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Author: Addison

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.

denial

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.

Thanksgiving

Thanksgiving

So there’s been a lot of me talking about GRS already. Or SRS or GCS or whatever you want to call it. I typically refer to it as GRS, which is “Genital Reconstruction Surgery” but GCS sounds very positive as “Gender Confirmation Surgery.”

I’ll be honest, it’s the only thing I can focus on right now. To me, this is the final step in my transition. While the hormones will continue to do their thing long after the scalpel is gone, the wounds turned to scars…. this is the last step. The point at which I feel like I can relax and just kind of be able to get back to living life.  As the one year of being out as trans is rapidly approaching, I consider all the things that have happened since 12/13/14. In some ways, I can’t imagine fitting much more into a year.

People ask me if I’m excited about surgery. The answer is not so easy. It’s complicated. Of course I’m excited but also I’m scared, it’s a major surgery. I could die or any number of lesser complications. I could end up numb for the rest of my life, and I don’t mean mentally. But still, I gotta. Because reasons. To steal a quote from a friend on Twitter, who said it better than I could:

“To me, GRS is an undesirable necessity. Like having a gangrenous limb removed. It’s traumatic and has downsides but I can’t really not do it.”

She’s right. I have often lamented to friends and others that I wished I could live as a “non-op” trans woman. That is, there are plenty of trans folk who never undergo any type of surgical intervention. Or something less drastic like a orchiectomy. It would be less expensive, less painful and ultimately easier in every shape form and fashion.  However, I’m not that lucky. I’ve always intended to go all the way. “No more half measures, Walter.”

no-half-measures

So what I still don’t know is who’s doing the surgery. As I mentioned in the previous post, I am nearly double booked. At this point, Dr. Schechter’s office has submitted a request for pre-approval from my insurance company. We should have that back sometime in the next week or so. At that point, his office will go ahead and lock in a date for me.

However, in the meantime and in between time…. Megan and I attended the Transwomen National Banquet, for which Dr. Bowers was the keynote speaker. After the dinner had ended, I had a brief moment to speak with Dr. Bowers. While I didn’t come out and say that I was going elsewhere, I let her know that she was my pick forever and always, but that I wasn’t sure if I could wait until 2017. While non-committal, she said she might be able to add a day to her schedule or something like that.

With that glimmer of hope, I did email again to her office manager late that evening relaying this conversation. I was hoping for a reply this week, but based on their past email reply timeframes compounded by the fact that it’s Thanksgiving week, that reply has not yet arrived. I’m fully expecting that when Schechter’s office calls to schedule I still won’t have an answer from Bowers.  At that point, I don’t know what I will do. I don’t want to put down another deposit and then maybe lose that money too.

I was doing the quick math in my head the other day regarding the expenses of GRS for me thus far and they tally up to $2200 out of pocket, excluding travel expenses and lost of wages from taking time off work. To which none will probably count against my deductible or out of pocket maximum for insurance.  Keep in mind, this is just for GRS. This doesn’t count the costs of just getting on hormones which was over $1000 between therapy, lab work and actual doctors visits. Being trans is expensive. Laser hair removal is super expensive too.. Ugh.

I had my 8 month endocrinology follow-up this past week. My blood work revealed that my body really would rather run on estrogen than testosterone. My T level is sufficiently suppressed. Per the lab, the normal range for adult females is 8 to 55, I’m currently a 10. The only 10 I’ll ever be, sadly. 😉 Estradiol levels were in the mid 200’s, I don’t have the numbers in front of me…. and the Progesterone levels have dropped from being off the scale high even by fem standard to middle of the range. Poorkay says keep doing what you’re doing, come back in 4 more months. That’ll put me back there the week before the tentative date for surgery and a week past my 1 year HRT anniversary.

253 Days on Hormones. ~122 days until GRS.

 

Oh, Chicago

Oh, Chicago

So, a lot has happened in the last few weeks. Big shit poppin’, in the parlance of our time.

Back in May, I had applied for and scheduled surgery with Dr. Marci Bowers to do my gender confirmation surgery. I had picked her out of the half dozen or so doctors that do the procedure because I liked her presence in the community. She has a great reputation for the work she does and so on and so forth. The problem is that with that reputation comes high demand. Specifically, that the earliest date I could get was 2/8/2017. When I heard this, I was extremely disappointed. Especially since I had to give her $1000 upfront as a deposit.

As the months have passed, my situation has changed. As I progress further and further into my transition, my dysphoria regarding my body has increased. The daily mental turmoil of dealing with my genitals has been huge. Waiting another (as of this writing) 451 days, 13 hours and 33 minutes seemed like a prison sentence I couldn’t fathom.

So, I started looking again for different surgeons that might be capable of doing the surgery. Someone that had a good reputation, but without the million day wait. At the same time, I was looking for a surgeon for a friend that did a different type of GCS that’s less common in the states. I had found Dr. Schechter for her, initially.. but when she said they didn’t typically have a waiting list, the gears started turning.

I went ahead and sought out yet another psychologist. Now I have two. Because reasons. Because Insurance. Because WPATH requirements. I setup an appointment with Dr. Kleinman here in Louisville to do an evaluation of my mental status and my readiness for GCS. See, if you’re a trans person and you want to actually transition, you have to jump through hoops. A lot of hoops. Oh, did I mention that the hoops are on fire? So on October 22nd, I met with her and spent a little over an hour explaining my story and life and how gender dysphoria has impacted me. She took a lot of notes, and we scheduled a follow-up for November to review the letter and make sure that it read to my approval.

I setup my own consultation with Dr. Schechter for 11/9. Megan and I went to Chicago this past weekend to meet with him. He was very personable, has a very impressive resume and list of accolades. He said he does about 150 gender confirmation procedures each year, which include both MTF and FTM folks.  He answered my questions and more importantly, Megan’s. I left knowing that, unless something dramatic changes, that he would be my new surgeon. I gave them the letter that I already had from my endocrinologist recommending me for the GCS, as well as my original hormone referral letter from Dr. Morse (my primary psychologist), who was not able to complete a new letter before my appointment, due to a medical issue of her own.

His office will not schedule a date until they have all the letters submitted. Once they have the letters, they will contact my insurance company to pre-authorize the surgery. Only after insurance gives a pre-approval will they lock in a date. I was able to pickup my referral letter from Dr. Kleinman on Thursday and I faxed it to Dr. Schechter’s office.  With the situation with my primary psych, they went ahead and submitted my insurance info. They said it can take up to 30 days, but usually they have something back from them within 2 weeks. Sooooo, if all goes well, I should have a firm date in a couple days. We’re shooting for 3/29/2016.  This date will satisfy my insurance (and WPATH) requirement that I live in my new gender and receive HRT for 1 year. Real Life Experience, they call it.

Between now and then, I am having to take on a new task. Hair removal. On my genitals. Yes, I am (somewhat) willingly letting someone shoot laser beams in my crotch. This is an interesting sensation. It’s not nearly as painful as I expected it to be. The laser on my face hurts much worse. The worst part about this is that it’s not covered by insurance. So it’s a requirement for the surgery. The surgery is covered, but the prerequisites are not? That doesn’t make sense. So yet more money out of pocket. I can’t even apply those costs towards my deductible or my out of pocket max for this surgery.

So I have 4 sessions planned. For that area, it’s recommended to wait 6 weeks between sessions. Having 1 session down, that leaves 3. Six weeks times three sessions, that’s 18 weeks. 135 days between now and 3/29. That’s 19.xx weeks. Cutting it close, but I think it’s doable.

The goal is to have everything planned and in place by the end of 2015. Then all I have to do is lie back and let my crotch be zapped between then and March. How hard can it be?

Gender Markers in Kentucky – A How-To

Gender Markers in Kentucky – A How-To

So, yesterday, I was able to get a new Kentucky driver’s license, with the correct gender marker! Very exciting stuff. As this has been a subject of debate and mystery for some time on various forums, mailing lists and other venues, I thought I would write a how-to. I was not the first to try this and succeed, so credit due to some other enterprising trans person for doing all the initial legwork.

For me, this is what worked.

NAME CHANGE

Ok, some of this might not pertain to you. Maybe you’re keeping your old name. If not, skip ahead. Additionally, if you’ve been in transition for a while and your doctor will write the letter for you now, you can combine a lot of this. That wasn’t feasible for me, so I’ve broken it down in two parts.

In Jefferson and Fayette counties, you do not need to appear in front of a judge to do this. You don’t need a lawyer. It’s not too bad in terms of cost. Here’s what I know works.

First, head down to the probate department, it’s on the 3rd floor of the Hall of Justice on 6th and Jefferson.  They will put you at a computer and have you fill in the blanks on a couple of forms. The cost is $43 to them, which can be paid via credit/debit/check (not sure on cash), you’ll also want to factor in another 5-10 dollars for certified and attested copies. You’ll also need a $8 fee to the Jefferson County Clerk’s Office, this must be check or money order. You’ll swear to the deputy that you’re not a fugitive from the law and some other stuff.

It took almost exactly a month for me to get my order back from the court. They’ll mail you the forms back. Once you have the forms, you will take one of the certified copies to the Social Security Office and update your name with them. You’ll need to wait 24 hours for their system to update. Trust me, I tried.

The next business day, go to the circuit court clerk and get a new driver’s license with your new name.  Achievement unlocked!

So for me, this is where the story stopped for about 6 months. I changed my name just around the same time I had started hormones. I had talked about getting a passport and honestly it just wasn’t a priority. I did ask my endocrinologist to fill out the letter that I copied and pasted from the state department website back in July. Once I had it, it sat in the center console of my truck for months until I traded the truck in… and was forced to clean it out. About a week after I sold the truck, I decided to suck it up and get it done.

GENDER MARKER CHANGE

Name change is somewhat straightforward. The gender marker change is kind of convoluted. However, unless you have had surgery and can update your birth certificate, this is the best thing I can tell you at this time.

First, Go to the state department website, copy and paste the letter from there to your doctor. Have your doctor fill in the blanks, print and sign on their letterhead. Here’s what it looks like:

(Attending Physician’s Official Letterhead)

I, (physician’s full name), (physician’s medical license or certificate number), (issuing State of medical license/certificate), am the attending physician of (name of patient), with whom I have a doctor/patient relationship.

(Name of patient) has had appropriate clinical treatment for gender transition to the new gender (specify new gender male or female).

Signature of Physician

Typed Name of Physician

Date

Take that, along with your name change court order and all the other normal stuff you need to get passport down to the post office (call ahead, make sure they can see you. I had to call 3 different branches before I could find one that would see me same day) and apply for a passport. Make sure you select your correct gender designation on the application. It’s easier if you fill out the application on the computer and print it out and take it with you. I was told 4-6 weeks. In reality, it was exactly 4 weeks.

Once you have the new passport, I went back to the social security office and requested to update my gender marker. I provided my passport and the clerk was polite and quickly had it updated. I applied the same logic to this as the name change. I waited 24 hours before I went back to the circuit court clerk office.  The morning of, I had called Frankfort and checked to make sure they weren’t going to shoot me down. They wanted to know if I had the documentation from my surgeon. I advised that I did not have that, but I had already updated my passport and my social security account.  They advised that if I had a passport, to take it to the branch and that’s all I needed.

When I got there, I had issues with the clerk but I since had spoken to Frankfort prior to going in, I knew I was right. I was polite but firm and insistent. She called her boss, her boss confirmed I was correct. Based on what I’ve overheard, both the Bowman Field and now the Outer Loop offices have done these. All that’s left at this point is to pay them their $12 and smile your best smile ever for the camera.

Questions? Let me know!

Coming out at work

Coming out at work

This conversation has come up a couple times here recently. I had intended to write it down anyway, just for the sake of posterity. I will admit, this feels very pieced together. I started this at 5am, to be a short little posts and it’s turned into a nearly 1800 word essay. I apologize in advance for my murder of the english language and my overuse of commas.

So, I had been out to family and friends for a while. I wasn’t out to everyone just yet, but I was trying to time everything just right so as to avoid as much overlap as possible. I wanted everyone to mostly hear it from the source.  I had been debating on when and how to approach the subject to management at work. I knew the company had a formal policy in place. I also know that in the corporate world, you don’t get fired for being gay or trans or black or pregnant. That’s discrimination. You get fired for breaking some obscure rule.

I built up the courage to just do it. It was the proverbial “FUCK IT.” I wish I had saved the original email that I sent out announcing my intention to transition at work. However, I didn’t. Sad. It was so short and direct. It was the kind of email you send out when you’re drunk and it’s 3AM.  It was something like:

“XXXXXX, This email is to inform you of my intent to transition from male to female. Here is the (company redacted) policy. (link) Please let me know what the next step is.”

I thought I had emailed the right person. I didn’t realize there was a difference between HR and the people who make sure we’re at work and such. So I had emailed a bombshell to my group time recorder. Who, understandably, was probably caught off guard by this email. She had forwarded my email on to one of the members of management.   My boss’s boss. (We’ll refer to her as Barbara.**) It died there for a while. I emailed again to the same person, who still didn’t reply. A few days later, I saw her in the center.

She stopped and said “I got your email and I forwarded it to the correct person.”

No mention of who/what/where. I assumed it went somewhere to the bowels of the company. At some point, I had gotten tired of waiting and did a little more research on my own. I found that we have what’s called a ERM, or employee resource manager, which is what everyone else in the world calls a HR rep. This person is, for reasons unknown, in another state. My first one was in Louisiana. My current ERM is in Boston. Who knows? So I had emailed this person, who wasn’t the best at communicating back to me what was actually going on.

Finally, I was pulled off the phone and asked to come to Barbara’s office. She apologized for the delay, my email lost in the hundreds of others received each day. She asked some basic questions and I tried to explain as best I knew. At the time, I feel like I was very knowledgeable but I’ve learned so much since then.  The basis of what I laid down was, I was switching teams. I would be changing my appearance, I was starting hormones, laser hair removal, name change, pronouns and finally surgery. I had originally intended to not start the social transition until after Hunter was born. This was something my wife had requested, and I had conceded to her. In the end, it didn’t work out that way. I explained that, of course, bathrooms were a concern.

She assured me that she would speak with HR to get their guidance on how to handle things and we’d talk soon. I assumed that I didn’t need to be specific, but in the end, my assumption was wrong. During this limbo period, the decision to wait until June was pretty much thrown out the window. Forced out, in femme, by my asshole of a doctor, I was a woman on the loose. As I had posted on reddit, it was kind of like trying to put biscuits back in the tube. Good luck with that. I went back to Barbara and I explained that the timeline was shifting and it was basically happening now, rather than months from now.

Again, days passed and I heard nothing. I emailed the ERM again. I spoke again with Barbara, who assumed that I would change into a woman and THEN use the ladies room. That is, she thought I didn’t want to use the correct restroom until after I had surgery. I explained, no that it was not the case.

Once again, HR and her talked, and eventually they came to the agreement that if I was presenting as a woman, I could use the women’s restroom. I was confused by this meeting, because I was already wearing a pair of yoga pants and a woman’s t-shirt. I got the email from HR, which read almost begrudgingly that since our building contains no single occupancy facilities, that I am permitted to use the women’s restroom.

Barbara confirmed the email but with a somewhat alarming side note. She said that instead of telling everyone, that she would deal with issues on a case by case basis, if they arose. I thought this was stupid and honestly, it went against the policy set forth by the company. It also didn’t address the name and pronoun situation. At the same time, I was trying to update my name with the company but they were refusing to do so until I had it legally changed. This is despite knowing other trans people within the company going by their new name without issue. I was waiting for my court order to come back to me, so I didn’t put a lot of energy into the issue as I knew it was self-correcting.  Also, enough time had passed that I was officially out to the rest of the world, so certain co-workers that I was friends with on facebook had read my letter and the gossip train at work was taking care of the notification process.

So, I went forth and into the women’s room. My very first visit to the ladies room, I decided to try and avoid people as best I could. I went to the fourth floor, which is largely vacant except for a handful of engineers that were all male, as far as I knew. They kept to themselves and rarely acknowledged that anyone else in the building actually existed.

So I walked up the steps from 2 to 4, took a deep breath and pushed the door open to find? A very startled older woman. The lights were low, so I just stepped aside, she went out, I went in. This game went on for exactly one week. Then I kind of got tired of trying to avoid people. My job requires us to adhere to a schedule without deviation. If we don’t adhere we can be written up. It’s a lot like high school, except high school is more flexible. So on the 7th day, I was on break, I didn’t have time to go to a different floor, I ducked into the women’s room on the first floor. When I came out, from across a dimly lit break room that’s the length of a football field, I’m spotted. Mind you, I’m wearing a dress, but still.

One of them yelled at me, “Did you just come out of the women’s room?”

I stopped, turned, looked at them and said, “Yeah?”

I could tell they were trying to decide what to do or say. They were not from my work center, but I assumed from the 5th floor, which is another self-contained call center with different management. I realized then that Barbara’s not telling anyone idea probably extended to the fifth floor.

I came back to my desk and I calmly typed out an email to the center director of the fifth floor that essentially said “Hi, I’m so and so, you don’t know me. I assume that no one has told you, but I’m transgender. The reason that I am telling you all this, is that I had a run-in with two of your employees who yelled at me when I came out of the women’s restroom. I am not trying to get them in trouble, but I do have HR’s permission, I’m working with XXXX, here’s a copy of the policy, etc etc etc.”

She emailed me back, thanked me for letting her know, because no one had told her. She called HR, HR called Barbara. At this point, they pulled me back out to a meeting with her and a couple other managers from my floor. Along with them, they had our union steward. They wanted to go over verbiage with me, as they were essentially holding huddles with small groups to cover everyone on the situation, and company policy. The union rep reaffirmed the union’s position that there was a non-discrimination policy and the union would not protect them if they attempted to grieve the issue. Management and the union in agreeance. Doesn’t happen often. In any event, feedback that I got was that there were a few people who thought my genital status precluded me from the ladies room, but they were told that they were free to find another bathroom elsewhere if they had such an issue with it.

From that point on, things got pretty easy. I only had one notable issue. I was standing in the lounge part of the bathroom, facing a mirror at a counter texting on my phone. The door opens, and I look up to the mirror to see a lady coming in. She sees me, stops and pivots on her heel and leaves.

Who knows, maybe she was uncomfortable with me. Maybe she was about to have blow out diarrhea and didn’t want me to hear. Who knows. At this point, I’ve been using the women’s room at work for 7 months. No one pays me any attention. I wouldn’t say that I’m accepted as one of the girls, but they tolerate me.

A couple weeks later, I finally got my legal name change. I was able to update my name with the company, get a new badge with 100% less facial hair. I have spent the last 6 months tracking down all the systems with my old name and getting them updated. But that’s a topic for another post.

** Not her real name.