So I just found out today that my insurance through Kaiser covers SRS, but not breast augmentation, trach shave, etc. I was wondering if anyone has gone through them for SRS? Who was your surgeon? I'm probably going to give them one more call tomorrow just to make sure I'm not getting my hopes up for nothing. They cover my hormones and therapy, but $15 co-pay for SRS?! I'm trying not to get too excited. I hope the guy I spoke to about it on the phone was looking at that right!
WOW congrats, i agree i wouldnt get too hopefull on the $15 t sounds just a little to good to be true. but any coverage is good. great find and the best of luck
Quote from: Sheala on March 03, 2014, 06:35:38 PM
WOW congrats, i agree i wouldnt get too hopefull on the $15 t sounds just a little to good to be true. but any coverage is good. great find and the best of luck
My insurance is through the State of California and most procedures and things are a $15 co-pay so it wouldn't be too far fetched. I just want to make sure I'm not getting bad information, ya'know.
WOW i guess i need to move to CA.... lol here in PA well with my nsurance 1: its not covered.... 2: my copay would still be in the hundreds at the least.
Quote from: Melia02 on March 03, 2014, 06:49:42 PM
My insurance is through the State of California and most procedures and things are a $15 co-pay so it wouldn't be too far fetched. I just want to make sure I'm not getting bad information, ya'know.
When I had KP my copay was a lot higher than $15. When I had my gallbladder removed my copay came out to around $200... Which, still isn't bad mind you considering I was hospitalized for a week. But... Weren't no $15.
But, if you can get GRS through Kaiser for under a grand I'd call that a success. I'd be curious who they'd get to do the surgery though... Kaiser typically doesn't pay for out of network, or, at least that was my experience with them...
I am there with you. Kaiser member, waiting to get started on HRT. It is also interesting to note that California's Affordable Healthcare plans also cover SRS and HRT.
So I've spoken with 3 different people for assurance today at Kaiser. SRS is covered under my plan and it's $0.00 according to my plan. My plan covers all in-patient surgery costs and $15.00 co-pay for all "day surgeries." I'm not saying this is how it will be for everyone, but it's included in my plan. From the sounds of it all qualified SRS patients get transferred to the SF Trans Clinic. So we'll see what happens. I'll keep posting in this thread as things develop. I don't qualify for breast augmentation (I already have them anyway), trachea shave, or FFS. All those procedures are excluded from my plan.
I did have everyone I spoke with read word for word what is covered. Transgender Sex Reassignment Surgery is among what is covered under "Transgender Services."
Yep. That has been my finding too. Sadly FFS, and tracheal shave are still considered purely cosmetic and breast augmentation can swing either way, which probably means a higher leaning to being deemed cosmetic as well.
Quote from: Colleen♡Callie on March 04, 2014, 06:25:16 PM
Yep. That has been my finding too. Sadly FFS, and tracheal shave are still considered purely cosmetic and breast augmentation can swing either way, which probably means a higher leaning to being deemed cosmetic as well.
Is your insurance through a state government employer too?
Not state.
County. County public library system. So close enough. But California actually made transgender issues standard for health insurance. So all insurance policies that meet California standards, which is most, will cover transgender issues and SRS.
Including California's Affordable Healthcare.
Wait what Kaiser plans are you talking about?? I have kaiser.
California banned insurances from excluding transgender health care.
So basically any and all health care plans that are regulated by department of managed health care (DMHC) or the department of insurance (DOI) in California will include transgender issues in the plan.
However if you're on a "self-insured" plan that is governed through ERISA, which is a federal law regulation, there's a good chance the insurance plan won't cover transgender issues.
http://transgenderlawcenter.org/archives/4273 (http://transgenderlawcenter.org/archives/4273)
I am on the Kaiser Senior Assistance plan and have medicare.
I don't know. I think medicare is federal, and mediCal is state? Don't quote me on that.
Best thing to do is log on to your Kp.org account and look up what is covered with your plan under their coverage tab. If srs and hrt are covered it'll list "transgender issues" as under your coverage.
Colleen I've been out of the state and haven't been able to get much information via phone. Have you found out anything new? I'm curious to know what doctor does it. I'd rather just pay for it out of pocket if it's some second rate doctor, ya'know. Not all free things are good things lol. I've tried getting in touch with my PCM and P-Endo, but they both want me to make appointments. I should have got the psych stuff out of the way when my primary asked last January, but she didn't know enough at the time to drag me in.
I haven't. Sorry.
I'm still waiting to get an appointment with my psychiatrist to start the process of getting on HRT. SRS is a long way off for me.
Quote from: Colleen♡Callie on March 10, 2014, 10:37:23 PM
I haven't. Sorry.
I'm still waiting to get an appointment with my psychiatrist to start the process of getting on HRT. SRS is a long way off for me.
Oh wow! Good luck to you and well wishes on your journey love!
They're making you see a psychiatrist for HRT? I didn't know that was still apart the Standards of Care protocol. I went right through to Endo and got my script. I also started overseas first, so maybe that's why. As soon as I get back to Cali I'll update this post.
It is apparently with Kaiser. They don't let their counselors and psychologists sign off on it.
Quote from: Colleen♡Callie on March 10, 2014, 10:37:23 PM
I haven't. Sorry.
I'm still waiting to get an appointment with my psychiatrist to start the process of getting on HRT. SRS is a long way off for me.
Kaiser covers trans care but their attitude seems to be "If we're paying for it you're gonna jump through some hoops first"
Not sure what part of California you are in, but the psychiatrist I was referred to in the Sacramento area made things super easy. My primary care doctor referred me because I had asked for HRT. Ten minutes into my appointment with the psychiatrist she asked "how is HRT going for you?" I told her that I was not on hormones yet. She looked at me and said "Why the hell not? I'll put the letter in right now". She got up, walked over to her computer and put the referral in before continuing with my appointment.
Hopefully it goes just as smoothly for you.
That sounds too good to be true however I sure hope it is. I'm sure my Blue Cross will not cover any SRS help.
Good luck GF.
Oh, I so hope it does.
I'm is SoCal, so we'll see.
Quote from: FrancisAnn on March 12, 2014, 08:57:59 PM
That sounds too good to be true however I sure hope it is. I'm sure my Blue Cross will not cover any SRS help.
Good luck GF.
I was skeptical too, but it's legit. I just can't seem to find out who does the surgery. That's my biggest hold up right now because I'm not in California at the moment to make an appointment with my PCM. As far as Kaiser making you jump through hoops, I literally walked in for a new provider physical and had a referral for Endo put in that day. I didn't even have to ask haha. My PCM also asked about surgery and told me I came to Kaiser at a good time because of all the changes. She just wasn't too up to date on everything. My Endo looked my labs over and prescribed my estrogen that day. No hoops, no gimmicks, no psych, and no drama.
Great for you girl friend. Go for it. It's so nice to see some good news from some of us SP girls.
Hi. New to the site, just joined, and this is my first post. I was okay with just lurking and reading but figured I had to join because of this thread, as I have some info to add.
I am insured under Kaiser in Northern California. And indeed SRS is covered, as it should be by now with most insurers in California as noted above by Colleen.
I transitioned 19 years ago and am just now getting around to the surgery. Imagine my surprise at learning that the procedure is now covered. Kaiser, of course, doesn't normally cover "out of network" services. You just get all services from Kaiser, period. But Kaiser does not have their own SRS surgeon. When services are not available "in-house", they contract with an outside provider, and provide coverage just as if the provider were in-house. The level of coverage (deductibles and co-pays and so on) should depend only on which Kaiser plan you have.
In this case the provider they contract with is Dr. Meltzer. At least, that's the case for MTF surgery, at least in the San Francisco area. I'm not sure how wide a geographical area that applies to, or who they use for FTM surgeries. I have already been to Scottsdale for a consult. Not only was I charged only a $10 copay (normal for the plan I'm on), but Kaiser covered the airfare and one night in a hotel near the clinic.
I have had a number of office visits locally at Kaiser. There was a general intake visit, a psych screening, a visit with a local Kaiser surgeon to authorize surgery, and so on. And each time, just the $10 copay, so by the time this is all said and done, I could have this whole thing for under $100, $200 max. (I don't remember whether my copay is higher for the actual inpatient stay, but I kind of think it isn't.) It's really rather astonishing.
The weird thing, though, is the idea that Kaiser now picks my surgeon for me. After all these years, it's pretty ingrained that I need to do my due diligence and research and choose the surgeon that's right for me. And now, poof! The decision has been made. At least, if I want insurance coverage, it has. As it happens, I've recently reached a point in my career where I actually have enough money that I could forego the insurance if I choose to, in order to use a different surgeon. And I'm thinking about it. I had been previously considering Dr. Bowers and so I have a consult with her this coming week. Just the consult alone will cost more than the entire treatment with Meltzer! If I choose her for the surgery... wow, that's a huge price difference, $23,000 minimum vs. $10. :P I waited all these years (for reasons not solely related to money), I finally decided to move forward with SRS (the timing is partially because I could afford it, finally), then I had the pleasant surprise of finding out it's now covered; it would sure be ironic to just forego that and shell out for surgery with somebody else. But I feel I still need to go through this selection process, even though there's a huge financial incentive to stick with Meltzer. I need to know that I made that choice myself, rather than just leaving such a big decision to somebody else. The price differential will surely play a role in my decision. But I need to at least consider the possibility that this once-in-a-lifetime decision matters, and that it might be worth the cost to choose somebody else. It's a tough decision, given the inherent crap-shoot of it all. I'd be interested in any thoughts anybody has on that conundrum. (Though maybe that deserves its own thread.)
First good for you that insurance will cover your SRS. That is rare. I would try to stay with the surgeon approved by your insurance company. If any problems should occur later you may have better recourse. He must be a qualified surgeon for SRS if approved by your insurance company.
Good luck to you GF. I wish Blue Cross offered such coverage in my US state. But that will never happen I'm sure.
Hmm, what kind of "recourse" are you thinking of? Like if follow-up procedures are needed... they might not cover it if I had the original SRS outside of Kaiser? Hmm, an interesting point.
As for being approved by the insurance company, I think we all agree Dr. Meltzer is "a qualified surgeon", but I wouldn't go so far as to trust an insurance company to make good medical decisions! :laugh:
My issue with Kaiser at the moment, at least for SoCal area, is the lack of trans-experienced caregivers. NorCal has a lot and Kaiser even has a transgender care center up there.
But down here, doesn't seem to be the case. I really wish there was a gender therapist through kaiser down here, because I can't afford to go to one out of pocket, and could really really use the expertise of one to work through a lot right now.
Hmm, maybe they can be convinced that they need to spring for you to go to somebody outside Kaiser. I know that takes cutting through a lot of bureaucracy. But therapy is an acknowledged, required part of this treatment, so if they can't provide an experienced person in-house, they need to provide somebody outside and cover you -- just like for the surgeon. Just my 2¢.
I know this is an old topic but I just wanted to say that Kaiser DOES cover SRS. I have a $0 copay (thank you Obama Care) and therefore both top and bottom surgery are completely free for me, as well as testosterone or anything I need. It is not difficult at all and there aren't any real hoops to go through. You meet with a gender specialist and if they okay you then you are good to go. I got okayed my first meeting. But I am taking it slow and steady.
Quote from: Beth on May 04, 2014, 05:58:27 AM
Hi. New to the site, just joined, and this is my first post. I was okay with just lurking and reading but figured I had to join because of this thread, as I have some info to add.
I am insured under Kaiser in Northern California. And indeed SRS is covered, as it should be by now with most insurers in California as noted above by Colleen.
I transitioned 19 years ago and am just now getting around to the surgery. Imagine my surprise at learning that the procedure is now covered. Kaiser, of course, doesn't normally cover "out of network" services. You just get all services from Kaiser, period. But Kaiser does not have their own SRS surgeon. When services are not available "in-house", they contract with an outside provider, and provide coverage just as if the provider were in-house. The level of coverage (deductibles and co-pays and so on) should depend only on which Kaiser plan you have.
In this case the provider they contract with is Dr. Meltzer. At least, that's the case for MTF surgery, at least in the San Francisco area. I'm not sure how wide a geographical area that applies to, or who they use for FTM surgeries. I have already been to Scottsdale for a consult. Not only was I charged only a $10 copay (normal for the plan I'm on), but Kaiser covered the airfare and one night in a hotel near the clinic.
I have had a number of office visits locally at Kaiser. There was a general intake visit, a psych screening, a visit with a local Kaiser surgeon to authorize surgery, and so on. And each time, just the $10 copay, so by the time this is all said and done, I could have this whole thing for under $100, $200 max. (I don't remember whether my copay is higher for the actual inpatient stay, but I kind of think it isn't.) It's really rather astonishing.
The weird thing, though, is the idea that Kaiser now picks my surgeon for me. After all these years, it's pretty ingrained that I need to do my due diligence and research and choose the surgeon that's right for me. And now, poof! The decision has been made. At least, if I want insurance coverage, it has. As it happens, I've recently reached a point in my career where I actually have enough money that I could forego the insurance if I choose to, in order to use a different surgeon. And I'm thinking about it. I had been previously considering Dr. Bowers and so I have a consult with her this coming week. Just the consult alone will cost more than the entire treatment with Meltzer! If I choose her for the surgery... wow, that's a huge price difference, $23,000 minimum vs. $10. :P I waited all these years (for reasons not solely related to money), I finally decided to move forward with SRS (the timing is partially because I could afford it, finally), then I had the pleasant surprise of finding out it's now covered; it would sure be ironic to just forego that and shell out for surgery with somebody else. But I feel I still need to go through this selection process, even though there's a huge financial incentive to stick with Meltzer. I need to know that I made that choice myself, rather than just leaving such a big decision to somebody else. The price differential will surely play a role in my decision. But I need to at least consider the possibility that this once-in-a-lifetime decision matters, and that it might be worth the cost to choose somebody else. It's a tough decision, given the inherent crap-shoot of it all. I'd be interested in any thoughts anybody has on that conundrum. (Though maybe that deserves its own thread.)
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