Insurance Cover Total Hysterectomy/Oopherectomy?

[ChaoticTribe]

I am wondering whether insurance will cover me getting a complete neutering ie removing the ovaries, fallopian tubes, uterus, and cervix. Typically this is referred to as a total abdominal hysterectomy, but when they cut through your abs it causes more problems later and also can make it impossible to work out for those who exercise that muscle. If possible, I would go for laparoscopic or vaginal surgery so they don't make big cuts in anything I need.

I do have a family history of endometriosis/cysts, as well as cancer. Three of my relatives had these surgeries all within the past two generations (aunts and grandmom). I myself have been bleeding every day lightly since June and am also suffering from pain. I do not yet have a diagnosis.

The only problem is I have insurance through work and they MIGHT have listed me as male, I don't know. If they did, they DID NOT get that information from me, since I wasn't given insurance applications to fill out or anything like that.

Has anyone had gynecological care or surgery covered while using male insurance?

If they don't cover me, can I contest this in court? I still have a female passport and birth certificate, as well as a vagina so if they refuse to cover my medical care I believe they would be violating bad faith laws.

[mm]

If you have been bleeding even a little everyday since June, get to a GYN and find out what is going on down there.  If it does come up with your insurance that you are listed as M, you could easily say it was a mistake somewhere from what you have stated.  You didn't say how old you are.  Age is a big factor in getting a hyster, very few dr will do a non emergency hyster if you are under 25.  Having a family history can help.  You are correct in thinking a non cutting through the abdominal wall is the best hysterectomy.  There are several procedure that are possible now for a total hyster.  I know going to a GYN and possibly getting an exam is not what you want to think about, but it could be life saving for you.

[ChaoticTribe]

Thank you, I will be going to a GYN in October and already have an appointment (it is the soonest I can get over there).

As for getting a hysterectomy, I already know there are several offices who will do it simply by request if you sign a consent form, so they should do it if you have a true need as long as you sign that same form.

I am only 21. When you say that some doctors don't like to do it if you are young, you mean that it's up to a doctor's discretion but insurance still must cover it if a doctor says it is medically necessary, right? Because I can't imagine the type of lawsuits that would come about if your doctor recommended it and insurance said no due to being too young.

I am pretty scared, just because I did research and I thought originally it might just be endometriosis because of the pain, but when I learned more I found out that abnormal bleeding for prolonged amounts of time is usually cancer if it is not hormonal, and I had my bloodwork done about a month ago for T and not only did hormone levels come back normal, my doctor also said it should be impossible to even menstruate with my hormone levels and 4+ months on T, so she said something is definitely wrong but a simple pelvic exam didn't unearth what it was. That was why I need to wait till October: I got a referral to a nearby place which has an ultrasound so they can further diagnose me because right now they're unsure of the problem and won't say what they think it is because there's not been enough testing done.

[mm]

Do followup in October, you want to find out what is going on.  I have never had a pelvic exam don't know if I could stand one.  Maybe this will an additional reason to use to get a hyster.  For what I know when a dr recommands surgery the insurance can say yes or no, most times it is yes.  I hope everything worksout for the best for you.

[ChaoticTribe]

Thank you very much, I hope so too. Fingers crossed!

[ChaoticTribe]

Just wanted to update and let anyone who sees this thread know that yes, insurance did cover the surgery. It was insurance I had gotten through my job though I no longer work there. I was harassed by my employer for taking the time off of work despite more than ample notice and notices from my doctors stating that it was necessary.

[Blaine]

I'm glad it worked out for you. My family has a history of cysts, endometriosis, and hystos for other medical reasons, so I'm hoping I can use that to prove my surgeries may be necessary. Thanks for the helpful info!

[Arch]

Glad it worked out, but for anyone in a similar situation, call the insurance company. Without giving anything away, say that there might have been a mixup, and do they have you listed as male or female?

[ChaoticTribe]

Yes, definitely check that. I was signed up for insurance as male since my ID is male and all that (though birth certificate and social security documents have yet to be ammended). But I found out this would prevent me getting the surgery covered. I couldn't get it fixed through contacting insurance, I had to call the corporate offices of my job and have it fixed, who then forwarded that onto the insurance company. It was a little bit of a pain in the butt though well worth it!

Now all of the extra parts are gone at least and no more suffering with the problems I did have due to them not functioning in the expected way.

[sneakersjay]

I was lucky in that I had a medical reason for the hysto brought up by my doc a few years prior to transition, so as soon as I figured out I was trans, I ran to his office to get it done while I still had F on my documents.  But I do know of other guys whose insurance and ID was male who got it covered.  After all, there are intersex people with varying parts who need medical care as well.


Jay