I was uninsured for a long time, but now I have health insurance that is trans-friendly. I haven't done any research on what I have to do to get surgeries covered or how much of my expenses will be covered--I'm planning to dig into that this summer.

But my policy is now covering some of the cost of my psychotherapy, and my therapist is putting down something like "anxiety" for the main reason I'm seeing him. This is true, but it's not the ONLY reason I see him; trans issues are obviously a big contributor to my anxiety, and I do see him, in part, for trans issues generally. And I started seeing him for trans issues in the first place.

Here's what's bugging me: He also asked whether I minded having "gender dysphoria" as a secondary reason. I got spooked and asked him to hold off. I would rather not have anything like that in official paperwork released to the insurance provider, but maybe this is just a kneejerk reaction from long habit. My therapist says that having GD as part of the official record might help me to get my surgeries covered later on. And we both acknowledge that my policy is pro-trans. Yet I still balk at having GD on my record.

Have you folks any other insights into the advantages and disadvantages of reporting GD to one's trans-friendly insurance provider?

Arch,
An interesting topic and it was discussed in the recent LGBTIQ Health Alliance conference recently.

As you know GD has been de-pathologised by WPATH, CPATH, ANZPATH etc because it is not an 'illness; or a pathology. But we have found that it is extremely useful to give a diagnosis of GD to places such as schools or to parents who then become far more accepting of the trans*kids (in particular) as they have a 'condition' that needs care and a duty of care by the school etc.

The problem is that many trans*people see 'diagnosis' as implying pathology, it does not. A diagnosis is an opinion based on factual and observational evidence. To the medical provider 'diagnosis' does NOT imply pathology (or should not except for the ignorant provider).

I readily use a diagnosis of GD to children as I want them maintained and protected in the school system.  I will use virtually anything to ensure that they have access to education in a safe environment and to access puberty blockers etc.

I suggest that you do not want that word used as it looks to you as pathologising. But I would accept a diagnosis if given to me in order to access care that I, as a normal healthy human being, deserve.

Just my 10 cents.

Arch,

I would agree with Cindy.  Diagnosis = factual condition, not necessarily something wrong.  But it sounds like something is wrong, as the cultural norm is that "so and so was diagnosed with <insert condition.>"

If it's beneficial to have it listed, then do so, if it doesn't affect your coverage.

Actually, I'm not consciously aware of having worries over being pathologized. It's possible that I resent it unconsciously or subconsciously, but I don't think so. My therapist refused to put GID into my surgery letter back when that label was most definitely a disorder, and he and I both know that GD is different. I think my whole problem is that when he says, "Let's put GD in your insurance claim," I immediately think, "Oh, no, a paper trail for the insurance company!"

But this is a different insurance company from the one I had when I was with my ex. In this case, a paper trail is probably a good thing because it sets up my GD well before I start having any surgeries. It can't hurt, and it might help.

I think...

In the past i think it was a huge disadvantage to have the GID marker place in any medical records. The doctors i had knew how discriminatory that was and used other co morbidity codes for my treatment. IE, depression, social anxiety, hormonal imbalance etc.

Now in feel its not that big a deal anymore if your insurance company had not kept the GD exclusions in there policies.

But everyone has the right to control there flow if information.

Do what you feel inside you gut tells you. They can also add the GD at a latter time if needed for surgeries.

Just be aware of any time requirements that might come into play. 

Insurance is good but also can be a pain.

Maybe things will become clearer after I get more info about how the surgical process goes.

Think that is a good place to start.

Hmmm.  A tricky question.

From the perspective of an average health insurance policy (with its standard trans-related healthcare exclusions), I would think it's always advisable to classify your conditions and treatments as relating to something other than GID.  My own therapist treats me for "anxiety", and my endo treats me for "alopecia" or something like that.  Covers therapy and all medication except the estrogen patches, which I buy generic and without going through insurance.

With a trans-friendly insurance policy like yours (although we don't know the full details, but congrats for getting that awesome coverage!), there seems to be no reason to hide provided you know exactly what is covered and what isn't covered.  But is there any reason to be open about it?  Would being open really have any advantages?  Maybe - I'm sure they'd want to see a diagnosis before they start approving surgeries and suchlike, but if it's just medication and counseling that you're receiving at present, why not just keep it hidden?

It's going to take us a looooong time to start to trust health insurance companies when they tell us that trans-related care is covered.  To me, it screams "papertrail!", and it might just take a minor shift in power in the next election to ensure that health insurance companies find it economically or politically unfavorable to continue offering trans-related healthcare, to ramp up your premiums, exclude treatment that would otherwise have been covered, or kick you out of the pool.

Why risk it?  Like with anything to do with being trans, we should be careful who we trust with our information.

Dying to hear the details of the coverage though...

Brenda, I'm a University of California faculty member. The coverage used to be good, but I've heard through the grapevine that it's gotten even better. Surgeries are covered, but I heard that the maximum lifetime benefit has been raised.

I have a Blue Shield PPO at the moment. It looks like it will cover out-of-network procedures if I pay a larger portion than usual. But I might be able to get more coverage if nobody within the network is qualified to do phalloplasty.

I need to generate a list of questions and concerns, and I need to track down any written guidelines or at least a specific contact person within the system. I don't have time for that now, but I'm hoping to have my ducks in a row by open enrollment time in case I need to switch to a new plan.

In general the biggest advantage is the dx/ddx is the key to getting coverage for therapies by private or government insurance schemes.

The downside is the condition discrimination by said insurance/medical service entity to not cover the condition (alleged cost, safety or effectiveness). ie follow the money because we all know that a drug for hep c that costs $7000... a week... for 12 weeks... ($84k) is more important than surgical therapy for gender confirmation that usually is much less cost to the benefit.

Quote from: Arch on August 08, 2014, 12:11:34 AM
Brenda, I'm a University of California faculty member. The coverage used to be good, but I've heard through the grapevine that it's gotten even better. Surgeries are covered, but I heard that the maximum lifetime benefit has been raised.

Nice!  That's one great trans-friendly employer, and I can't imagine that their insurance coverage for trans-related medical care is anything other than some of the best available.

If only other states/companies would follow suit instead of pandering to the conservative healthcare lobbyists who continue to push for trans exclusions...

The trans coverage was one of the reasons getting the job was so important to me. But by the time I put my application packet in, California had already mandated trans coverage across the board. All the same, I knew that if I didn't get the job, I would have to sacrifice a lot to get everything taken care of before I started looking for work again. It wouldn't have been pretty. It would have meant cramming surgeries into an eighteen-month period while I worked part time at my other job and tried to finish my dissertation. I would have had some unemployment benefits, but living that way would have sucked away all of my savings and a good piece of my retirement funds. Still, I considered it worth the price. I knew that I would be better off than a lot of trans people even under such circumstances.

Now things are looking pretty rosy. I still can't quite believe it.