Insurance And Transitioning - Specifically Surgery...

I thought I'd give my thoughts on surgery, specifically male to female "bottom surgery" - aka SRS (or GRS as some prefer).  The vast majority of insurance plans here in the United States have typically not covered SRS.  Obviously I'm a bit biased here, but it's my understanding that the cost to do so would be incredibly trivial to do so in the grand scheme of things so that's very frustrating.  This appears to be something that is starting to change and that taken by itself is a wonderful thing for myself and a great many others.  I have high hopes that when my wife's enrollment comes around next month that her plan may start covering it, or if not this year then next.  Now that's simply speculation on my part and I could obviously be wrong.  However, even if it does, it leads me to what I really wanted to discuss anyway.

What if it does cover it?  A great many people seem to think it's "just that simple", but I don't think it really is "that simple".  There aren't all that many surgeons performing the procedure in the United States and the assumption is that even if her plan (or for that matter some/many/most other plans) will start to cover the costs, how many surgeons will actually take the insurance?  I know Dr. Bowers does and her office from all accounts does a wonderful job working with people and their insurance companies to get things taken care of, but her waiting list tends to be very long (a year give or take is my understanding) and despite the fact that she is now working with a second surgeon (Dr. Nicole), I can only envision that if more insurance plans start to cover SRS that the situation is not going to improve.

Yes there are other surgeons who take insurance, but some (most?) either simply do not, or even if they do, they still require payment for their surgeon's fees up front and require you to deal with your insurance company to be reimbursed.  I believe Dr. McGinn handles things this way and in that case I believe that means coming up with something in the vicinity of $14-15k (note: edited this up from $12k based upon talking to someone who just spoke with Dr. McGinn's office) up front for her fees and then hoping you can get some/most/all of your money back from the insurance company.

That doesn't even touch on the expenses outside of the actual procedure as for a great deal of those seeking surgery there will be travel, lodging, food, etc., for a good two weeks - oftentimes for two people as generally I believe you really do need someone to come with you for the procedure.  Even done very cheaply I think this would add at least a couple of thousand dollars to the total that insurance isn't going to reimburse, and possibly significantly more.

So where does that leave me and others?  Well, unless some things change beyond insurance simply covering the procedure, not a whole lot better off than we were.  In my case, Dr. Bowers was my original choice and I'd be okay with the wait, especially if it turns out that J's plan will start covering it with this coming years plan.  However, I believe we'd still have to come up with our deductible up front (I believe it was $5k this most recent year) - although I don't know that for certain - plus probably another $3-5k for travel/expenses/etc.  Could we pull that off?  I suppose so, but it wouldn't be overly easy to just come up with $8-10k for something that I/we didn't "have to have" so despite the fact that I'm certain J would say I/we should do it, I'm not sure I'm willing to put her/us in the position to have to sacrifice other things for that.

But if her plan chooses to not cover it until the following year (or not at all), then we're back to where I've been the last year or so, and that's trying to justify a good $20-25k to "hopefully" make me happy and the more I think about it, I just don't think I can justify the sacrifices needed to make that happen.  Yes we'd see some of it back on our taxes the following year, but depending upon how things went down it probably wouldn't be all that much and even if I had the surgery late in the calendar year and filed taxes as early as possible we'd still be talking about several months before we'd see anything out of it.

So what's my point?  Well I'm not really sure I have one other than to say for all of those who are talking about insurance and SRS - I'm hopeful that we start seeing more coverage just as many of you are, but I'm also realistic about what that coverage may really mean and that simply may be "not a lot" unless some things change.  And I'm not sure how much they will change as many of these surgeons simply don't have an incentive to take insurance.  They have thriving practices as is and don't have to put up with the hassles and headaches that come from dealing with insurance companies and as such can set their fees as they see fit.

With that being said, I shared a picture of myself the other day, so today we'll post one from the same day (a week ago Saturday) with both J and I. :)

With that I think I'll bid everyone a good night, and hopefully have a more upbeat subject next time. :)

- M