I don't know if this has been asked before but I wasn't able to find a topic related to this.
If there is anyone here who is on Medicare or Medicaid, is it possible for them to cover top surgery?  If so, how does the process go?

Quote from: makipu on September 29, 2014, 04:31:38 PM
I don't know if this has been asked before but I wasn't able to find a topic related to this.
If there is anyone here who is on Medicare or Medicaid, is it possible for them to cover top surgery?  If so, how does the process go?

For Medicaid, it depends on your statem you can look it up.  It is rare, however.

Medicare has now said that it will not automatically deny claims for GCS, but I don't believe that there has yet to be any success from surgeons getting paid as of yet.  Some surgeons aren't planning on taking it because they don't pay a lot.  Leis said he won't.

Several guys have gotten it paid for thru US Medicare. (We are not talking re: national Australian system.)  As Brett says, it's not automatic, but the denial is not automatic. This group on FB might be helpful if you are not aware: Medicare Transgender Surgery Support group. Medicaid is not the same. This is a state program so therefore programs vary by states. Some states like Mass., California, and Colorado it's illegal to discriminate against trans people but other states are not so liberal on this.

Top surgery is about the easiest to get covered. There haven't been too many cases of SRS getting covered, but that too is possible. Just much more complicated.

--Jay

Thank you for the information. I will look into it. Also, is it possible to be unhealthy for top surgery because I am constantly suffering from chest (heart?) or breast pain all the time.

Quote from: makipu on September 30, 2014, 08:51:33 AM
Thank you for the information. I will look into it. Also, is it possible to be unhealthy for top surgery because I am constantly suffering from chest (heart?) or breast pain all the time.

I'm not sure the question here, but it is possible to have top surgery due to back trouble, I htink that's the most common reason. It's done for someone who is like a DD or something. It's done as a reduction (and they just don't say how much they "reduce". (There is some question as to how "okay" it is to do this. But they are pretty much the same cost surgeries.)

Also it is possible to be too ill for surgery, never mind top surgery. Yes, I have heard of it, but normally what they will do is do top surgery but in the US where they normally do it out patient, they will hospitalize you for a day or two. However, unless you have breast pain from cancer, normally that's not serious (unless you somehow hurt yourself from binding). But if you haven't hurt  yourself from binding, pain like that isn't uncommon. Actually used to have it quite a lot as I recall. Chest pain isn't a common symptom of heart problems as people think. The most common symptom it is is of digestive problems such as GERD (chronic heartburn). You might look that one up. It's perhaps serious but not anything they wouldn't do surgery for.

I am guessing you are doing the anxiety about surgery thing. I would guess, like me, you are thinking of all the reasons they wouldn't do surgery, but normally they will. And the reasons they won't are few.



--Jay

Thank you Jay. When I went to the doctor a few months ago for this chest pain she also mentioned it could be from heartburn although I am not sure about this because it's literally constant. I wake up and go to sleep with it. The location is right below the left breast. I wish it wasn't something so serious.

This is not necessary a benign condition and you should definitely see your doctor. It can actually eat out the lining of your esophagus and make your more susceptible to cancer. Not that that's the usual outcome. It is very common, esp after 40 (but there are children who have it). It is common for the symptoms to come and go and to vary by day or week. Sleeping with your upper part of your body elevated can be very helpful. Also not eating a heavy meal before you go to sleep.

GERD won't keep you from having top surgery but the anesthesiologist should know about it.

--Jay

Quote from: makipu on October 02, 2014, 09:24:42 AM
Thank you Jay. When I went to the doctor a few months ago for this chest pain she also mentioned it could be from heartburn although I am not sure about this because it's literally constant. I wake up and go to sleep with it. The location is right below the left breast. I wish it wasn't something so serious.

They said that they would cover mastectomy (I didn't mention anything related to gender though) if it's considered 'medically necessary'.  I still don't understand why sex reassignment surgeries and especially top surgery isn't covered because by binding I am hurting and damaging my other organs. If I don't bind, I can't physically function properly and when I do bind I am actually worse obviously physically but ALSO mentally because of the pain. I can't even weigh the distress in a scale to determine whats worse because they're both bad in different ways.

Every transgender I have ever talked to said that their surgery was not covered by insurance. If you do have a non gender related problem with your chest, then you might be able to get away with having it attributed to the health issue. As far as I know, gender dysphoria is still listed as a mental illness, despite research showing that it is caused in utero.

sam1234

I believe insurance that covers top surgery covers it as transgender related surgeries. Unless you have severe back pain, I know people getting covered for that reason (usually you have to have a series of treatments and hx of it) some surgeons are sympathetic.

Yes, it is getting covered. For the most part, people are getting covered in large companies and/or liberal ones (like Apple or Google vs Hobby Lobby). I do know quite a number of people who are getting it covered but it not in any way common. It is getting covered more often. You go by not the company, but the policy. For instance, Blue Cross has policies covering it, and many more not covering it.

Gender dysphoria is not considered a mental illness. It's considered a psychological problem (like an adjustment disorder), why it's in the Diagnostic and Statistical manual used in psychiatry and psychology. Transition is considered the treatment for it. Transgender is not considered to be even a psychological issue (except I believe in childhood).

--Jay

The latest bit of research I have found is investigating a chromosome deformity. There is also a theory that its a neurologic problem, the brain going one way while the body goes the other. The therapy recommended is surgery.

If people are finding insurance that covers transgender surgeries, that is awesome. The cost is outrageous.

Sam1234

The other problem with insurance policies and companies is that their coverage and exclusions vary by state and sometimes even by county.

Certain colleges do have insurance that students have access to that covers trans care I know but I'm not sure if it goes as far as to cover surgery but it might. The Twin Cities college in Minnesota comes to mind. You can do a search on trans friendly universities and there is a list out there that has most of the colleges in the USA listed and also how trans friendly they are as well as if they have health care plans that cover trans health care.

Recently there was an inmate who won a suit over being able to change gender in prison. Guess who pays? Not the prisoner. Yet the rest of us have to pay ourselves. I have no problem with an inmate having the right to change gender, but it seems like we are the ones being punished.

Sam1234

This is one case. There are thousands of others where people don't even get hormone replacement and are housed in solitary confinement. The rate of MTF incarceration far outweighs the rest of the population.

Yes, it was one glaring case, it was also in a state that i believe requires trans surgeries to Medicaid patients, so I wouldn't get all upset about the wrong stuff.

--Jay

Quote from: sam1234 on February 08, 2015, 07:59:18 PM
Recently there was an inmate who won a suit over being able to change gender in prison. Guess who pays? Not the prisoner. Yet the rest of us have to pay ourselves. I have no problem with an inmate having the right to change gender, but it seems like we are the ones being punished.

Sam1234

The fact that the inmate was able to get the transition isn't what bothered me. What irritated me was that there are plenty of us on the outside who really need to transition and don't have the means to do it. The chances of the inmate having the money to have it done was next to nothing, yet people in the same situation out here have to fend for themselves.

I consider myself lucky that my parents were willing to step up and not only accept me but help me through the process. They had no way of knowing if transitioning was going to improve my life, and yet they went all the way with me. When I hear from people who can't transition or have no support, I guess I'm acutely aware of the Hell they must feel they are in. Perhaps I over reacted.

Sam1234

And my point was that this one inmate was only one inmate in a vast number of inmates that for the most part get solitary confinement for being trans and will rarely even get hormones.

The chances of this happening again are fairly low.

--Jay

Quote from: sam1234 on February 09, 2015, 02:15:04 PM
The fact that the inmate was able to get the transition isn't what bothered me. What irritated me was that there are plenty of us on the outside who really need to transition and don't have the means to do it. The chances of the inmate having the money to have it done was next to nothing, yet people in the same situation out here have to fend for themselves.

I consider myself lucky that my parents were willing to step up and not only accept me but help me through the process. They had no way of knowing if transitioning was going to improve my life, and yet they went all the way with me. When I hear from people who can't transition or have no support, I guess I'm acutely aware of the Hell they must feel they are in. Perhaps I over reacted.

Sam1234

Some insurance issues depend on the wording your Dr. uses. Lets say that plastic surgery is covered. If your Dr. lists gynomastia as a reason for mastectomy, it might get covered. Same for hormones. My insurance won't cover anything transgender, so my Dr. had been putting low testosterone caused erectile dysfunction. No one every gave me any grief. Now the Dr. I have now, I don't trust and am actively looking for a TF physician.

Sam1234

I don't think I can post links but looking up grs insurance coverage I managed to find a link on the hrc website listing insurance coverage for grs. But I do not think the list only includes private insurances.

Hi Sam, do you know if this actually would work if the doctor put gynecomastia? Would there be issues at all?  Also, will any surgeon do this? 

If your gender change was legalized, then breasts would be seen as an abnormality. Part of the insurance thing would depend on your provider.

Some surgeons would probably just put gynomastia, and it wouldn't be a lie. Males shouldn't have breasts and the fact that they shouldn't be there plus the obvious anxiety they cause might be enough for a trans friendly surgeon. I didn't have to request that with a surgeon, but I do know that my original Dr. had no problem putting erectile dysfunction on the insurance form. Besides, it was a true statement. Its all the wording. Worth trying.

Sam1234