I'm sure there are many people on our site that are impacted by what this newspaper article lays out. Perhaps reading this article will help in dealing with medical/insurance denial of benefits. Being blind sided by insurance issues & procedures can be horrible.
"Many trans patients have trouble getting their insurers to cover gender-affirming care. One reason is transphobia within the U.S. healthcare system, but another involves how medical diagnoses and procedures are coded for insurance companies. Nationwide, healthcare providers use a list of diagnostic codes provided by the International Classification of Diseases, Tenth Revision, or ICD-10. And many of those, advocates for transgender people say, haven’t caught up to the needs of patients. Such diagnostic codes provide the basis for determining which procedures, such as electrolysis or surgery, insurance will cover."
This story is a half page long in todays Sept 12, 2022 LA Times. Page B2
I hope the info helps someone.
Regards,
Donna T
Comments
I'm Confused
That's odd. I haven't put it to the test, but I heard whispers that the Veterans Administration pays for at least parts of MTF procedures. Perhaps one must be a Veteran of a war" I was an unwilling participant in the Vietnam Conflict. From my observation Transgender FtM folk seem to get along without trying to create a penis.
My own MtF surgery was done in Thailand. I got home sick as hell from a bacterial blood infection an the VA were very proactive in saving my life. 18 years later, I often have doubts about my sanity from the action. And, classifying me as Mentally Ill is part of what got me that treatment.
Depends on the VA One is using
It's been over two years Amarillo VA washed me out of TG care claiming I had aged out. They were only supplying Estradiol tablets and it was a hit and miss most of the time with them anyway. Usually for months at a time they didn't. I was paying for my hormones myself and picking them up in OKC.
When Amarillo washed me out of TG care I switched to OKC VA. They began supplying estradiol injection after I informed my primary care Dr. I was self medicating.along with progesterone. He wanted me to go with the estradiol pill, spirolactone, and finesteride. I refused and gave him along with all my other doctors a notarized informed consent. For more than forty years I have studied and researched MtF hormones, lab reports, and talked or emailed girls who transitioned. I named all the nations it was possible for the girls to order the hormones along with the success stories and horror stories they had run into. I also have medical records going back X amount of years along with names of my doctors. I present as female and always have from day one when I checked into admissions. I'm not a beauty queen but I do pass without any doubt.
Each VA has their own set of rules and how much support they will give to a veteran. The VA has put out a directive how TG is to be accepted and treated. It doesn't mean "that VA" is going to follow the directive. If one has a choice it might be simpler to find a VA that is following the Directive than to fight the VA they are going to at the moment if they aren't receiving care. The Directive is split into two parts. One for transgender and it covers a lot of data the VA should be following. The other part is for GLBT. but is for gays and lesbians and I never understood why they listed T only in the header of the Directive.
If one is a TG Vet and not getting support, Start researching, the VA is there and they will give it unless it's like the Amarillo VA. The fight wasn't worth it. They didn't have a clue what MtF trans is. I was having to explain everything to them when I was there. Everyone was super nice and I answered a kazillion questions for the doctors and nurses but it takes more than asking a patient what TG is before they will ever truly understand. Like years of training and research on their part.
They aged me out because at a certain age estrogen is no longer prescribed to women. Risks of blood clots, heart attacks, seizures, etc go up exponentially. It's true but I'm not GG and the research done with genetic women doesn't fit transgender MtF women. I couldn't convince them or get them to read the years of independent research. Why should they when I was the only TG patient they had?
The OKC VA refusal to accept a court order to change my legal name on my VA records along with my gender marker unless I had a driver's license with all the required info ticked me off. Due to Gov Stitt's exec order Oklahoma isn't changing driver's license. A double negative. Thus I sent a complaint to the Inspector General saying I love my doctors and medical personnel but I had run into a snag with the OKC VA. They sent me a form to fill out asking if I wanted to allow my name to be used or if I preferred they didn't. Hell Yes! I want them to use my name as I signed and printed my name on that form and then printed the name the OKC VA won't let me change. I included a copy of my SS and Medicaid card with my legal name and gender on them along with a notarized copy of the court papers and sent it back certified registered mail. I wanted them to be sure and get my answer.
Be nice and give a clear precised reason one wishes to file a complaint. I tried going through Patient Advocate and it was a wash so I took it to the top. Remember it's gov one is dealing with. If you thought molasses poured slow in the winter, try dealing with gov. Hope I have a new gov ID and a new driver's license before they put me in that plot next to Jean. But if I don't this life has been a heck of a ride.
Oklahoma born and raised cowgirl
What the VA will Offer
Gwen, I didn't quite answer your inquiry about the VA paying for trans issues. They have a sliding scale depending on many things.
1: how many years active duty
2: is medical for what happened on active duty
3: is one retired from the military after completing full duty
4: the biggie is up to the VA location the person is using, some follow the VA Directive for trans care others ignore it. Irregardless none offer TG SRS (sex reassignment surgery). Breast implants, I've read stories but following up leads no one knows and if they do they aren't saying. The official is no they do not. I'm only guessing as I couldn't nail anyone down to a definitive answer. There was a VA in Oregon and one in Georgia who were leaders in TG care a long time before the TG issue ever came up. I heard both went stealth but the care was still there. Hearsay isn't it wonderful? Just like fiction, how much is truth mixed in with the lies?
Gwen, ask your Patient Advocate but don't give up if you don't like their answer. They are probably clueless themselves. You wouldn't believe what is in that VA Directive for TG the OKC VA doctors and admissions didn't know. I didn't believe they would ignore my request after I gave them a copy of the Directive and filled out all the proper forms for how they should have my name listed.
Sheesh, I get more satisfaction at times sitting out in the yard talking to the cats and goats. At least they don't ignore me as long as I have treats. Their loyalty can be bought with bribery.
Hugs Gwen, don't give up hon.
Barb
If life was easy non of us would want to move over at the end and let the next generation have a go at it.
Oklahoma born and raised cowgirl
The usual rip-off from the insurance companies.
I'm not sure how much the ICD-10 (or ICD-11) classifications are at fault and how much it's just the insurance companies' practice of underpaying or refusing to pay if they think they can get away with it. Those fat bonuses for the top execs have to come from somewhere.
Insurance companies are famous for misprocessing claims -- always to their benefit, of course. The people I know who have gotten SRS have generally had to fight the insurance company, even when it's explicitly insured. Even when the surgeons help, it's touch and go.
I haven't tried to get my insurance to pay for electrolysis. I think one could make a convincing case that the genital electrolysis is medically necessary, but you'd have to go through the people that process exceptions, and it might take a while. I've had to fight my insurance company because they are consistently using the wrong reimbursement rate for my psychotherapy, even though it's quite clear in the plan document, and it's been going on all year. (My favorite excuse: "it's not mental health care".) We think they're hoping that they'll just wear me down and I'll give up fighting. I just didn't want to wage another battle for electrolysis, and I'm fortunate in being able to pay for it out of my own pocket.
One complication with genital electrolysis is that it takes quite a while -- a year or more -- and I don't think the surgery gets pre-approved until a few months before the surgery date. So you'd be arguing medical necessity based on a procedure they haven't yet approved.
The joys of the USA-an health industry. Great medical care -- if you're rich enough to pay for it. ☹
Great insight
You explain things very clearly. "They" will fight you and deny you repeatedly. Armed with knowledge, knowing your rights and what to expect can only help those that are in need. --
Donna
Donna