TransVentures

So let me tell you about what I’m dealing with these days….

I had planned to write this entry for the last few days. I even have a couple of drafts that will likely never see the light of day. I wanted this to be a happy entry, a fun entry. Something exciting. Much wow.

I was hoping to be able to say that I’ve finally got a real date for my surgery. That I can sit back and relax and just check off days on the calendar. However, this is not that entry. Oh no, of course not. One door opens, and then a Trump-like villian builds an electrified Jurassic Park style 10,000 volt fence.

So, as you may recall…. I originally had picked Dr. Bowers. Because reasons. A myriad of reasons. However, with that reputation comes droves of dysphoric transgender women looking for new hoo-haas. So the wait has been an issue. I’ve been on the cancellation list trying to get a leg up on the situation. It had not happened. I started to get nervous and began to look at other options.

In October, I found a surgeon in Chicago by the name of Dr. Schechter. He seemed very competent, amazing resume, etc. I set up a consultation with him in early November. Post consult, they had submitted a request for a pre-determination to my insurance company. That’s where things get weird.

I spoke with Dr. Bowers face-to-face later in November when she was in town for a banquet and I explained my unique situation. She seemed concerned and interested in helping me, so I immediately contacted her staff.  Things looked good and the office manager said we needed to start in on insurance approval immediately. I hurriedly sent over all the paperwork and crossed my fingers for the best.

Not long after, I received notice from Dr. Schechter’s staff that my claim had been denied. The reason was that I haven’t met certain requirements today. However, we were attempting to schedule for after those requirements had been met. They would not schedule me without this approval. Unless, of course, I want to pay out of pocket.

I contacted Dr. Bowers’ staff again and let them know of the situation. They advised me that I should attempt to appeal but that it would be 1-2 months… yes, MONTHS… before they could even get around to filing my insurance paper work. So I moved forward with the appeal.

I submitted the appeal on December 14th, assuming that Blue Cross Blue Shield would take the full 30 days to make a determination. So I sat on my hands and I waited. I didn’t email any of the doctor’s. I enjoyed the holidays and I tried not to think about it.

Last Monday, I got a letter in the mail saying that my appeal had been denied. From what I could tell, the insurance company totally ignored my letter altogether and doubled down on their original verbiage. That’s point where I lost my collective shit. Remember “Ferris Bueller’s Day Off?” That scene where Cameron looks down and sees the odometer on the Ferrari? Just like that, except without the hot tub later on.

As I have been known to do, I went to twitter and I started a (nearly) perfect (shit)storm.

From there, things got weird. The next day, I decided that work was not in my best interest, what with my heightened mental status. So, having finally blown off some of the steam, I was going to try and just let it go. Maybe I would have to wait until March. I had some other ideas. But then there was a knock on the door. Who could that be?

Ok, so I earned that. 140 characters doesn’t give me enough rope to truly hang myself. Wait, that’s not right either. Umm.. I was trying to say people denied care are more likely to commit suicide. Not that I was going to kill myself. Simple misunderstanding.

After having an awkward conversation with the very nice police officer, I went back to Twitter and some friends and I bantered back and forth about the denial, the police and the “man.”

But later that day, I got a phone call from Blue Cross. In a crazy turn of events, they reversed the denial. After a brief rush of euphoria, I emailed Dr. Bowers’ office and let them know that I was approved for surgery and politely asking what the next step would be.

Despite a number of emails exchanged, the most informative answer I’ve gotten from Dr. Bowers’ office is that that they’ll work on it this week or next. This is even with a representative at the insurance company willing to personally process the claim.  I have basically begged them for more information, but all I get are vague replies, days later.

So, I decided that maybe I just needed to give up on Bowers. Maybe it just wasn’t meant to be. Schechter’s office wanted a bunch of additional clarification from the insurance company, which the rep at BCBS agreed to do. She faxed them a special letter with the info they needed. I thought that at that point, I could get a date. So I emailed them on Monday and asked them what the status was. I waited until today (wednesday) to call them and see what was up. Now they’re wanting additional info. They still won’t schedule me. Well, she offered to schedule me if I would pay out of pocket.

I let the lady have it. I really just let it all go. I told her that I didn’t feel like they really wanted my business. I felt like they were not putting enough effort forward to obtain their required documents from the insurance company. That I had done all the heavy lifting because once again, no one will advocate for me except me.  She was unmoved by my plight.

  
I contacted the rep at BCBS again and asked if she could help hand hold Dr. Schechter’s office through whatever they needed. She said she would reach out and get back to me as soon as she had more info.
Meanwhile, by Christmas, I’m sure Bowers will find my file under the pile.

Edit: As my friends so eloquently explained, GRS/GCS is a seller’s market. There’s a ton of demand and only so many surgeons. I think this climate has led to the poor customer service that we’re seeing. We are put on endless wait lists and we’re meant to feel lucky when it’s our turn. It’s sad, because I don’t think that’s what the providers intended for when they started in this field.

In any event. for months, I’ve been walking on eggshells with both doctors. I know they don’t need me like I need them. Writing all this might make it worse. I might never get a surgery at this point.

Update, 10:16 2016.01.14 – email from my insurance regarding Dr. Schechter’s refusal to schedule me, still. 

  

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.

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?