious reduction if I get the money together one day but can't get "permission" to have top surgery, that maybe I could get a major reduction from D to A and tell them to make me as flat as possible?  :laugh: But yeah, I'd still need the nipples scaled down. I couldn't go around shirtless like that.
Title: Re: Top Surgery Insurance Loop Hole
Post by: Epi on February 06, 2012, 07:28:22 PM
Quote from: Bahzi on February 06, 2012, 09:26:13 AM
I've paid my 'fair share', and then some, thank you.  I paid into this plan for 2 years and never used it until HRT, because unlike the other people at my work, I don't smoke and am not overweight/have a drinking problem.  They drive up the rates with their chronic, self-inflicted conditions,  and it costs way more than a few blood panels.  The only option for HRT in my city charged $380 after in-network discounts for blood work, and I had to have that done every 3 months for the first year and a half.  I can barely manage my $200 premium, I don't even make $10 an hour.  After moving soon, I'll probably have to go down to the basic plan next year when it's open enrollment again, for now I'm locked in through the year.

I and a few other co-workers researched dumping our employers plan and finding private coverage, but no, our employer wouldn't pay any of it, and the rates for anything approximating the same coverage were way higher than we'd be paying through the company, because they pay half.   I haven't looked into it again since the reform, but I didn't even qualify for most private policies last year because of my mental health history.  It would have involved a lot of lying to get covered, even though my hospitalizations were years and figuratively a lifetime ago.

Only some Planned Parenthood's offer HRT services, and none anywhere near me.  We're in talks with the local PP's about trans care right now, but PP recently lost a lot of funding, so it's unlikely they'll be able to offer that service here anytime soon.

My credit's already pretty crappy, and I've had collection agencies after me before, old hat.  I finally got out of debt and am rebuilding credit, but this is worth ruining it again for me, because this is what I need to do to function currently and to keep living.  If I get busted, I'll deal with the consequences, but I've had enough disadvantages in life that I don't feel guilty for how things are being billed.   *shrug*

2 years, you think that's a long time?  2 years is nothing.  Clearly you don't know how the world is out there.  You think Uncle Sam cares that there are senior citizens living below the poverty line that still have to pay $500/month for their health coverage?!  No.  You complain about $200/month now and that you don't even  make $10/hour.  If I was you I'd reexamine my life plan, because at 27 if you don't have any real job skills to get a decent paying job, what makes you think that will change?  It won't.

Who do you think pays the difference for when you default on something?  Everyone but you. If you can't afford something, DON'T BUY IT.  Simple as that.

Frankly, I don't think you understand what being at a disadvantage really means.  You've never had to beg for food on the streets, have you?  Your parents didn't die unexpectedly while you were still a teenager leaving you and your siblings wards of the state to be cast out onto the streets on your 18th birthday?  You're clearly not satisfied with the way things are, yet you won't lift a finger it seems to do anything that requires honesty and a little hard work.

I know plenty of people who would be grateful in this economy to have your job and health insurance.
Title: Re: Top Surgery Insurance Loop Hole
Post by: Bahzi on February 06, 2012, 09:01:36 PM
Quote from: Epi on February 06, 2012, 07:28:22 PM
2 years, you think that's a long time?  2 years is nothing.  Clearly you don't know how the world is out there.  You think Uncle Sam cares that there are senior citizens living below the poverty line that still have to pay $500/month for their health coverage?!  No.  You complain about $200/month now and that you don't even  make $10/hour.  If I was you I'd reexamine my life plan, because at 27 if you don't have any real job skills to get a decent paying job, what makes you think that will change?  It won't.

Who do you think pays the difference for when you default on something?  Everyone but you. If you can't afford something, DON'T BUY IT.  Simple as that.

Frankly, I don't think you understand what being at a disadvantage really means.  You've never had to beg for food on the streets, have you?  Your parents didn't die unexpectedly while you were still a teenager leaving you and your siblings wards of the state to be cast out onto the streets on your 18th birthday?  You're clearly not satisfied with the way things are, yet you won't lift a finger it seems to do anything that requires honesty and a little hard work.

I know plenty of people who would be grateful in this economy to have your job and health insurance.

You don't know me, let's set that straight for the record.   What kind of self-righteous, embittered person assumes things about someone's whole life and experiences like that?  Seriously, dude? 

I got a fortune cookie today that said 'Good health is the greatest wealth one can have, cherish it', and I do.  I have many health and mental health conditions that did put me at a severe disadvantage, to say the least.  I was on disability for a short period, and got off it as soon as I was able to because of my own hard work.  I do work hard, for my sanity, every day.  2 years at the same job is a very long time for someone with my issues.  It's a privilege to be (mostly) able-bodied and have as many conditions as I do and not be on medications for them.  Much of that is due to my own hard work though. 

I work a high stress job 45-50 hours a week, that I am very grateful to have, thank you (and I'm one of the hardest workers they've got in return), and afterwards, I come home and work out for 1-2 hours because exercise is the only thing that stabilizes my moods and regulates my sleep schedule, since the psych meds I used to take gave me a neuromuscular condition (as well as immune system and heart problems) that makes it difficult for me to do a lot of jobs.

I never wanted to go on those meds since I had pre-existing conditions I feared they'd exacerbate, they were court mandated after I fought back against the four cops who brought me in on false charges and beat the ->-bleeped-<- out of me for fun because I 'looked like a dyke', and refused to undress for them.  I had no money for a lawyer, and my public defender bullied me into taking an NGRI plea, then after spending 2 months locked up in a state institution, I had to take whatever psych cocktail the doctors wanted for a year, and have been dealing with all the adverse health effects they caused ever sense.

The debts I ran up were federal loans for college from back before my mental health issues became prevalent, and that's what I've been paying off by working so many hours (as well as bills I ran up when I was psychotic during my first manic episode when I was 19), so I can finally go back to school soon.  Yes, I'm 27, and I've not made all the right choices so far in life, but I'm still trying.  I know all my issues are still 'first world problems', I keep it all in perspective.  I don't have a lot of time, but I'm involved in local trans organizing and activism, because I do want to reach out to others who haven't had some of the advantages I have, like my job. 

I don't think my life is one big hardship, I have some amazing friends, I'm as healthy as I've ever been, my job has been supportive of my transition, and I rarely, if ever talk about my problems; people never know I'm bipolar or agoraphobic, or have PTSD unless I tell them.  Which I typically don't- I don't want sympathy, but it would be nice if strangers wouldn't make assumptions based on some notion they have that everyone else has an 'entitlement attitude'.   There's disagreeing with someone, and then there's personal attacks.   
Title: Re: Top Surgery Insurance Loop Hole
Post by: Epi on February 06, 2012, 11:05:03 PM
Quote from: Bahzi on February 06, 2012, 09:01:36 PM
You don't know me, let's set that straight for the record.   What kind of self-righteous, embittered person assumes things about someone's whole life and experiences like that?  Seriously, dude? 

I got a fortune cookie today that said 'Good health is the greatest wealth one can have, cherish it', and I do.  I have many health and mental health conditions that did put me at a severe disadvantage, to say the least.  I was on disability for a short period, and got off it as soon as I was able to because of my own hard work.  I do work hard, for my sanity, every day.  2 years at the same job is a very long time for someone with my issues.  It's a privilege to be (mostly) able-bodied and have as many conditions as I do and not be on medications for them.  Much of that is due to my own hard work though. 

I work a high stress job 45-50 hours a week, that I am very grateful to have, thank you (and I'm one of the hardest workers they've got in return), and afterwards, I come home and work out for 1-2 hours because exercise is the only thing that stabilizes my moods and regulates my sleep schedule, since the psych meds I used to take gave me a neuromuscular condition (as well as immune system and heart problems) that makes it difficult for me to do a lot of jobs.

I never wanted to go on those meds since I had pre-existing conditions I feared they'd exacerbate, they were court mandated after I fought back against the four cops who brought me in on false charges and beat the ->-bleeped-<- out of me for fun because I 'looked like a dyke', and refused to undress for them.  I had no money for a lawyer, and my public defender bullied me into taking an NGRI plea, then after spending 2 months locked up in a state institution, I had to take whatever psych cocktail the doctors wanted for a year, and have been dealing with all the adverse health effects they caused ever sense.

The debts I ran up were federal loans for college from back before my mental health issues became prevalent, and that's what I've been paying off by working so many hours (as well as bills I ran up when I was psychotic during my first manic episode when I was 19), so I can finally go back to school soon.  Yes, I'm 27, and I've not made all the right choices so far in life, but I'm still trying.  I know all my issues are still 'first world problems', I keep it all in perspective.  I don't have a lot of time, but I'm involved in local trans organizing and activism, because I do want to reach out to others who haven't had some of the advantages I have, like my job. 

I don't think my life is one big hardship, I have some amazing friends, I'm as healthy as I've ever been, my job has been supportive of my transition, and I rarely, if ever talk about my problems; people never know I'm bipolar or agoraphobic, or have PTSD unless I tell them.  Which I typically don't- I don't want sympathy, but it would be nice if strangers wouldn't make assumptions based on some notion they have that everyone else has an 'entitlement attitude'.   There's disagreeing with someone, and then there's personal attacks.

So you're arrested, regardless of the charges, and instead of acting civil you become combative and commit battery upon a police officer?   And it's their fault they had to restrain you?   You most likely would have been released on your own recognizance in 72 hours, you really shot yourself in the foot with that one.

If I was the arresting officer you would have been treated with respect, but the second you put the safety of not only myself, my staff but the public as well at risk I would have not hesitated to use necessary force to restrain you and prevent you from injuring others or yourself.

You really should consider looking into Teacher Loan Forgiveness.  It is probably one of the best ways now to have Federal Stafford loans forgiven.  Being a teacher is one of the most honorable and rewarding professions there are, plus it has good union benefits.

But frankly, I really can't rationalize your logic.  Since I've worked 6 times longer than you have does that mean I am 6 times more entitled to commit insurance fraud?  This is really a matter of forward thinking.  I would like to see that not only my grandmother, but your grandmother are taken care of.  But with the rising cost of health care at one point it will become even more difficult to provide adequate care.  Insurance companies commit malpractice constantly in order to make up for lost "profits", which is wrong.  But committing fraud because you're dissatisfied with your health coverage isn't right either.  How can we expect or demand professional integrity from healthcare insurance and providers if the insuree/patient doesn't conduct themselves in the same manner? 

Everyone is entitled to what they earn, but fraud is stealing.  If you stole it, you didn't not earn it.
Title: Re: Top Surgery Insurance Loop Hole
Post by: Bahzi on February 07, 2012, 12:01:38 AM
Quote from: Epi on February 06, 2012, 11:05:03 PM
So you're arrested, regardless of the charges, and instead of acting civil you become combative and commit battery upon a police officer?   And it's their fault they had to restrain you?   You most likely would have been released on your own recognizance in 72 hours, you really shot yourself in the foot with that one.

If I was the arresting officer you would have been treated with respect, but the second you put the safety of not only myself, my staff but the public as well at risk I would have not hesitated to use necessary force to restrain you and prevent you from injuring others or yourself.


Uh, no, I didn't 'become combative' until after I had a black eye and a busted jaw, I hadn't attacked (physically or otherwise) anyone.  I wasn't even manic at the time, my mother knew that and called the cops on me after we had a disagreement and I walked out, she told them I was psychotic because she couldn't control me anymore and couldn't take it.  She's admitted this and apologized since.   

TRIGGER WARNING:

The officers told my mother I'd be taken to a local hospital's psych emergency center.  I went quietly, and knew I'd be in a 72 hour hold, and accepted it.  I'd signed myself in at my parent's request (they threatened to leave me downtown with no way home when I was a teenager if I didn't) before, so I knew the drill.  The officer didn't take me there, he took me to the jail's psych emergency center, and attacked me when I called him out on it (I never raised my voice or was disrespectful, just calmly explained that I knew the difference) and refused to strip naked in front of the male officers after they made sexually harassing comments towards me and mocked my gender presentation.  They 'offered' to do it for me, 'restraining' me by punching me in the face repeatedly while others held me down and ripped my pants off (literally ripped, mind you).  What would you have done as a sexual assault survivor in this situation?  I ended their attack by 'assaulting' one of the officers, and then they gave me my jeans back to put on, walked me down the hall and booked me, gave me an arraignment date, and turned me loose on the streets.  Does that sound like what should have happened if I were insane, or it was really a psych emergency arrest? 

There you go making assumptions again, does that feel good, to tell someone how their situation was their own fault without any knowledge of what happened?  You ARE being an ->-bleeped-<-, make no mistake.  I'm contacting a mod, this has gone far enough.