Seriously considering challenging Medicare for GRS

[Guest LesleyAnne]

I am seriously considering challenging Medicare for my surgeries. From what I've read so far I will need supporting documents from current doctors of my dysphoria, and it's severity, of which I'm hoping my VA doctors can provide, at least some of what I will need. Also my Gender Therapist. Unfortunately I don't have an endocrinologist that I see since there are none available near me that see Transgender people, nor that want to in my area.

I've been on HRT for a year now, and have had a bi-lateral orchiectomy. So the clock is ticking for GRS because of the orchiectomy (most of the surgeons that do the surgery for GRS don't want more than 3 years to have past since that operation).

It's been a year now since my orchi, and if I am going to get a surgeon to agree to perform GRS it should be soon. Affordability is a major issue as it is for a lot of us.

Anyone else here at Laura's considered Medicare, and if you have, what obstacles you've encountered?

At age 66 I feel like it's never to late!

Love to all........

[JJ]

Actually it won't be necessary to challenge Medicare-they now cover GRS. Here is an article on it in the Washington Post. http://www.washingtonpost.com/national/health-science/ban-lifted-on-medicare-coverage-for-sex-change-surgery/2014/05/30/28bcd122-e818-11e3-a86b-362fd5443d19_story.html

There are a lot more articles out there but you need to use the ter sexual reassignment surgery and Medicare to find them. Not a term many of us prefer but necessary to fetch the information you are looking for.

Johnny

[Guest LesleyAnne]

Thanks for the article Johnny.

I actually read another one

http://transequality.org/blog/ending-trans-exclusions-the-path-to-inclusive-healthcare

....and it basically said the same except it added:

"The decision means that in the future, transgender patients covered by Medicare should receive an individual coverage determination for requested surgical care of gender dysphoria, and their preauthorization cannot be summarily denied (note: this does not mean it is summarily allowed). Levi also addressed some of the short-term challenges the community may face in finding Medicare participating providers."

On top of it all I am trying to find out if the Medicare Administrative Contractor (MAC) that process claims reimbursement for Medicare Part A, and Part B for Tex, NM, Colo. And OK. who have the authority to deny claims based on their assessment of an individuals need would deny me SRS in spite of Medicare's national ban being lifted.

Gov. Abbott has not built a favorable atmosphere here in Texas for my chances since his influence on Novitas who is the regional MAC. feels that all mental heath programs to his belief are nothing but a cash cow for the Psychiatric community. He believes that there is no such thing as mental illness of any kind. He took the extraordinary steps in the state of Texas to defund all programs, and it was signed into law.

I'm only saying that this could very easily influence the regional MAC into denying this type of claim, since it's a Dysphoria. Knowing Texas I feel I am going to have an ugly fight on my hands.

I hope not, but this is why I need to build a very strong case to go against this influence. It may very well be hard for me to do.

The other obstacle is to find a provider that will do SRS under Medicare, and I don't know of one?

[Guest Angelgrlsue]

Hi Lesley Anne

I am in the same situation as you are. Dr. Marci Bowers in San Mateo, California is accepting all insurance from what I read on her website. I am in the process of sending her a personal letter to confirm this and to find out if she will accept Medicare for GRS. You may want to write to her as well. Good luck.

Susan

[Guest LesleyAnne]

Thank you Angelgrlsue,

I will write to her, and maybe we can compare notes.

My only fear right now though is the first step of seeking the regional MAC's authorizing payment to a provider, any provider.

I will keep you posted.

[Guest Angelgrlsue]

Hi Lesley Anne

I just received an email from Robyn at Dr. Bowers office and she has informed me that Dr. Bowers does not accept Medicare as insurance. She will accept all other major insurance carriers though. Her out of pocket fee for SRS is way up there now too.

Susan