Hi All,

I have not posted lately due to extensive traveling and work I have been doing for the LGBTI communities through out the US. One of the biggest tasks I am involved with has to do with health care issues that T and I people face in all respects of their lives. (We are working on both TS and IS, regular health care issues).

I would like to offer the opportunity to all of you readers in here to have your voices heard. You can PM me or you can write here publically depending on what makes you the most comfortable. The issues that are at our attention at this point are the following:

1. Access to care
2. Disclosure issues to Medical Dr.'s outside of the community when needing general care from a provider
3. Medical conditions that are TS or IS related and the knowledge in the general medical community
4.. Access to therapy/counseling for Pre Transition in your geographic location ( it would be great if some of you would tell me how far you have to travel for services and where your location is if in the US.)
5. Cost issues; Insurance, lack of coverage, what is not covered what has been covered for individuals and how, why etc.
6. Have you ever been denied care or rejected by a specific individual provider? ( You don't have to share their name,, just what happened and what area of the country you were in)
7. For those of you that are well traveled in the US. What areas did you find easier to access care ( be as specific as you feel comfortable with please) and where was the toughest places for you to access care?
8. Do you ever refuse to go to a doctor out of fear even though you need to?

Anything that you feel is worth sharing we want to hear from you. When I say we, I will be voicing your writings to others working on healthcare issues for the TS and IS community. I will not disclose any names that are disclosed to me. It would most likely be best if you stuck with your screen name for the website to make you feel comfortable.

I am asking all of you that read this to please respond, even if in private. Those of us out here on the front lines looking to make changes NEED to hear from you! 

Last Note: If anyone was at the Philadelphia LGBTI Health Summit in March please contact me through PM I would like to pose a few questions to you that I can carry back for the planning committee, we are looking for suggestions for next years Summit. Thanks!


Peace
Taylor

PS anyone that would like to stop in and say hello, it would be great to hear from some familar voices!!

Quote from: taylor on May 08, 2007, 11:13:49 AM
I have not posted lately due to extensive traveling and work I have been doing for the LGBTI communities through out the US. One of the biggest tasks I am involved with has to do with health care issues that T and I people face in all respects of their lives. (We are working on both TS and IS, regular health care issues).

I was wondering what happened to you. Glad to see ya back again!

Thank you Taylor for what you are doing.  I don't really have a lot of information, but I will give you short answers.

I have access to general health care only, no specialists.  I have a woman doctor and she has been very friendly, she knows "nothing" about TS, but has been willing to learn and ask questions of me.

My insurance is through my wifes employeer, Cal State.  They use Blue Cross and "anything" to do with being TS is "specifically" excluded in their policy.

I pay for HRT, counceling, everything out of pocket.

The closest therapist to me is about a 2 1/2 hour drive and costs way too much, so I do most of my counseling with Dr. Leonhardt through weekly interactive chat on the web, dialy emails, journal that only she has access to and some phone calls (she is listed here at Susan's in North Carolina) she has been excellent.  Admittedly most of our time is spent on issues other than my ts issues, that was settled long ago.

Sarah L.

Hi Susan, things are active as always around here!  Good to see you! Heading to Alaska next, this can get so crazy, but I look forward to that.

Peace
Taylor


PS Sarah, thanks for your response!

I live in DC. I am lucky enough to have the Whitman Walker Clinic for health care needs.  They have an agreement with my insurance company (a nice way around the insurance exclusion for HRT).  I am also getting my therapy covered (50%, but this has to do how much my therapist is charging and insurance allowances).  SRS...well that is going to be a battle against the exclusion in an insurance policy (luckily there is a legal aspect to doing this that could be made in DC, this is not the case other places).  I generally speaking do not have access issues.

Insurance exclusions are a BIG deal.  They largely stem from the innaccurate diagnosis and treatment description in the DSM-IV and the characterization of SRS and HRT as "experimental" proceedures despite the fact it has been used to treat TS for 50 years and has a 98-99% success rate in treating the condition (SIGNIFICANTLY higher treatment rate than anything else found in the DSM).  Changing the DSM-V to match the Standards of Care should be a top priority.  This very well could effectively have the effect of defeating the justification for the exclusion. 

The lack of insurance coverage is why there is huge cost issues involving the treatment of TS.  HRT, SRS and in many cases psychotherapy are not covered by insurance carriers.   In fact if insurance companies find out about the TS condition it is often used as grounds to deny all future claims. 

In general there is a lack of education regarding TS amoung the medical community and insurance companies outside the specialists.



I have BCBS in DC, BCBS seems to be particularly bad about the exclusion.  Luckily the DC policy only excludes anything physical  (HRT and SRS).  However, because of thier agreement with Whitman-Walker, there is a way around the exclusion for HRT.  Whitman-Walker has an endo that specializes with TS patients and a pharmacy.  A great LGBT clinic, A major benefit of living in a major urban area. 

The thing is the exclusion may violate DC law.  If I get denied I am very tempted to litigate the issue to force the exclusion issue into court and begin a "battle of experts" and expose the exclusion for exactly what it is: a discriminatory policy based in bigotry and ignorance.  The pre-authorization documents are going to be legal as much as medical and they will include an open threat of litigation.  (The costs of a court battle will be more expensive for the insurance company than the costs of SRS.)

Amy,

Thanks for sharing all that you did, much of what you are voicing is exactly areas we are focused on, such as the DMS-IV. We also are in communication with Etna as one primary Insurance company that is showing concern for their lack of coverage for people in need within the TS/IS community. There are some lights at the end of a very long tunnel.

As for litegation in DC.  If you are facing a situation please keep very strict and detailed notes, copies of everything etc of every person you talk with...( I am sure you know this) However, if you would like to have contact with possible legal assistance and someone watching on your behalf as things unfold, please contact me and we should be able to assist you in some respects that you may be interested in.  While I posted this thread on healthcare issues, we work with legal issues all the time as well.

Part of what I do (literally) is educate medical workers etc. You are very right in what you state, the need for education is serious. The interest is increasing and there are those of us out here truly working to bring change to those asking to be educated, and they are asking thankfully.  And all your voices is what we need, thanks for the post.
Peace
Taylor

Taylor,

Here in the north SF Bay area I am covered with Kaiser on my wife's policy. They cover once a month therapy with a co-pay of 20$. HRT is also covered with plan prices for estrogen and spiro. SRS is not covered tho. Thanks for your important work on these issues.

Rhonda

Luckily I am a lawyer, but I also work on a corporate campaign. I may be a lowly researcher, but being a researcher has big advantages when you have time to prepare a document and craft an effective publicity campaign (I will have a hard time avoiding being a public figure anyway). 

Hey there Taylor, it's good to see that you are alive and kicking LOL.  As a Canadian my own situation would not contribute to yours as our our health care systems are quite different.  However, I would just like to encourage all members to contact Taylor and relate their cares and concerns on this extremely important issue that we all must face at some point in time.  It's through the efforts of people like Taylor that make our lives that much easier.

Steph

Hey Taylor!

I can understand busy.

Looks like you have quite a bit on your plate. Alaska? Hope that you weren't on that boat that went to ground the other day.

I'll email you the info and we still need to get together one day for lunch or whatever.

TTFN

    I was lucky.  My psychologist was 5 min from my house.  He specializes in GLBT patients. I lived in NJ at the time.  I moved to PA and he is now 45 min away.  I didn't change psychologists because I liked him.  I no longer see him because I feel I'm doing well.  My insurance covered his bill because it was for depression. Which was true.

   The next closest mental health care professional I liked was 2 hours away in Philly.  She was good but also twice the price.

    My MD in NJ sucked.  When I left after telling the Dr. I was transgendered all the people who worked there were pointing at me and looking at me through the window.  I never went back to her.  She has since "retired".  I think she may have lost her licence.  That was the rumor anyway.

    My next MD in PA was very professional and interested in learning more about treating a transgendered individual.  Unfortunately, she moved to Philly.  Figures, that's where the good doctors go.

   I went to see a plastic surgeon in north east Pennsylvania for facial feminization.  He wouldn't treat me because I didn't some sort of core physician and a group of other doctors treating me.  Later he said he had done a lot of research on my behalf and even sent me a copy of the HIGBA document.  He said he would perform some procedures.  None of them were facial feminizing.  I had already decided he was an idiot so I ignored him.  He wasn't trying to discriminate.  He was/is just uninformed.

    I later found someone who was experienced in facial feminization in Philly.  Very nice.  Very professional and knowledgeable.

    My GRS surgeon was also in Philly.  Two hours away but I didn't mind.  At least I didn't have to fly somewhere.

    I had some lab tests for GRS done at a local hospital.  Their billing is *totally* messed up.  I paid in cash and they sent me a bill anyway.  They insisted I pay it.  I had to sick the BBB on them.  They finally backed down.  I'm sure they didn't have a clue the tests were for GRS.  They are just messed up.

    Health care is expensive but I didn't find any of the services inflated because it was for transgendered care.  Except for my psychologist in NJ I had to pay out of pocket for all my transgendered care.  That's why it took me seven plus years to transition.

   Seems to me that the closer you get to a big city the more you have to pay.  Also, the closer you are to a big city the better the care is.

    I will tell a health care professional that I'm transgendered if they need to know.  If they don't like it that's too bad for them.  I'll just give them a thank you and a good bye.

    I found that *finding* someone experienced in treating GID was the hardest part.  Of course, now that I found this site that won't be as hard.


   

Here in Australia, health care for TS/IS is not a problem.

I have not really had any problems with health care, but then again I do have a GP that has many TS patients, my psych has been seeing TS patients for a very long time, the hospitals I have been too with my girlfriend have never really been a problem, with the nurses treating us just like any other patient.

And better still, our medical system is for everyone, you do not pay to see most GP's, you get a generous refund from the government if you do have to pay covering 80 - 90% of the cost, you do not pay to go to hospital (that is unless you have Private Hospital Insurance, then you have to pay a fortune, but the trick here is even if you do have Private Hospital Insurance, you tell them you are a public patient, and pay nothing).  Our medical system is setup so that every citizen of our country can go to hospital for free or see a GP for free.

I have to pay for my HRT medicine, but it is heavily subsidised by the government via the PBS (Prescription Benifits Scheme), which means I pay approx AU$2.45/day or AU$73/mth for my HRT medicine, which is quiet reasonable.

We can apparently get an Orchie on Medicare (paid for by the government), but I am not going go down that route, so I do not know, I will wait for SRS, which is not free, and costs about AU$15,000 - $20,000, apparently.

Thus far my psych has not changed me, and done all expenses via Medicare, which means no out of pocket expenses for me.

I live in Canada, so I don't know how helpful my information would be -- plus, each province varies on what they cover and what kind of services are available. But, good luck with getting the US info you need.

Here in Fort Worth Texas there is only one gender therapist, Dr. Rita Cotterly... she is 15 miles away from me. There are a few therapists in Dallas but they are over 40 miles away. There are a few endo's and one Gyno for HRT. I am being sent to the Gyno this go around and my appt is at 1:45 p.m. tomorrow...and about 5 miles from my house.

I guess I'll let you know how it goes and how nice and informative he is...at $210.00 for the consult he better be damn good. There is a new Endo in Arlington Texas but she just started up and was asking for links and help for TS. I sent her the www.transgendercare.com link and hopefully she will read it and learn.

Everything will be out of pocket for me even though I pay close to $200.00 a month for Health Insurance. It sucks but thats how it is. Almost every insurance company the company I work for has gone with almost always excludes GID/HRT and spells it out clearly they will not and do NOT cover any costs including therapy. Exclusion is the name of the game.

I have had no issues with my general practioner who is not part of the community and knows everything about me.

Hi all,

Before I hit the trails again I want to thank all of you that have written so far. Your voice does matter and I am looking in here and hearing you all! For those that are just coming to this thread, please post. And for those of you out side the US post anyway! This gives me some cross cultural comparrisons to work with, and that is always good.

Lori, you stated something that I have found to be quite true, and would like to see if others have experienced the same, some of the BEST care is outside of the TS community, the regular docs, not the so called specialist, I have often wondered exactly why. I have my ideas, but they are speculative.

Lost In Time: Lunch is a must gal! I will get up with you when I get back and settled in to breath lol  thanks for the email!


Peace
Taylor

PS one other question for those that don't mind sharing, I am interested in what you have been or are being charged for Therapy sessions where ever your located. Remember if you want anyone is welcome to PM me anything they feel they would like to have remain private. 

I think mine was $90 an hour (Canadian), but he had a sliding scale that went down to $80 an hour.

Dennis

Hi Dennis,

Good to see you around, and being an admin that is great!  Ummm, sense you are an admin, can u tell me how I change my mood. cause I am all but angelic lol...or is this something you can change for me, I tried to figure it out and managed to lock myself out of the site for a couple of days, have no idea what happened there.

Peace,
Taylor

Yep, go into your profile and on the left there will be a tab called 'forum profile information'. You can change it in there.

Dennis