Insurance Woes.

Insurance Woes.

I’m lucky enough to have insurance that covers the vast majority of transgender related care. I’ve had no problems accessing therapy, endocrinology appointments or getting my hormones.

When I changed my name with my workplace back in April, Blue Cross Blue Shield issued me a corrected membership card without me having to even call or write. Which is more than I can say for CVS Caremark who can’t be bothered and still like to misgender me and then tell me to update my gender marker. (I have.)

So I was fairly hopeful for a smooth process of getting coverage for my upcoming GRS. Dr. Schechter’s office submitted the paperwork for pre-approval on November 13th. Yesterday, December 4th, I received a denial letter in the mail. Of course, I also got a phone call from Dr. Schechter’s office prior to that saying that they had gotten a denial letter.

The reason cited is that I have not completed the one year requirement for “real life experience.”  That is, I haven’t yet completed a year in my gender role (*cough*)… Which is 100% true and accurate, except they’re ignoring the fact that when the service is rendered, I will be compliant.  My one year date is March 16th for “full time” and March 18th for hormones.


I’m being told by the insurance company and Schechter’s staff that I need to wait until March to resubmit. Which is great, except that Dr. Schechter won’t schedule a date until they have insurance pre-approval. I’m trying to get scheduled for March. Obviously the date I’m shooting for won’t be available anymore at that point. This is not shocking when you consider Dr. Bower’s availability. I scheduled with her in May of 2015, for a date in Feb of 2017.  Furthermore, what happens if I don’t have insurance at that point? I have so much money tied up in this surgery and I’m still not 100% sure it’s going to happen.

At the same time, before all of this happened Dr. Bower’s office came back and said that they might be able to get me in earlier but again, we need insurance pre-approval. They were/are in the process of submitting to BCBSIL for the same thing. So I’m trapped. I can’t afford to pay for the surgery out of pocket. Who has $25,000 just laying around for a rainy day? Maybe I could sell a kidney? Anyone want a Kidney?

One thing that I want to argue is that the WPATH SOC is a guideline. It’s not something etched in stone. It’s not designed to be so inflexible that there aren’t exceptions. I argue this point and I’m not even looking to be that exception. I’m not trying to get surgery before the 1 year mark. I think I’m a great candidate for it. I have one of the best situations a trans person can have. I’m employed. I’ve changed every possible thing that I can. I have full support of my family and friends. I’ve been in continuous therapy for nearly a year (4 days from now) and I think my therapist and I are both bored because my life is mundane at this point.  So, do I think the RLE should really apply to me?  No, not at all. I went full time as quickly as it was practical. I started hormones as soon as someone would actually write the prescription. I changed my name as soon as I went full time. I changed my gender marker as quickly as I could.  I dunno, just rip the stitches. Get it over with. No anesthesia.

Do I think that I’m somehow going to change my opinion before then? Am I going to detransition? Will I regret this surgery? Of course not. Regret is something that might come if there’s unforeseen complications. There’s nothing that’s going to happen in the next 3.5 months that’s going to put me back into boy mode.

So what’s next? I guess I try and argue my point with them.. It’s my only option right now, short of winning the lottery or selling a kidney. I could refinance my house, maybe?  I just know that I can’t spend anymore days at work crying at my desk because some CIS person in an office thinks that I need to prove my gender identity.



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