Hi guys,

I'm starting this thread as a way to both keep myself organized and help other people who are starting to investigate and make plans for bottom surgery. This post will probably be a little lengthy, as I'm going to detail everything I've done up to this point. I'm planning to post updates every time there's something worth noting, or every time there's a bunch of things I need to keep track of. Feel free to ask questions, make comments, etc. Thus far I have done the following:

- Research (May 2015 - January 2016): I spent about eight months looking into all of the different bottom surgery procedures, common combinations of them, complications, pros/cons of each, and results from different surgeons. I eliminated several options from my list both in terms of procedures and surgeons. I am settled on full meta with a hysterectomy, vaginectomy, urethral lengthening, scrotoplasty, testicular implants, mons resection, and pubic lift. At least based on what I've researched, that is the likely combination of things that I'll need to achieve the results I want.

- Insurance Inquiry (September 2015): I wrote to my insurance company via email and asked about coverage for the above procedures, specifically asking if they were excluded and if they were not excluded, to tell me in depth about the coverage that I could expect. They responded back in October 2015 and said that all procedures would be covered under my surgical benefits at varying percentages based on whether the provider was in network or out of network.

- Requesting Referrals (September 2015): At my quarterly check-up with my PCP, I requested a referral to the mental health team at the clinic I go to for bottom surgery referrals. They could not start this process until I was officially on testosterone for a year, so this didn't happen until December 2015.

- All Referrals Received (January 2016): I met with a LPC for about half an hour in December 2015 and filled out a questionnaire that they use to fill in their referral letter for bottom surgery. She made an appointment for the end of January with a PhD level psychiatrist who will co-sign her letter in a similar visit. I also requested a letter from my PCP detailing the extent of my HRT treatment.

- Scheduling Consults (January 2016): I scheduled consults with Dr. Schechter and Dr. Bluebond-Langner. I feel confident that both could likely get me good results, but am leaning towards Dr. Schechter and am hoping to have surgery scheduled with him before my consult with Dr. Bluebond-Langner. I am going to keep my appointment with her (as of right now) to get more information for guys who are looking into her as an option.

I'm also running two separate to-do lists as I get closer to having surgery planned - one directly related to the surgery itself, and the other to all the little tasks that need to get done prior to surgery.

For surgery:
- Call Dr. Schechter's office and confirm whether or not he will perform a hysterectomy at the same time as stage 1 of meta.
- Follow up with PCP about scheduling a hysto locally if necessary.
- Get copies of all referral letters.
- Print out email from insurance to take to consult with Schechter.

Other tasks:
- Update name on Mastercard to pay surgery balance with.
- Update name on CareCredit just in case.
- Inquire about Schechter's recommended hotel, start making hotel or airbnb choices.
- Find a dog walker.
- Discuss options with potential caregivers.
- PUMPING.

Updates today:

I saw my PCP and got a referral for my hysterectomy, and the letter that Dr. Schechter requires regarding my HRT history and medical fitness for surgery.

I called the doctor's office I was referred to for the hysterectomy. What a debacle. It's an OB/GYN office, so I understand that the majority of folks who are calling are female. But I haven't been ma'amed in a while so that was a little irritating.

The first office person I spoke with took my insurance information and started entering me into their system as a new patient. He ma'amed me once and I corrected him immediately. He apologized and continued on filling in information. At the end of our call, he said that unfortunately my insurance information appeared to be inactive. We confirmed all of the information that he had input, and it all seemed to be correct. He advised me to call my insurance company and make sure there were no issues with my account and to make sure they hadn't issued me a new member number or anything.

So I called my insurance company. She told me that the issue was on their end, but that he had likely put some piece of information in incorrectly. I asked if gender marker could be one of those items, and she said that was 100% what she thought it was. I thanked her and gave the office a call back.

Luckily I got someone with a brain this time! I let her know about the previous call, what my insurer had said, and what I thought the issue was. She was extremely apologetic about the mix-up, and got it all sorted out. I now have an initial appointment with the doctor on Feb. 3rd to get checked out and hopefully I'll be able to schedule something within the next week of that appointment.

May I ask, does your health insurance cover the procedure? If so, what provider and what area are you in? I'm right outside of Philadelphia and PA has trans exclusions for non-private plans.

Quote from: CMD042414 on January 07, 2016, 01:53:39 PM
May I ask, does your health insurance cover the procedure? If so, what provider and what area are you in? I'm right outside of Philadelphia and PA has trans exclusions for non-private plans.

Hey CMD042414,

Yes, they will be covering the cost of the procedures (with the exception of my deductibles/co-pays/out of pocket maximum of course). I have CareFirst Blue Advantage through DC HealthLink (Affordable Care Plan Marketplace). I emailed them a few months ago and they told me that trans related or not, the procedures all fell under my surgical benefits as stated in the plan, and gave me an example of what that looked like.

I purposefully took a job in DC so that I could get DC health insurance. They aren't allowed to exclude on the basis of gender.

I have heard of guys taking part-time jobs with Starbucks or Apple to get health insurance. Both of those cover transition related procedures.

Quote from: FTMax on January 05, 2016, 03:45:19 PM
Updates today:

I called the doctor's office I was referred to for the hysterectomy. What a debacle. It's an OB/GYN office, so I understand that the majority of folks who are calling are female. But I haven't been ma'amed in a while so that was a little irritating.

I decided the phone call would be excruciating, so I went into the OB/GYN surgeon's office to introduce myself to schedule the hysto.  They didn't get it.  Even though I tried to explain it as clear as possible.  Was I there for my mother?  I kept trying to explain.  They just wouldn't get it.  All they saw was a man standing in front of them, so it was completely outside of their frame of reference.  I finally said, "Caitlyn Jenner, but the other direction!"  They were like, "oh!"

Quote from: FTMax on January 07, 2016, 04:38:15 PM
I purposefully took a job in DC so that I could get DC health insurance. They aren't allowed to exclude on the basis of gender.

I have heard of guys taking part-time jobs with Starbucks or Apple to get health insurance. Both of those cover transition related procedures.

How sad is this?  Guys taking jobs just to get the surgeries they need and so many guys moving to CA so they can get Medicaid to go to Crane.  Me, I spend every waking minute waiting to hear what price Crane accepts from the insurance company so that I can find out how much I have to pay.  I cracked 3 teeth about 3 months ago in my sleep. I know due to the stress of the complications that have occurred just to make this whole thing happen.  So, now I am in the process of getting oral implants.  $4,800.  Lovely.

Transition can be so stressful.  It is sad, but instead of being excited about my surgery, I just want it to get here, so I am done with all of it.  I thought this was supposed to be an "exciting time".  It very much hasn't been for me.

The lady I spoke to the second time I called was still a little confused. I had to clarify that I had a uterus that shouldn't be there, but she understood after that. I had originally tried to schedule the appointment online, because the hospital advertises that they do that. But the doctor I was told to request had no availability for the entire year on her online schedule.

Hadn't considered going in though! I'm not looking forward to the initial apopintment. My friend (who's having surgery with Crane around the same time you are, Bimmer Guy) went to the same place for his hysto and apparently they are pretty good once you're in. They let him hang out in an exam room instead of having to wait in the lobby for the doctors to be ready. So hopefully things go as well for me.

It is sad! I've read of guys who are unhappy working for the two companies I mentioned who are hanging on until all their medical stuff is complete because it's so hard to find coverage that doesn't automatically say no. I guess in that sense I'm in the same boat. I would be trying much harder to find a new job if I knew their insurance options would cover everything I need. But my goal is to not be working in DC after this year, so we'll see.

I'm not sure I've hit the excitement point yet. To be honest, I'm a little sad about having to do the hysto in advance. I understand that it's for the best, but it means I'm going to have to spread procedures out more than I wanted to in order to have enough vacation time. My insurance rolls over on July first, so I'm hoping that the hysto and stage 1 are complete by then to minimize the amount I have to spend. I don't think it'll be possible to get implants in before July unfortunately.

Touched base today with another guy who is going to see Dr. Schechter. He's going a few months later than I am, but he had the foresight to ask on the phone about how the schedule was looking.

Apparently they make every attempt to schedule surgery 6-8 weeks after the consult if you're ready to go. That'll still fall within my 3 month window post-hysto, so I'd be looking closer to 10-14 weeks out assuming that hysto falls within the 2 weeks prior to the consult or week after. That puts us at the end of May.

And that would be ideal! Fingers crossed that everything goes well with scheduling the hysto and insurance doesn't drag their feet with an approval that they've basically already given. Schechter currently doesn't have a wait list, and I'm hoping it'll stay that way for a bit. If I haven't already had it by then, I'll at least go into the consult with a date for my hysto and we can plan around that.

The amount of legwork we have to do is pretty astounding. I'm not looking forward to trying to set up my bottom surgery process.

This is a great thread. I hope you don't mind keeping it up.

Quote from: Arch on January 12, 2016, 03:49:46 AM
The amount of legwork we have to do is pretty astounding. I'm not looking forward to trying to set up my bottom surgery process.

This is a great thread. I hope you don't mind keeping it up.

Astounding is actually not an exaggeration.  I had no idea it was going to be like this.  I am 6 weeks away from meta and Crane still hasn't settled prices with the insurance.

Quote from: Bimmer Guy on January 13, 2016, 07:14:59 PM
Astounding is actually not an exaggeration.  I had no idea it was going to be like this.  I am 6 weeks away from meta and Crane still hasn't settled prices with the insurance.

I started speaking with someone the other day who was very involved in the scheduling process with Crane, and just told them to kick rocks. Scheduled a consult with Schechter instead. Apparently they had been giving him the run-around since Austin had to be rescheduled. I can't even imagine. It's terrible that you're being made to wait like this, especially with it being so soon. I was under the impression that everything was sent off to insurance 80-90 days in advance of surgery for Crane (since you generally aren't getting in sooner).

Quote from: Arch on January 12, 2016, 03:49:46 AM
The amount of legwork we have to do is pretty astounding. I'm not looking forward to trying to set up my bottom surgery process.

This is a great thread. I hope you don't mind keeping it up.

My goal is to lay it all out there and help guys come up with a checklist, so that when they get to that point, they can take a look and start planning. I was so completely confused prior to starting the process, and there really aren't a lot of solid resources out there about the initial pre-surgical process. I hope it continues to be helpful!

Quote from: Bimmer Guy on January 13, 2016, 07:14:59 PM
Astounding is actually not an exaggeration.  I had no idea it was going to be like this.  I am 6 weeks away from meta and Crane still hasn't settled prices with the insurance.

Well, at least you aren't three days away...but, seriously, there's no way I'm going to go through a repeat of my hysto insurance ordeal when I get to bottom surgery. If I don't have all my ducks in a row ninety days in advance, I'm going to start knocking some heads together. These procedures are too complex and too expensive and just too damned important for all of this last-minute crap.

Quote from: Arch on January 14, 2016, 12:52:38 AM
Well, at least you aren't three days away...but, seriously, there's no way I'm going to go through a repeat of my hysto insurance ordeal when I get to bottom surgery. If I don't have all my ducks in a row ninety days in advance, I'm going to start knocking some heads together. These procedures are too complex and too expensive and just too damned important for all of this last-minute crap.

True, not three days away, like you were with hysto.  Very true.  But, you truly do not know half the story when it comes to my experience with Crane and his office and the changing from Austin to San Fran.  The last 9 months has been daily, daily stress.  I will say it out loud.  I would not do this again.  I would not schedule with Crane again.  I have never had my mental health in this kind of distress before, and I have been through some ->-bleeped-<- in my life.

This has been a horrible experience.  They don't return phone calls.  They don't return emails.  I still do not know if 6 weeks from now I will be handed a bill when I get out of surgery.  Oh, and I don't know anything about the hospital either and how much I might owe them.  They don't call me back, either.  It's been grand.

And I have knocked some heads together.  More than once.  They say it will be different.  They say it will change (sounds like a freakin' relationship).  And here I am 3 weeks later with no information and no responses again.  They were sent the insurance offer 5 weeks ago.  And nothing.

If I had to do it again, I would go with Schecther.  Especially because I am getting meta.  I can't be confident and say what I would do with phallo, since I don't have any sense of Schechter's phallo work.

Am I even THINKING about my meta in 6 weeks?  Have I considered what I will buy/pack/etc?  No, I am just stressing out as to whether or not it is going to be paid for.

Your friend was smart, Max.  I was too deep into it to pull out.

I'm disturbed to hear about the unresponsiveness of Crane's office. I'm not sure that my insurance would cover Schecter or someone else. I know that my case manager immediately trotted out Crane, and I got the impression that he is THE man I'm expected to go to. But I also don't want to travel far. Northern California is bad enough; I don't want to go halfway across the country.

Did Crane's staff used to be better before Crane started trying to open the Austin office? Or have things always been iffy?

BG, I am SO sorry to hear about the stress you have been going through. I found my whole transition, with the resulting fallout, to be incredibly stressful, but I think the hardest parts (apart from dealing with my partner) have had to do with power held by others over my transition. Insurance coverage is great, but the process of jumping through insurance hoops can be excruciating. I'm glad I haven't had to do a whole lot of that yet.

I'm really hoping I can avoid most of the hoops. That was my intention in reaching out to them in advance, so we'll see.

Arch, you may have some struggles getting Schechter covered. I know Crane is the guy that most west coast insurers refer to. I think the only way you'd be able to have someone else covered (in-network) is if they were performing a procedure that Crane doesn't do. And I can't think of anything one does that the other doesn't. You could try for out of network coverage, but I don't think they'd reimburse for travel expenses because you have Crane in-network. I'd look at your policy though.

AFAIK, it has gotten progressively worse since Crane first conceived of Austin. It got really bad once Austin was delayed, and has not improved since.

I feel horrible saying it, but I was actually relieved to hear that Austin fell through. I figured that I'd be more likely to get Crane himself if he was still focused on California. But I don't know whether this "reprieve" will truly help; he might continue to work on the Austin problem, or he might start making plans for another city. My target date is so far out (probably summer 2017) that anything can happen.

My insurance charges more but will cover a surgeon in the "second tier"--not fully in network but not out of network, either. I didn't mind doing that for hysto because I already had a relationship with the surgeon, and I required only one procedure. I would hate to do it for two or three bottom surgery evolutions, especially on top of boarding out my cats for three weeks and losing thousands of dollars in summer income.

If at all possible, I'm staying fully in network. If that means Crane, then so it will be.

I didn't fall through all the way. Just very delayed. I think the last update I heard was this summer it would be ready. Basically the hospital he was working with decided at the last minute that they didn't want transgender surgeries being performed there, so he switched to another hospital that is still in the process of being built. I don't remember the name of it, or I'd check the status of it. I know the microsurgery team that will be working in Austin has been in SF the last few weeks training with the existing team.

I'm not 100% sure on what the logistics look like for everyone in the practice currently. The doctor Crane was teaching (Dr. Chen) has started performing his own surgeries, and they're looking excellent. I don't know if the plan is for them both to travel between both locations, or if Chen will primarily be in Austin, or vice versa. It doesn't mean there won't still be issues with the office staff, but depending on your timeline and who ends up where, Chen may be your surgeon. Something to look into.

Yeah, I have a lot to do. I've already written to the office, and I got what appeared to be a canned response with lots of information. I am pretty sure I know which procedure I want, and I know that Crane will be fully covered. That's it.

I'll start the ball rolling again in a few weeks or a month.

A real update for today!

I spent yesterday on pins and needles waiting to find out if the federal government in DC was going to close due to inclement weather. My doctor's office closes when they do, and it is abysmally difficult to schedule an appointment with the psychologist and psychiatrist they have on staff, because there are only 2 of them. I've had this appointment since the beginning of December and was dreading potentially having to reschedule.

So I woke up, went into work, and happily discovered that they would be open, and see patients up until 12pm. My appointment was at 11:30

I met with a psychiatrist for about ten minutes who read over the letter the LPC wrote at my last visit. He asked me what my surgical plans were so far, if I had support, if I felt I would need any additional assistance from them in terms of meeting pre-op requirements or post-op care. He told me the surgeon who's performing my hysterectomy is a good one. Very, very short chat. He cosigned the first letter and I was on my way.

It's kind of surreal sitting with all three of these in hand after so long. It definitely feels good to cross it off the list of things to do before my consult.

I decided today that I'm going to cancel my consult with Dr. Rachel Bluebond-Langner. Though I'd like to hear what she has to say and see her work, I'd much rather schedule my hysto that week instead of spending time driving to and from Baltimore to talk to someone I know I'm not going to have surgery with.

Finally an update! Three updates, to be exact. Apologies in advance for length.

I had my hysterectomy consult today. I was kind of dreading this consult, as I wasn't sure what to expect - would they be confused when I checked in, would I have to undress, would I need any kind of lower exam, etc. It went very well. I will break it down here, in case anyone else is also wondering and worried:

I arrived, gave the receptionist my information, and let her make copies of all my referrals. She let me sit in a different waiting area so that I wouldn't have to feel awkward with all the pregnant ladies.

A nurse took my vitals and input my medical history. Then the surgeon's assistant (a junior doctor that she has trained) came in and described the procedure to me. He said there was nothing in my medical history that led him to believe I would not be a candidate for a two-incision laparoscopic assisted vaginal hysterectomy. They'll be taking everything out. As long as there are no complications and I'm able to urinate once I'm awake, I'll be allowed to go home that day.

We discussed my upcoming consult in Chicago and decided that it was best to wait until after that trip. We also decided that since my case is straightforward, we would do the pre-op consult today instead of having me come back. He gave me an information packet with the number of the scheduler who would be contacting me, a pre-op checklist to arrange my procedure at the hospital, prescriptions for pain medication, and an order for lab work.

The surgeon also popped in to go over things. I let her know that I get ultra nauseous from anesthesia, so she made a note in my file for the anesthesiologist. I also showed her my scars from top surgery, and she decided she would try to use Dermabond on my pelvic incision to reduce the likelihood of scarring.

So now I'm just waiting for a call back from the scheduler. I have a meeting at work tomorrow where we'll determine what the best course of action is. I'm hoping to have a day picked out before the scheduler calls, which should be in the next week. Even though I'm a little disappointed about having to wait, I feel a lot better not having to worry about that and my upcoming consult with Dr. Schechter. They did offer to do the hysto this Friday if I didn't want to wait, but it just wasn't enough notice.

I also got a follow-up email from Dr. Bluebond-Langner's office. They confirmed that she does NOT perform metoidioplasty. This is good news - it confirms that there are no surgeons in my network that perform meta, which means that I will most likely be able to convince my insurance to cover Dr. Schechter as in-network. I'm interested to see how much the hysto comes out to be. It's all in network, and my in network maximum is $4k. A friend of mine had his at the same facility/same provider a few months ago, and his bill was about $3400. He does have different insurance though, so we'll see. It would be hilarious to me to pay more for a hysto than for meta, but I'll take it. The second stage will fall after my insurance resets for the year, so I'm hoping to make the most of it.

And on a final note - I've decided that I will be reactivating my personal blog after my consult with Dr. Schechter later this month. Whatever updates I make there, I'll be cross-posting here. I'm still deciding if I will share pictures there or not. A few people here have already requested pics - whether or not I post them online, I am definitely willing to send them directly to folks.

Your experiences not only inform the rest of us but also remind us that big, daunting tasks need to be broken down into small, manageable pieces.

Of course, this particular puzzle seems to have about a thousand pieces...