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Insurance copays for bottom surgeries

Started by Lucy Ross, March 13, 2018, 09:43:07 PM

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Lucy Ross

There are figures on all kinds of threads here but would be interested in one just detailing what people paid out-of-pocket for GCS, or orchis too, once their insurance company chipped in.  I've spoken with people who paid next to nothing for the orchis, and only a few grand for GCS, which gives me hope, being poor and all.   
1982-1985 Teenage Crossdresser!
2015-2017 Middle Aged Crossdresser!  Or...?
April 2017 Electrolysis Time  :icon_yikes:
July 12th, 2017 Started HRT  :icon_chick:
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Donna

We are fortunate here that bottom surgery is fully covered by the provincial health care including travel to the clinic.
Orchi and voice therapy is also cover by the province for transitioning.
December 2015 noticed strange feelings moving in
December 2016 started to understand what my body has been telling me all my life, started wearing a bra for comfort full time
Spiro and dutastricide 2017
Mid year 2017 Started dressing and going out shopping etc by myself
October T 14.8 / 456
Came out to my wife in December 2017
January 2018 dressing androgenes and still have face hair
Feb 2018 Dressing full time in female clothing out at work and to friends and family, clean shaven and make up
Living full time March 1 2018
March T 7.4 / 236
April 19th eligard injection, no more Testosterone
June 19th a brand new freshly trained HRT and transgender care doctor for me. Only a one day waiting list to become her patient 😍

[/
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SadieBlake

I had no co-pays, had to get myself to SF and find a combination of airbnb + friends I could crash with for the 3 weeks they wanted me nearby for follow-up appointments.

Pre-authorized insurance was one of the factors in my choice of surgeon.
🌈👭 lesbian, troublemaker ;-) 🌈🏳️‍🌈
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Sydney_NYC

It all depends on the insurance policy. My deductible is $250 (Tier1) and $2000 (Tier2) with a $2500 maximum out of pocket expense for the year. Since my surgery was technical out of network but fully covered with an exception as no one in-network could perform the covered procedure, they covered it as Tier1. (Thank you NJ State Law). However, since my surgery was in November I had already met my out of pocket expense for the year between prescriptions, therapist and doctor co-pays plus an emergency room visit earlier in the year from pink-eye that was severe at 9pm. So I was lucky on the timing and didn't have to pay anything for my GCS.

If I hadn't made my max out of pocket expense for the year it would have been a total of $1500 ( $250/day inpatient hospital stay copay for the first 5 days plus another $250 for the surgery itself.)
Sydney





Born - 1970
Came Out To Self/Wife - Sept-21-2013
Started therapy - Oct-15-2013
Laser and Electrolysis - Oct-24-2013
HRT - Dec-12-2013
Full time - Mar-15-2014
Name change  - June-23-2014
GCS - Nov-2-2017 (Dr Rachel Bluebond-Langner)


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Lucy Ross

Thanks guys!  My policy is much like yours, Sydney, $750 deductible and $2k max, no tiers.  Some surgeons bill the company, others want to be paid up front - Bowers vs. McGinn, those are two examples I'm familiar with.  The only two, really.  Don't know what other docs want.  Like you I'd prefer to be able to just drive to the facility, we have a clinic preforming operations 45 minutes from me, but the surgeon's waiting list is already 2 years out I think. 

Love your new avatar!  You look radiant, after being operated on by a robot too.   ;D  Was that thing operating on its own, or was it just being controlled by the docs?  Mechanical devices operated remotely by a human are called waldos, both terms are from science fiction.  As you're "geeky" you might know this stuff already.   ;D
1982-1985 Teenage Crossdresser!
2015-2017 Middle Aged Crossdresser!  Or...?
April 2017 Electrolysis Time  :icon_yikes:
July 12th, 2017 Started HRT  :icon_chick:
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Sydney_NYC

Quote from: Lucy Ross on March 16, 2018, 02:56:49 AM
....
Love your new avatar!  You look radiant, after being operated on by a robot too.   ;D  Was that thing operating on its own, or was it just being controlled by the docs?  Mechanical devices operated remotely by a human are called waldos, both terms are from science fiction.  As you're "geeky" you might know this stuff already.   ;D

Thank you for the avatar comment :)

The robot was controlled by the surgeon the whole time. I think they called it robotic-assisted instead of Waldos. I am geeky, but didn't know that term. Shame on me, LOL.
Sydney





Born - 1970
Came Out To Self/Wife - Sept-21-2013
Started therapy - Oct-15-2013
Laser and Electrolysis - Oct-24-2013
HRT - Dec-12-2013
Full time - Mar-15-2014
Name change  - June-23-2014
GCS - Nov-2-2017 (Dr Rachel Bluebond-Langner)


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ForeverLacey

#6
Let's see, my Co Pay so far has been $19,300 out of pocket. After almost a year of fighting my insurance with appeals I might see 60% of that if I'm lucky. Sucks when you have employer provided health insurance with transgender exclusions.  :(
Started HRT Nov 2007
Full Time September 2009
GCS With Dr Brassard May 2017
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softbutchharley

When I transitioned - nothing was covered by insurance anywhere......And I had darn good insurance :) I even got back billed for DR visits and hrt coverage after all my physical work was done.
I took a second mortgage on my home (which has since been paidthank goodness) to pay cash for everything pretty much. I once estimated the totals with clothing/hrt/dr visits,surgeries, etc at about 60-70 K .
Those today are very fortunate, and TY and KUDO'S to those who went before as the vanguard and paid the dues so others would have an easier road :) TY to my predecessors !!!!!!
Those who deny freedom to others....Do not deserve it for themselves.  Abraham Lincoln
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softbutchharley

Addendum :) My insurance is BCBS until May when I will be Medicare (required) . BCBS has changed in the 10 years since I started thinking about taking my life back and moving forward. A booootiful thang :)
http://mcgs.bcbsfl.com/?doc=Gender%20Reassignment%20Surgery
Those who deny freedom to others....Do not deserve it for themselves.  Abraham Lincoln
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ForeverLacey

Quote from: softbutchharley on March 23, 2018, 08:39:22 AM
When I transitioned - nothing was covered by insurance anywhere......And I had darn good insurance :) I even got back billed for DR visits and hrt coverage after all my physical work was done.
I took a second mortgage on my home (which has since been paidthank goodness) to pay cash for everything pretty much. I once estimated the totals with clothing/hrt/dr visits,surgeries, etc at about 60-70 K .
Those today are very fortunate, and TY and KUDO'S to those who went before as the vanguard and paid the dues so others would have an easier road :) TY to my predecessors !!!!!!

Yea I am easily at $70k over the past 10+ years. A large chunk of that was electrolysis though, but I still have an FFS coming up later this year that will put me over 100k.
Started HRT Nov 2007
Full Time September 2009
GCS With Dr Brassard May 2017
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