Hey all,

So it's official: My family is going to support (financially, anyways) my decision to have facial feminization surgery. However, because of the very high cost of the procedure they want me to do everything I can to get this covered by insurance.  I know it's a remarkably rare thing, but I seem to remember seeing someone on this forum mention that they had pulled the feat off!  My family has really amazing health insurance (they've been paying for my hormones, for one thing), so I do have a better shot than most.  If anyone knows anything about this, I'd really love some advice!  I'm really angry that this isn't covered in the first place, it's insulting.  But this is the world we live in.

Thanks

I would like to know too especially someone from Canada

thanks for starting this thread

Here in the province of Quebec it is not covered. Both the government and private\work insurance consider this as esthetic only and therefore not medically necessary.

But as to where you could concentrate your efforts is on having multiple medical specialists confirm that it IS necessary for your mental well being. Then it could fit in some other rule that would make it covered.

Quote from: shedevilcanada on August 03, 2014, 09:04:38 AM
I would like to know too especially someone from Canada

thanks for starting this thread

The way the one lady here on susans was able to successfully get it covered by insurance was by seeing therapists who agreed with her that FFS would be beneficial for her and that without it she wouldn't be as happy as she could be, it's very subjective and I am sure she worked VERY hard to make this happen for herself. The thread is not far gone in the posts so u can probably easily find it. This was done with an American insurance company and healthcare system being very different in Canada and the UK to that of the US, I'm not sure it would be of huge help in those cases, but as a guideline, it might, after all what you have to prove regardless of where you are is MEDICAL NECESSITY for it.

I would not in all honestly put all my eggs in one basket with this one unless you ladies are very resourceful and have great skills and determination , you have to pair that with the right health insurance and a lot of luck and even in the states it probably matters what state you live in. All that into consideration you may or may not be successful, if you are in Canada you would have to find an FFS surgeon within Canada wouldn't you?

Hey shedevil, I know you are still wanting to have a couple of extra revisions to certain areas of your face even after your 2 FFS operations, I really had much hope for your last revision to fix most of the issues... Is it a matter of just perfecting it now? Or are there really still parts that need feminising more? Sorry for asking that, I hope I'm not intruding, but are you on HRT and all too? Like are you full time or are you waiting for the surgeries to be spot on to start transitioning? Just wonder, not to intrude but cause I would hope no one should need so many revisions. I wonder if it is simply self perception at this point and maybe you do look very feminine compared to your starting point? What are your thoughts Hun?

Thanks for the replies so far,

Just for the record, I am in the States.  I wonder though if it really is easier here than Canada...as a whole, our healthcare system is FAR, FAR worse-even if my family's insurance is top tier. 

While I paid for all of mine out of pocket, I wonder if there are parts such as rhinoplasty that might potentially be covered. I've known cases where it was handled as correcting a deviated septum, medically necessary, and therefore covered by insurance. I never looked into it myself.

First off I am in Alberta, Canada and from what I can gather it would not be covered at all with health care insurance the provincial version at least.  But the idea that perhaps if you could prove that it is medical *mentally" necessary perhaps it is yet one hurdle to be changed.  I can not see this in near future as Alberta at least does not cover boob jobs which would definitely constitute something important then again genetic females take a while to grown their boobs too so patience is the key.

By the way just doing research really about to see therapist real soon so this is not from experience just what I have read about the issue.  And lord knows I know I need some major modifications yet I am unemployed at the moment but do have some money not enough by far but such is life.  At the moment I would classify my self as an fat balding middle aged guy with hair growing like a weed but hope this will also change for the better physically and mentally.  The more I read the more I connect with a transwoman which is starting to scare me in ways but the thirst for change is there.  O heck just don't know at this point seems like a mountain to climb and at the end hoping to have 2 mountains haha:)

Quote from: androgynouspainter26 on August 06, 2014, 08:05:20 AM
Thanks for the replies so far,

Just for the record, I am in the States.  I wonder though if it really is easier here than Canada...as a whole, our healthcare system is FAR, FAR worse-even if my family's insurance is top tier.

That's kind of my point.

Quote from: Sabine on August 06, 2014, 09:50:37 AM
While I paid for all of mine out of pocket, I wonder if there are parts such as rhinoplasty that might potentially be covered. I've known cases where it was handled as correcting a deviated septum, medically necessary, and therefore covered by insurance. I never looked into it myself.

Rhinoplasty is covered in the UK if you have a deviated septum and they will work on it aesthetically to go along with the deviation correction. I know this cause a guy friend of mine with a deviated septum and he had his nose broken a few years back and they improved it while they were there. Considering Canada's insurance is similar i would imagine it is there too .

I didn't know it could be covered by the NHS. Mr. Musgrove mentioned that he thought I had a deviated septum and wanted to perform septorhinoplasty on me.

The only way you're going to get this covered is if you can prove it is a medical necessity. It also helps if the source of your insurance is employer based and if that is a Fortune 500 employer.

I know that-it's a question of how.  I know for sure there's someone on here who had it paid for by insurance, I just can't remember her name.  Anyhow, my parents have really, really good health insurance.  They've been paying for my hormones in full. 

Quote from: androgynouspainter26 on August 16, 2014, 08:17:27 PM
I know that-it's a question of how.  I know for sure there's someone on here who had it paid for by insurance, I just can't remember her name.  Anyhow, my parents have really, really good health insurance.  They've been paying for my hormones in full.

I think I know who you are talking about.

-She contacted her insurance company, got them to agree to cover it. Then her employer switched providers...
-New insurance company was resistant.
-Met the requirements from WPATH for SRS surgery as far as letters for FFS and appealed.
-Insurance company gave in, FFS got paid for.

The key thing you need to know is that this is a medical necessary surgery, deemed so by a couple federal court rulings. Look into those, mention those when you talk to your insurance company. Worst case is you can write off the cost on your taxes, best case is you get it covered.

I'm having surgery in December and am going through the hoops, or at least starting to. I intend to have my surgeon bill the insurance company regardless of what they agree. And when it gets denied, challenge it, its a medical necessity and any court challenge should uphold the federal court ruling. Of course legal fees are a few thousands, but if surgery is $20k+ that's a small price to pay ;-)

One approach may be to have an FFS consultation, and have the Dr. send your insurance company their findings/recommendations, and try to get pre-approval authorization for the surgery. Which surgeon(s) are you considering?

Lauren-what is the name of this court ruling?  That'd be a huge help for me.

Quote from: androgynouspainter26 on August 16, 2014, 08:45:20 PM
Lauren-what is the name of this court ruling?  That'd be a huge help for me.

I do not have this handy and cannot find it at a glance. But I know 100% that there are a few rulings, its not just one. I'm about to kick off this whole insurance process so I can keep you in the loop if you want, especially when I come across this info again.

Oh yes, please do!  Once you reach 15 posts, feel free to send me a PM, or just post it here.  I'm trying to get this to happen this winter as well...