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Please begin with an informative title:

I am trying mightily to hold myself to the promise I have made...if only to myself rather than anyone else...to write a diary about medical insurance.  It is hard for me to do.  Those memories are exceptionally painful.  Having to fight an insurance company, on your own, when your employer takes the side of the insurer is not something I would recommend as an emotionally positive experience.  Doing so in the face of mass scorn is no less so.

Part of what has kept me from writing this piece is that I suspect, deep in my soul, that the same folks who have been so kind to visit my diaries from time to time will be the same folks who might do so again, that the folks I really have to convince in order to generate some positive result from what I say wouldn't open one of my diaries on a bet.  Preaching to the choir has its limitations...

Intro

You must enter an Intro for your Diary Entry between 300 and 1150 characters long (that's approximately 50-175 words without any html or formatting markup).

I have avoided the single-payer diairies like the plague.  Why abuse myself needlessly?  It's not that I don't think it is important, I'm just unfortunately sure that none of it applies to me, at least at the point where the "me" becomes an "us."

I've told my story.  I'm still telling it.  But there was an undercurrent constantly present.

Changing sex is expensive.  We scrimp and save trying to pay for the over $5000 necessary for medical, psychological, and pharmaceutical bills per year, knowing that we also need to raise about $10,000 more for the surgery, because most insurance companies refuse to cover this condition.
--Crossing the Gender Line
--Robyn Elaine Serven
--1993
1993 dollars.  I can't even imagine what it costs now.  I could research it, but I refuse.

The question of money was on my mind from the start.  At first, it was, "Where am I going to get the money to support myself after my wife leaves me and my employer dumps me?"  The first happened.  The second came damn close.  But even beyond that, even managing to keep my job, how was I going to afford treatment?

Sure, I was a college professor.  So at least I had a good job by most standards.  But I was making less than $40K a year, even if I taught extra in summer.  And before she left, my wife made sure that I was flat busted...so to speak.  But at least I had insurance, right?

I mean, I'd paid for insurance for over ten years and never used it (It is often the case that transpeople do not take care of their health prior to transitioning.  I refused to undress in front of a doctor).  My insurance would have to be good for something, one would expect.  

My insurance was what kept me from walking away from my job.  But it is also what forced me to come out.  The time came for me to get treatment and that meant dealing with insurance and that meant paperwork would arrive at my college's HR department complete with diagnosis.  So the day I made my first visit to my therapist was the day I came out as well.

There was an uproar.  It's detailed elsewhere.  Insurance-wise, what I discovered was that my insurer didn't want to pay.  For anything.  Not for therapy, not for prescriptions, not for having a doctor monitor my health, and most definitely not for surgery.  I have a huge suspicion, that having come out as transsexual, any health problem I encountered would have been denied coverage, viewed as a result of my misuse of the equipment I had been provided.  Fortunately, my dentist couldn't discover a link between taking estrogen and a testosterone antagonist and losing my teeth, that wouldn't have been covered either.

Where was I to turn?  Why, my representatives in Human Resources!  That's the ticket.

Except not.  When I sat down with the director of HR and asked for coverage, she suddenly became an agent of the insurer.  "We don't cover that."

That started a long battle.  First there was me going over her head to the insurer.  And then up that food chain.  I have a phobia against talking to people on the phone, and this was the absolute worst.  When I exhausted that track, I turned to the Arkansas State Insurance Commissioner and demanded my rights.  

By this time, I was extremely well-versed in our insurance contract and knew I should win, since there was no explicit exclusion of sex-reassignment.  The insurer claimed, in order, that the treatment was experimental, cosmetic, and a preexisting condition.

Translation:  There aren't enough of them to worry about, they're crazy, and they should live their lives the way God intended.

I responded:  
1. Forty years of a procedure moves it beyond the stage of "experimental."  

2. A quote from the Harry Benjamin International Gender Dysphoria Association (now the World Professional Association for Transgender Health), which established and monitors the Standards of Care:

Surgical treatment for a person with a gender identity disorder is not merely another elective procedure. Typical elective procedures only involve a private mutually consenting contract between a suffering person and a technically competent surgeon. Surgeries for GID are to be undertaken only after a comprehensive evaluation by a qualified mental health professional. Surgery may be performed once written documentation testifies that a comprehensive evaluation has occurred and that the person has met the eligibility and readiness criteria. By following this procedure, the mental health professional, the physician prescribing hormones, the surgeon and the patient share in the responsibility of the decision to make irreversible changes to the body.  The patient who has decided to undergo genital or breast operations, however, tends to view the surgery as the most important and effective treatment to correct the underlying problem.
3. I'm taoist. Besides, who's to say I am not treading the path God intended me to travel?

-----------

I was given the opportunity of responding in writing.  Among other words, I included this:

On The "Necessity" of Surgery

I have been told that my surgery was "unnecessary."  

I was not told this by my psychologist, who must decide if I am properly transsexual and treat me for the ravages that many years of self‑denial, parental neglect, and cultural terrorism have wrought.  

I was not told this by my medical doctor, who must decide if I'm in the proper physical and mental condition to undergo hormone therapy and who must supervise this therapy.  

I was not told this by the psychiatrist who must eventually have to decide if surgery is the proper course of action.  

I was not told this by the surgeon who will eventually have to decide if I am physically and mentally ready for surgery, decide whether or not such surgery is proper for me, and then perform the surgery if it is proper and I am ready.  

I was not told it was "unnecessary" by any of these people.  I was told it was "unnecessary" by an insurance company.

No one at the insurance company has met me in person.  I was not interviewed prior to this decision being made.  It is a generic decision, applicable toward all transsexuals by all insurance companies.  To the insurance company I am merely Patient Account #92078100 and a transsexual, and as such I have no rights.  No further explanation need be given.

It seems to me, from an admittedly biased viewpoint, that if any of these people listed above has the right to decide on the  "necessity" of my surgery, it is not the insurance agent and it should not be done unilaterally.  

It is my place to accept myself for who I am, to begin the journey.  It is the place of the psychologist to verify my condition and walk beside me down the path.  It is the place of the doctor to help me negotiate the hormone therapy, to show me the route.  It is the place of the psychiatrist to be society's representative in decided my fate, to be the gatekeeper.  It is the place of the surgeon to help me across the threshold into my new existence.  It is the place of the insurance company to use the money I have paid them to pick up the tab for the trip.

It seems to me that people that have been denied coverage for some medical treatment by insurance companies have been paying premiums to those companies under false pretenses.  Perhaps they should be repaid the money that the insurance company received during the years the clients mistakenly thought they were really insured.

I won.  Sort of.  I got coverage for therapy and pharmaceuticals, but not for electrolysis (which I didn't think I would get anyway).  And a decision about surgery would be made when it was actually time to have surgery.  

What followed?  The insurer colluded with my employer to change their contract to HMO status.  I refused to be switched over.  So my employer changed insurers until after my surgery.  And then changed back.

I was screwed.

I survived.  I had a job.  Some of us do have money to finance everything themselves, like my friend Danielle Bunten Berry (you may have played some of her games.  She wrote into the charter of her corporation (Ozark Softscape)  that any of the partners could have a sex-change at company expense.  Good deal if you can get it.  Most of us don't.  Most of us end up unemployed or underemployed, scratching out a poor existence, trying to piece together the wherewithal in the midst of hostility.  Some of us choose to market our bodies, one way or another (if you can't find a link to that, you are not trying).  

Your culture.  We do what we can to survive in it.

I could turn my back, but I'm not a "I got mine and that's all that matters" kind of person.  So I've tried to help others over the years.  People helped me and I view it as payback.  That's why I am here ar Daily Kos:  still paying back.

It is such a difficult time to recall.  But the topic had been brushed in a few Gender Workshops, as well as Diary: retrospection.

So a few days ago, I wandered into a diary and asked:

The diary mentioned
Cover all medically necessary services, including:

a list

I just have to ask:  who decides what is "necessary"?

Is sex reassignment surgery going to be included in that?

The answer to the first question seemed less than promising:  a "board" that would set standards.  A political board.
A board made up equally of Democrats and Republicans would basically decide what gets covered.

For each party:

1. one hospital administrator
2. three medical doctors (a surgeon, an internist, and a family practitioner)
3. one dentist
4. one psychiatrist
5. one nurse
6. one lay person
7. one HHS budget specialist
8. one veterinarian
9. one computer system analyst
10. one electrical engineer
11. one pharmacist

These would be full-time jobs nominated by the Surgeon General to the President and subject to Congressional confirmation.
...
There was no answer on the second question.

I think we're screwed.

Would someone like to disabuse me of this last notion?  Please?

Extended (Optional)

Originally posted to Robyn's Perch on Fri Jul 13, 2007 at 10:13 AM PDT.

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