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beneficii
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04 Jul 2014, 11:27 am

As the independent review board found, there really is no justification for Medicare, or for any health plan, to exclude coverage of sex reassignment surgery and there hasn't been for 30+ years. Other countries cover this procedure yet in our country many health plans continue to exclude it, even some without legal basis, which is possibly what's happening in my case.

Years ago, I became aware that I was special in terms of the country I was born in, and that the specialty was a lack of coverage of sex reassignment surgery. This knowledge greatly burdened me for years.

I then was able to start hormones, but the insurance reps at the insurance company, even as they covered lab and office visits under the GID code (the correct code) kept telling me all of this was specifically excluded. I had major depression, panic, and rage set in, leading to 3 hospitalizations and missing a lot of work. This cost my company at least $15,000 and it was only for getting me back to where I was when I started.

I had my recent request for surgery denied, sending me back into deep depression. Seeing the vague wording on the denial letter and the fact my hormones have been getting covered under the GID code (in direct contradiction to what the insurance reps kept telling me), my lawyer is suspicious and we are engaged in in discovery right now, but still this whole process has had a huge impact on my mental health. I went on continuous leave for nearly a month, and I just found out my company is going to be paying for all that time I've been out under our short-term disability plan, which went all the way back to the insurance company's denial of sex reassignment surgery. My boss has been having to pay my coworkers overtime to cover my hours.

So, yes, going back to the first paragraph, I am a victim of the attitude of many insurers toward sex reassignment surgery. I also cannot help but detect a subtle irony that because of their attitude they've ended up paying far more to keep me stable than to pay for what's causing the underlying issue.

So yes, I am a victim of an unjust system that needs to change and change badly. And I'm damn proud to say it, whatever the vicious people who deserve the fate of Sodom and Gomorrah have to say about it.


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Kraichgauer
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04 Jul 2014, 4:47 pm

My understanding of transgender people has evolved over the years, changing from a total lack of understanding to acceptance. A big part of that had to do with a friend dating a transgender woman, who has since become a friend as well. Once while my wife and I were out to eat with them, our new friend had confided in me how she felt uncomfortable because she thought people were staring at her. Going through life as an Aspie, not knowing if I'm behaving properly in public or not, made my heart go out to her.
If I can change, then I have to think most other people can. Hold in there, and good luck. Know that there are people who side with you.


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Nights_Like_These
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04 Jul 2014, 6:16 pm

I can't even imagine having to go through all of that :(

I know sex reassignment surgery is covered here in Canada, but only if you live in certain provinces. I know Alberta just cut funding in recent years for sex reassignment, and I believe some of the provinces on the east coast don't cover it either.

If only it were possible to let others live in your shoes for a time so they fully understand what it's like to have a mind and a body that don't match up.

Sorry you have to go through that...


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