I've finally settled on what all I want, and I want to push on insurance to see if they'll cover anything. I know Crane is willing to work with insurance and his wait list lines up with what I'm looking for in terms of timing.

Multiple places online say that he performs MLD. The wording on his website leads me to believe that he will only do it if you make a strong push for it. But he has no pictures in his gallery of any MLD results.

I love his other work, but I'm not open to RF and not a good candidate for ALT. Is it worth inquiring about? Has anyone gone in wanting MLD and had him try to/succeed in changing your mind? I know what I want, but I'm not always the best advocate for myself in a healthcare setting.

I don't know, but I would send an e-mail and find out for sure.

I should take my own advice. I need to send out a query about scheduling.

Quote from: ftmax on August 23, 2015, 12:39:06 AM
I've finally settled on what all I want, and I want to push on insurance to see if they'll cover anything. I know Crane is willing to work with insurance and his wait list lines up with what I'm looking for in terms of timing.

Multiple places online say that he performs MLD. The wording on his website leads me to believe that he will only do it if you make a strong push for it. But he has no pictures in his gallery of any MLD results.

I love his other work, but I'm not open to RF and not a good candidate for ALT. Is it worth inquiring about? Has anyone gone in wanting MLD and had him try to/succeed in changing your mind? I know what I want, but I'm not always the best advocate for myself in a healthcare setting.

He will do it.

Thanks guys.

I sent his office an email today asking if they'd be willing to share any MLD results that they have available. Hopefully I don't have to schedule a consult just to see some pictures. I'm also waiting on responses from Dr. Schecter and Dr. Miro. I'll make an update with everybody's responses this week, and hopefully I'll have good news from my insurance company as well.

My insurance people are really dragging their feet, and all I need is a simple hysto here in my own city. How long ago did you start getting the ball rolling?

This'll be my first go at them. I have health insurance in DC, so legally they can't exclude anything trans related. BUT I still need them to tell me if they have anyone in network that does MLD, and if they don't (which I am almost banking on since only a few surgeons do), if they'll waive the out of network crap so I can go to someone else.

Then I'll need to see if what I'd end up paying for everything with insurance is less than what I'd pay out of pocket for everything if I went with Dr. Miro.

I'm sorry your insurance is going so slow Did you get in touch with them yourself or did you go through your doctor to make the request for coverage? Mine has been pretty responsive whenever my doctor reaches out, I'm hoping its the same when I talk to them this week.

Quote from: ftmax on August 24, 2015, 06:58:53 AM
I'm sorry your insurance is going so slow Did you get in touch with them yourself or did you go through your doctor to make the request for coverage?

Never occurred to me to have my doctor ask, but my regular doc left the practice. I'm currently seeing a GP who didn't even get my needles OR my dosage right. Don't think I can rely on him for anything this delicate. I'm always suspicious when the nursing staff tells me how AWESOME a particular doctor is...so far, it's never been true. Same thing happened with a new vet at my regular pet clinic. The tech told me how WONDERFUL this vet was, and I nearly murdered the woman for intentionally inflicting pain on my cat just to prove a point THAT I ALREADY UNDERSTOOD. So, yeah, this doctor is not awesome, but nobody else in the division looks like a good fit, either. This clinic system isn't fully covered, anyway, so I should think about using the system that IS covered.

I checked my messages. I have been waiting for three weeks to even find out the name of the surgeon my insurance uses. This is ridiculous--I need to start nailing down a surgery date NOW because I have a very narrow window of about one week. Time to send my case manager a message.

Urgh, looks like I have hijacked. Sorry. But I'm thinking that if my case manager is so slow with something as basic as a hysto, I'd better call her a year in advance for phallo.

Sheesh.

Ah that sucks Sorry to hear that Arch. Are there no other options where you are that you could try out?

Feeling a little disappointed at the moment. I still haven't heard back from my insurance regarding bottom surgery coverage. I emailed asking (1) if they would cover all the procedures I am looking to get, and (2) what I would need to do to have them say it's medically necessary (I've got a diagnosis, I'm on HRT, been living as male for a year as of September, etc.). No response yet, but it was quite a bit of stuff that they'll need to look up.

I did hear back from Crane's office - he is willing to perform MLD, but he doesn't have consent from any previous patients to share their results. They said he only has permission for what is on the website. I asked if he's able to share any at an in-person consult, so it'll probably be a few more days before I hear back from that.

Dr. Schecter's office said he only shares results in person, but they are willing to reach out to insurance on my behalf pre-consult if I haven't gotten a firm answer from them at that point.

Dr. Miro responded personally and sent me a whole breakdown of costs for each procedure and offered to do a consult in October when he's in New York so that I wouldn't have to spend extra money flying to Belgrade. The cost of everything is even lower than I thought it would be. He is making it really hard to want to wade through all the insurance BS

I've heard that Miro is quite reasonable, even when you factor in travel and accommodations.

How many surgeries do you need for MLD?

I was hoping to get away with two for an ALT phallo, but I had to stop exercising when I became disabled...regained a lot of weight. Crane's site says that if a patient is heavy, the extra subcutaneous thigh fat necessitates an additional surgery.

It's still possible that my foot injury will heal (my hands/wrists are chronic, so they won't heal) and I will be able to lose the weight again, but after two years, I'm losing hope. I had been eating a lot of junk out of depression over my condition. I wish I hadn't been so strung out; at least I could have avoided gaining quite so MUCH extra weight. At the moment, I'm trying to lose some by controlling my diet. But exercise is the key factor, and I'm stuck being sedentary. Grr.

P.S. If you get a consultation with Crane and you see some MLD results, please come back and describe them. I still haven't ruled out MLD, and I'm sure that a number of other guys would be interested in more information.

Miro broke the costs for me down in 3 stages, and based on the way he divided up all the procedures it doesn't look like he'd do anything less. The third stage was just the final urethral tubularization and glansplasty. So maybe if there were absolutely no complications with the urethra after the first stage, he could do the glans in stage two and call it a day? Idk, I am figuring on 3. It's kind of nice though, because he wants a minimum of 6-9 months between each stage and payment is per stage so there's a good bit of cushioning there. Even still - he's less than half the cost of Crane if I have to go out of pocket. Even including round trip international airfare. 

Based on the pinch test I'm not a good ALT candidate. I feel you on the weight loss struggle. I didn't realize quite how much I'd gained over the last few years. I'm going to have to drop some weight anyway, but I can't see my legs thinning out enough for ALT. I thought Crane did lipo on the phallus during the second stage if it was needed - not sure where I read that though so don't quote me on it.

I absolutely will! As long as insurance cooperates, I'm planning on doing in-person consults with everyone in the US who will do MLD. Based on all the digging I've done so far that leaves me with Crane, Schecter, and (possibly?) Salgado.

Forgive me if you have talked about this elsewhere, but what is your motivation for seeking MLD in particular? I haven't fully decided which procedure I want because I don't know all the variables that might factor in. Learning about other people's decision process could be helpful to me.

The donor site is the biggest deal for me. I'd be open to ALT if I was a good candidate for it, but I'm not and I don't see myself ever getting to the size that I would need to be. I've got a thing about my wrists that makes me lightheaded just thinking about RFF, but it's not a deal breaker.

I don't *really* want to fuss with hair removal. I think it would make my dysphoria worse in the short term. I'd like a concealable scar. I want an average sized peen with good aesthetics. Where I think they'd have to end the graft if I went with RFF would only give me about 4-5", and I'd prefer in the 6-7" range.

Sensation is at the bottom of the list for things I care about. The only way I'd be sad post-op is if I had no feeling whatsoever.

When you combine it all, MLD is really the only option where I get everything I want. The only downside for most people seems to be the difference in sensation, and maybe I'd feel differently if that was something I cared about.

I care about sensation, but not so much that I'm willing to have my forearm ripped up for it. Too visible to the outside world, even if it heals beautifully in the long term.

Every time I think about phallo--a lot, these days--I get so crazy mixed up and angry. I hate that I care about bottom surgery when so many guys don't seem to. I don't want to go through it all--losing income, traveling, being separated from my animals, being in pain, facing complications--and after all that, get a result that won't behave like my ex's penis at all. I wonder whether I'll face more dysphoria when the damned thing doesn't levitate on its own. I guess I can't really do better than Crane, and I'm glad that my insurance covers him. But I hate needing these surgeries in the first place.

If only there were a way out...

Oh man, I feel you. I was firmly in the "I don't care" camp pre-top surgery. It's funny how quickly things can change under the right circumstances. The shift makes me so upset sometimes. I just really hate feeling inadequate.

And I can commiserate about leaving animals. I'm in DC so I'm going to have to travel no matter who I end up going to, and the thought of leaving my dog for more than a day gives me more anxiety than having post-op complications 

Yo, just swinging by to say that I don't have any info to contribute, but am reading this thread with interest as someone who's also very interested (and alternately disenchanted with) phallo. Ugh, bottom surgery. I really want it, but oh man, aint nothin comes easy.

I have dreams, stupid dreams, in which I'm thinking, "Hey, what I have isn't bad at all. I don't need phallo. I can even do without meta!"

And then I wake up and realize that the several thick inches I had in the dream are nothing like reality.

I don't see a way around phallo. I have to have it. But I consistently feel that when my life offers me an easy option and a difficult one, the difficult one is the option I really want. I don't know why I always have to do things the hard way, no pun intended.

Arch, this thread has me convinced that we are sharing parts of a brain.

I go through the same conversation in my head everyday. "You know, you don't really *need* phallo. You don't stand to pee as it is. You can give girlfriend the business just fine. Be sensible! If anything just get a release and maybe a mons resection!" I don't know where it comes from, but it drives me nuts. I know I won't be happy with anything less than phallo. I've known that for months now. I don't understand why it's still a thing that the netherrealm of my brain is clinging to. It's not an option for me.

I had some really good talks with folks yesterday about surgeon choices. I'm going to sleep on it a few more days, but I'm strongly leaning towards going with Dr. Miro. Whenever I make up my mind, I'll start a new thread and start documenting the process there. I don't think we have a Miro phallo thread, so it may be helpful for people.

Update: Just heard back from insurance and they will cover everything except my out of pocket expenses. Feeling very conflicted right now as far as what I want. Moving forward with getting mental health referrals for now.

This sort of outcome is exactly why I started to panic and become paralyzed after finally getting job stability with trans-friendly insurance: CHOICES.

If I hadn't gotten the job, I had a very strict and no-nonsense plan for how to proceed. No options--just one way to do it, and a very short timetable to boot.

Now I have all of these choices, and they're sorta killing me. But choices are a GOOD thing. I just don't deal with them very gracefully.

Right! Ugh, makes my brain hurt. At least for the next few weeks I can focus on losing weight and working with my doctor on those referrals. I am at least going to email Miro back and agree to a consult when he's in NYC in October.