Medical care problems

[Lucca]

My experience with doctors and their staff hasn't been nearly as bad as that of many others', but it's still become pretty frustrating.

 

So, back when I switched insurance and went to my HRT-prescribing doctor for the first time on my new insurance, the insurance company ended up rejecting the claim. After arguing for awhile on the phone, it turned out that the reason for this was because the claim was filed with the diagnostic code of "transsexualism", and they refuse to pay for anything related to trans care, so I was liable for the entire bill. Great.

 

I talked to my doctor about this, and she told me that she'd send in all future claims with a different generic diagnostic code so they'd be covered, and she would dispute the rejected claim so I wouldn't have to pay it. Luckily, with the new diagnostic code, all my visits since then were covered, but I still kept receiving bills for the old visit.

 

I talked to the receptionist at a future visit a couple months later and told him that I was still getting messages about my past bill, even though the doctor said I wouldn't have to pay it. For some reason, he seemed incredulous that the doctor would have told me that. After repeatedly stating that yes, my doctor did in fact tell me that she'd find a way for me to not pay out of pocket due to a problem with my insurance that she was supposedly disputing, and he can ask the doctor herself for confirmation, I finally just spelled it all out for him. In front of the entire waiting room, who I was purposely trying to be discrete in front of, I explained that my claim was being rejected because I was trans, and because of the diagnostic code of "transsexualism" that was used.

 

That seemed to get him to shut up, but I have no idea why he was this clueless about insurance claims being rejected when he works in a doctor's office that is known for its transgender care. And with all that, after months of waiting for my doctor's office to do something, there was still no progress on getting me out of paying the bill. I eventually just paid out of pocket over the phone when the company called me.

 

Now recently, I went to a different doctor for a consultation for him to perform an orchiectomy. We got to talking about price, and whether insurance and/or Medicaid would cover it, with him insisting that Medicaid and most insurance do actually cover orchiectomy and other trans care. I don't still have that same insurance anymore, but I told him about my troubles with getting insurance to pay for my trans medical care in the past, with them covering absolutely nothing, and specifically mentioned the diagnostic code of "transsexualism" that gave me problems. He then told me "that's not a real thing" and brushed it off, and I had to reiterate that whether he thinks the term "transsexual" is politically correct or not, this was a real diagnostic code that was really used in my claim, and it's the real reason why my real doctor's visit wasn't covered and I had to pay real money for it. I think that got it through to him, but Jesus Christ.

 

Like, I don't get it; why do people who work in trans medical care have this much trouble understanding discrimination against trans people? They're either not properly discrete, or they sound like they're reading from a politically correct script instead of listening to what their patient is telling them. I mean, I've had a lot of garbage experiences with doctors in the past that have nothing to do with trans care or that I had before I even realized I was trans, so this is not something solely endemic to trans care, but it's more frustrating here because of the demographic/social differences between me and the doctor/administrative staff and the social stigma involved.

[Jani]

I'm sorry you are having so much trouble.  I do not believe there is a diagnostic code for "transsexualism".  My Therapist used the code for Anxiety when I saw her and my endocrinologist (trans specialist) uses Hormone Disorder.  My primary care doctor input the code the Gender Dysphoria, DSM-5 302.85 (F64.1). The older Gender Identity Disorder was removed in 2017 edition of the DSM.  Any of theses work to satisfy insurance although I have not filed any claim for anything transgender related at my primary doctor, the code is just for the record.    

 

The staff at these facilities should be more discrete in holding discussions about medical records in the lobby area.  Understand not everyone in the office is privy to the filing of claim information. You should speak with someone that does billing.

 

58 minutes ago, Lucca said:

...I've had a lot of garbage experiences with doctors in the past that have nothing to do with trans care or that I had before I even realized I was trans, so this is not something solely endemic to trans care...

Don't be bashful about speaking up when this happens, saying your transgender needs are not related to this.  This will give them an opportunity to reply and move on (or defend the point).  Often doctors, like many of us, fixate on the first thing or biggest issue they come across to the exclusion of the true problem.  You can say, OK but lets get back to the reason I'm here which is xxxx.

 

Jani  

[Lucca]

I don't know all the behind-the-scenes details, but when I was on the phone with a representative from my old insurance company, they told me (without me telling them beforehand that I was trans or what the reason for my visit was) that my claim was rejected because of the "diagnosis", and that the diagnosis was "transsexualism". My doctor did not dispute that that's how it was filed when I talked to her, she was just surprised that they rejected the claim because of anything in the diagnosis. All future visits were given the diagnosis of "anxiety" for billing purposes, which worked.

 

I mean, it's not even an incorrect diagnosis. I'm just frustrated at the hubbub that has ensued as a result because my insurance company didn't take it.

[Jackie C.]

You're absolutely right. I've been "outed" in front of a room full of people before. That's extra-fun for me because I don't generally respond to my dead name by default anymore so they get to repeat it a couple of time and say it louder before I realize they're calling ME. Then I'm mortified and do the walk of shame into the office. Fortunately, getting my name legally changed cleared most of that up.

 

I could rant about insurance in this country for days if you let me. I'm sorry that happened to you though. At least my insurance company is up front about when they give me the middle finger for trans care.

 

As for discrimination, I don't think it's intentional. There aren't that many of us so people don't get a lot of practice dealing with us. Mistakes are made, apologies usually given, but most people just don't give us the consideration they probably should. Not out of malice, but rather ignorance. They really don't know what it's like. Hopefully, given some time, that will change.

 

Hugs!