Labs

[Guest Lacey71]

What labs will be required for HRT? I am getting insurance to pay for Spiro and finasteride; as I have a medical need.; ) but labs and E will be out of pocket. Trying to shop for best deal.

[Guest DanD]

you do have a legitimate medical need anyway, you know.

but if you dont think you do, then no wonder other people use that line and get away with it when its not correct.

whats a medical need anyway? it is something for the patients' physical and/or mental health benefit.

They pay for that %$ electro whatever therapy if your doctor said you "needed it". Yeh well it sure has a way of either making people alot worse real quick or making them suddenly never complain again of unhappiness, (if theyre smart) --so they can get the Heck out of there!

If you get depressed about this, how much do you think it is for them to keep you at a mental ward for a week?

How much do you think all those antidepressants and things cost the insurances?

-it would be alot nicer to treat the cause of the depression and anxiety, and cheaper. When I realized that, I realized I had a valid point. Why would they be unwilling to help with something rather than dope you out of caring bout anything at all, thus causing you more grief and dependance.

Something to think about. The AMA says mones and surgeries for transsexuals is a medically necesary treatment. I know why doctors and insurances dont always go for that line, because they want to make more money and get away with it, but that doesnt make them right. Transpeople need to learn in their own minds first this is necessary and why. And why isnt it necessary for heaven sakes? of course it is.

[Guest DanD]

the labs will be the usual everything they do when they do a complete check up.

the cholesterol levels and the various types, the fats, various vtiamins, the blood, white and red count and platelets especially, generaly a complete CB7 or 8. basicly that.

the mones levels but not all the time.

also check your heart and liver and spleen/lymph system.

the liver and spleen/lymph systems both act as filters basicly, so theyrw affected by things that you injest, mostly.

I have a copy of a book here called Hormones By a trans woman who is -or was..a doctor..it would say alot more details, but it's too wordy..

She seems to think its a health helped for an mtf to get mones, but for the ftm she goes on and on about the riisks, but she overdoes it on those.

its probably a very risky thing, messing around with mother nature like we do, but what options do we really have anyway?

so we chance it, but try to avoid the bad things the best we can, and hoe for the best like any one else does.

[Carolyn Marie]

In my experience, the first time the doc wanted complete panels, plus baseline T and E levels. After that, it was just T & E levels plus liver and kidney function. But doctors have their own preferences, and so it will vary, as usual. I try to schedule my HRT doc a little after my annual physical with my GP. Then I've got all the blood work done and don't have to pay anything beyond the co-pay. My GP knows I'm trans of course, and doesn't mind ordering the E & T tests. The insurance company doesn't mind, either, because as a "post-menopausal" woman, those are routine.

HUGS

Carollyn Marie

[Guest Lacey71]

Thank you for responding. I have medical need for all meds for transition but not an insurance policy that will agree. I work with a dear friend that is FtM, who was suicidal, and could not get them through insurance even though his life might have depended on it. I take Spiro for htn and finasteride for bph. Insurance pays cause it is covered. Labs and E though medically necessary are not covered for my dx of gender dysphoria. Appeals exhausted,I can not change this. I just thought that maybe my new friends, that have been dear to me through this, might have a little insight into the road I am traveling. I have been independently managing my transition and will do research as to what labs are needed BECAUSE I know that MY life depends on it.

[Guest DanD]

Carolyns right you know, you can get the labs done for your GP anyway. you always want ot share your labs with various doctors you see anyhow.

GID is a mental disorder not a medical diagnoses, thats why.

if youre getting "HRT" of any type for any reason they should cover testing to monitor it.

and im not trying ot be a pain in the donkey even if i might seem like it. ive helped alot of people deal with stupid insurance companies, and alot of times its just the dumb doctor's billing people messing up.

sometimes its the insurance but theres often ways around the cobwebs in their books and brains.

it gets to be one of those dumb games, like the way lawyers play at court, and everyone else gets ripped off, and the bad guys run free. annoying.

[Guest Maria_B]

Actually, these days DanD, it's classed as a medical disorder or a medical condition, not a mental disorder. So no, thats not why.

[Guest DanD]

Pysch labels are different in different countries. Sometimes the labels are the same but the words they use to define those are different. so, you could have one correct diagnosis in usa for example, but it might be diferent in England. Years ago some of us had some fun going thru the differences and comparing those two countries specificly. It would lead one to assume in SOME countries it must be realllly different, as as we all know society decides the norm, you know? and societies across the globe arent the same.

regarding billing and some other things...

But all you need on the claim form is the reason for getting the labs done? to monitor HRT is the reason.

The doctor could merely write down that its to check your system out like they do for a physical anyway. that is a valid medical statement too.. and is all they need on an insurance form aside from the numbers and names etc. because when someone takes medicines or is on HRT of any kind, they should get some labs done now and then to monitor it, it doesnt matter what kind of HRT.

One doctor's nurse actually wrote "sex change" as a "diagnosis" as to the reason I was getting testosterone, right on the prerscription. and of it got bumped, at least at the one pharmacy, (the pharmacist was a jerk), the other disregarded her stupid note on it, since she didnt need to write that on there anyway.

there is no medical thing called a sex change. and hormones dont change your sex anyway. -If they did that would be really something!

another funny thing, as an example of that

a breast surgery is called a variety of things, depending on the methods they use.

it might be, for one example: an expanded bilateral breast reduction w/nipple free grafts.

but its not a sex change and its not srs.. srs is another term with no meaning since it doesnt mean some specific thing they actually do, its more like, the overall result of a bunch of things.

the first surgeon i saw regarding breast surgery, he told me, as another example of how they use words, or dont use them.. he told me i could have my chest surgery done by him at St Francis Hospital, which is a catholic hospital and they do not allow sex changes, but a chest surgery is not a sex change so it can be done there.

You can get them done in Oklahoma but sex changes are illegal there, or were, the last time i read up on the subject. You can get a variety of the procedures done, if you divided up the bottom surgery into parts, they can do certain parts but not other parts of it. which is really kind of stupid if you ask me, but they didnt ask me.

there are two US federal guideline books they use for psych diagnoses and neither one is the DSM book, and they differ too.

Similiar word game jibberish books for the physical medical things.

thats why i mentioned lawyers, lawyers and courts use words..and kind of miss- use words, in different ways.. then they mean totally different things than what we would normally think.. Old Daniel Webster would have a fit over it.

this kind of wandered all over the place, here, since i have a thing for words.

insurances dont use normal words either. its like you have to learn their whole way of talking and reasoning out things in order to communicate with them, and throw their own rules back at them, if you can. If theyre making an excuse not to pay for something, come up with a few really good reasons to cover it, and it helps sometimes. depends on the plan though, but its easier with things like medicare or medicaid here because they dont have an actual list of things..they simply cover anything that is "medically necessary."

"Medicially necesary" is anything that is for the patient's mental and or physical health benefit.

How do they determine that? Medicare does not, the doctor does.

Thats why its important for the doctors billing people to explain things well, -and to fill out the whole form!

Its been my experience that most of the time something didnt get paid, its because the billing people did not fill out all the info that the form asked for. Stupid things like, forgetting to have the doctor sign the form.

and then the billing people have the gall to tell you the reason it wasnt covered is because medicare doesnt cover it..

[Guest Maria_B]

Aaaand we're dealing directly with someone who is American, DanD. She also had a question she asked. You've more than expressed an answer, so thanks, just you're putting blame on something that is not responsible, which is not fair.

[KathrynJulia]

Dan,

We're here in America.

Lacey. Insurance should not refuse to pay for a Liver Panel and a Chem Panel. Since they have a diagnosis for Gender Dysphoria, they raise a white flag on Hormone levels. Liver Panels and Chem Panels are a common yearly ordered lab tests. Your Family Practice or Internal Medicine Doctor can order them and have them coded for an annual physical. Insurance would then be forced to cover those tests.

Kathryn

[Guest DanD]

GID is a mental disorder not a medical diagnoses, thats why.

if youre getting "HRT" of any type for any reason they should cover testing to monitor it.

Hardly matters to me at this point, but I stand by that statement.

Maria commented:

"Actually, these days DanD, it's classed as a medical disorder or a medical condition, not a mental disorder. So no, thats not why."

Two things there, and you missed them both:

In the USA, its in the DSM book. It is a psych/mental disorder here.

I think its silly but thats a fact. the thing i find most silly about it is, it mentions someone showing signs of "pre-homosexuality" when its

1. got nothing to do with homosexualtiy and

2. since homosexuality isnt a disorder anymore, then how can "pre-homosexuality" be a disorder?

Its ok, they'll change it and make it even more stupid if they can. That might sound grouchy but actually i laugh at it. its just a billng code book for therapists to use, thats all it was meant to be in the beginning anyway.

And frankly, if theyre gonna say i've got a disability or a disorder or a disease or an illness and they call it GID, or transsexuality OK. But then I feel they should respect the valid known treatments for the condition and pay for them without playing any more games with us about it.

My point was to the exact issue of billing the insurance for the labs...

to have to medical monitoring of someones chemicals in their body, a PSYCH label is not a valid reason to get a medical monitoring done like that. so it would get bumped on a claim. Thats why GID does not make sense.

you'd simply write reason for labs: monitoring of levels due to HRT, and/or medications.

if youd call and talk to someone at the insurance and say thats why, theyd cover it.

it would be careless disregard for the doctor not to do labs, and also for them to not cover it. think about it.

i'm outta here.

That valid reason to get it done, is

if youre getting "HRT" of any type for any reason they should cover testing to monitor it.

or if youre taking any kind of medication that might require monitoring...same thing, they should cover it.

in fact, They can order a lab for anything; if the doctor simply has a hunch she might have something wrong, but he doesnt know what, maybe nothing, he can still order a ton of labs and tests and get it covered by insurance.

Saying GID simply does not make sense in this instance of blood work.

and considering the insurance approved some of the medication, monitoring things is not specific to that one medication they didnt apporve of, and N/A anyway. When youre a certain age over here, they expect you to have at least one full physical a year with complete labs and tests of various kinds, and even more as your age progresses.

I know i wandered kind of on a side topic there, and got into trivia a bit.. but i was not getting on anyone's case about anything, as you're saying.

[JJ]

Dan-the DSM has been updated and it is NOT a mental disorder anymore. There are threads about it here with links to the changesif you want to look it up. Roght now in the US there is no major medica; group who classifies it as mental disorder any longer

Johnny

[Guest Maria_B]

GID is classified as a medical disorder by the ICD-10 CM and by the DSM-IV TR. Yes, that includes the DSM.

The way you had written what you did implied insurance was denying it because of the classification of a Mental Disorder.

[Guest DanD]

just saying labs needed for monitoring of the meds is good enough.

but i didnt know they updated it as JJ was mentioning.if they updated it then i'm just behind the times with it.

funny my therapist usually would have mentioned that kinda stuff to me..

have they changed the way they handle it in Australia lately? i had a real good freind over there (MTF) and she had to save uo money for her srs to get done, she had to pay half, which was i think around $15k. I wondered if they still do it like that or not.

i think in theory you have free medical over there but it seems like its not so free, or maybe just for us?

[Guest Maria_B]

How about we talk in PM's? This thread is Lacey's, not fair to hijack it.

[Guest Lacey71]

I am soooo sorry to have caused such a stir and completely apologize if I sounded" bitchy" . I am really having an emotional week. I had first laser on face! That hurt!!! Dysphoria is raging, have Dr appointment for hormones but cost is high. I am so grateful for these forums. I live in a small, closed minded town where hate crime is not unheard of. I work with sexually violent predators that make transition @ work unsafe. I also seem to cry @ the drop of a hat. Thank you for Laura's.

[JJ]

You know folks the real question here is what labs are required and not the funding. It's nice to give Lacey helpful advise financially but that should not become the focus when that is not the purpose of the thread

I can't answer because I'm going in a different direction. I do know that lab costs can very enormously depending on the lab and have heard there are free labs through some LGBT groups if you are lucky enough to live in an area that does it

Mmight be good to contact your local trans group or LGBT group and see what they say about your area. I have heard of labs as cheap as $100 and others over $800 but that is pure heresay.

Johnny

[KathrynJulia]

Lacey

You have nothing to appologize for. Finasteride can change liver enzymes, so a doctor can and should order a liver panel to check both enzyme levels and cholesterol levels. Spiro is a potassium sparing diuretic and so knowing potassium levels along with Sodium levels found in a Chem Panel is appropriate and unrelated to your dysphoria. People forget that Spiro is also a blood pressure medication. So Chem Panels are appropriate for insurance to cover.

If you have any further questions about labs, pm me. I have 18 years of experience working in Laboratory Medicine. I'll do my best to answer your lab questions. Kathryn

[JJ]

Lacey the stir was not your fault in any way. We are here for questions and support. We can't always answer question and may have differences in opinion when we do but we should always have respect and remain supportive. Please don't feel you have to apologize.

I have enormous admiration for the job you do. And for you

Hugs

Johnny

[MaryEllen]

@DanD

You are hijacking Lacey's thread. You've said your piece. Now let's get back to Lacey's original topic.

MaryEllen

[Guest JennX]

You mainly want to monitor your:

1. Estradiol (E2) level

2. Testosterone level (free + total)

3. Liver function (aka hepatic panel and enzymes)

4. Potassium serum level

Don't forget to check your potassium level on Spiro, as it a potassium saving diuretic and it can quickly cause your potassium levels to spike. Too much potassium can stop your heart, which is not good.