This is a letter I just received when I inquired about SRS being covered now that the trans care exclusions were lifted. It seems the lifting of the trans exclusion was just a political ploy and nothing will come of it. I have seen Medicare work when I had Gall Bladder removal surgery. The hospital billed Medicare and the patient was responsible for any shortage or deductible. This letter makes no sense except SRS Surgeons have gotten comfortable with private pay and the fees they charge is my only conclusion. For those of us dependent on Medicare it seems we are still second class citizens with no right to have the appropriate treatment for our condition. Yes, Medicare lifted the trans care exclusion, but if no one accepts it I consider it a public relations stunt. Some things never change. Looks like my dream is going to die.
My comments in the letter are bold type Hi Jessica:
The whole trans community is excited by Medicare lifting the ban on transgender surgery. Unfortunately, there are several issues that the trans community is either not aware of or doesn't understand completely.
When an insurance company says it is going to "cover" a procedure, it does not mean that it will pay the surgeon's fee in full. (
This is true) It means it will pay some amount of money it has assigned to that specific procedure less any copay or deductible associated with the patient's policy. With insurance companies other than Medicare or Medicaid, a surgeon's office can pre-authorize a surgery. Medicare does not allow for pre-authorization of surgery (
this is totally untrue. Medicare always pre authorizes surgical procedures). They require the surgeon to perform the surgery and submit for payment. They will review it and if approved, they will pay some amount of money. Medicare's reimbursement is extremely low, and if a surgeon accepts Medicare, he/she must accept what Medicare pays and cannot balance bill the patient (as can be done with other insurance companies)(
Totally untrue as I had to make the difference up on my Gall Bladder surgery). So, it is quite possible that a surgeon accepting Medicare can perform a 4,5,6,7 or 8 hour surgery and either not get paid at all, or get paid only a minimal amount of money (
total garbage).
We not accept Medicare or any other insurance. We do however "cooperate" with other insurers (
Wait, you just said you do not accept Medicare or any other insurance). We cannot do that with Medicare (
another untruth). Non participating surgeons cannot bill Medicare for their services, and patients who have procedures performed by non-participating surgeons cannot bill Medicare independently for the surgery (
true as surgeons have to be approved to provide services).
I do not know of any surgeons, trained or experienced in gender identity surgery, who accept Medicare.
