Turned down by another Surgeon

[Angelgrlsue]

I do not know how many SRS surgeons I have gone through now, but every single one has turned me down because of my insurance. I receive permanent Medicare as my primary insurance, and not one SRS surgeon, so far has nto accepted this insurance. They will take any other major insurance but not Medicare. I am not even able to pay into another insurance company because I have permanent Medicare, I even called Medicare to find out if I can get off Medicare and they said NO! It is because I am permanently legally blind and that will always remain, it is like the federal government owns me or something,  in a way they do.  I was just turned down my Dr. Marci Bowers because of my insurance.  This is really taking a toll on my mental health, I have fought so hard, and applied to so many surgeons to just get turned down every time.  it is not that they do not want to do the surgery for me, they would gladly perform the surgery, they just want to make sure they get paid. I don't blame them though, I would want to get paid too.  Right now, I feel like I am going in circles with trying to find a surgeon that will accept my insurance. 

 

Believe it or not and maybe I am a rare case, but most of my adult life, I was a homemaker,  do not have much paid work experience.  My main job was to keep up the house, raise our child, be a good partner and I did and was.  Finding work at my age now, is not so easy, but I do apply to jobs everyday, in hopes someone will interview and hire me, so at least I will have some extra income that I can save towards paying for surgery.     

[MaryEllen]

I can easily see why you are discouraged, Susan. I would be too if I were in your place. I would urge you not to give up. I think I read somewhere a transgender group had set up a fund to help those who could not afford the surgery. I'm afraid I can't remember who it was, though. That might be something you could research.

MaryEllen

http://jimcollinsfoundation.org/

[Carolyn Marie]

That is really a tough pill to swallow, Sue.  I can't think of a legitimate reason for not accepting Medicare as payment for GCS, unless they don't pay enough to cover the doctor's expenses.  Have you asked for explanations from the doctor's offices, and if so, what have they said?

I don't know if this will help, but here is some relevant information, some of which might be useful for the doctor's office staff.

http://www.transequality.org/know-your-rights/medicare

I wish you luck, hon.

Carolyn Marie

[Jani]

I'm sure the reimbursement value may be a problem.  One issue that I'm aware of from being in the government and working for a federal contractor is that with many government and government-sponsored agencies are known for long payment cycles that scares suppliers away.  Plus there may be other arcane rules at hand.  

Jani

[MarcieMarie12]

Jani, that is also another problem. They require so much paperwork to get reimbursed and if things are not filled out just right you may find yourself in legal trouble. It is why some physicians don't accept medicare.

[Briana]

I sure feel for ya on this.  Medicare and state insurance programs can be tough to deal with when it comes to reimbursement.  It's hard for individuals and providers to understand all the "rules".  Sometimes, you'll get different answers from those that actually WORK within the various agencies.   In general, most physicians & physician offices know what they will and won't be reimbursed for.  Some procedures are just not covered.  For some procedures, the reimbursement rate is so low that many providers, ahhhh...shy away from accepting those cases.  

I don't know what you're seeking to have done (SRS I assume), or if you've tried this yet, but it's sometimes helpful to start out with the payor; in this case Medicare.  Generally, when working with their claims dept they can tell you what is and isn't covered, and  what the reimbursement rate is.  That can sometimes give you some insight as to why the rejections and where to go from there. 

[Briana]

On a side note, you mentioned employment.  Have you tried transcription?  Despite the growing technology of speech to text, there's still quite a need for transcriptionist.  Many times it's to make corrections when speech to text doesn't get it right.  And there's still plenty of straight up transcription work.  Many transcription companies have a bulk of their transcription staff work from home.  You need to be a good keyboardist, use some basic technology, and have a solid internet connection.  Anyway, something to look into.  

[Jani]

2 hours ago, Briana said:

it's sometimes helpful to start out with the payor; in this case Medicare.

This is solid advice.  Thanks for bringing it up Briana!

[Timber Wolf]

I feel for you, Angelgrlsue. Even though SRS is not actually at the top of my list of importance for things I want to get done, the things that are, are currently completely out of reach for me financially. 

I know the pain of looking in the mirror and seeing the things that just don't line up with who and what I am, and the feeling of hopelessness that tries to overcome me. I just close my eyes and be thankful that I've come as far as I have and have found acceptance with my family and am now living as Carla with them. Then I remind myself that I really don't know what the future may hold and I keep hope.

I wish I could give you a way to make things all hunky dory, but I haven't found that way myself yet. But this does help me get through.

 

Lots of love,

Timber Wolf?

[ErinLeach]

 

Angel, have you tried Dr. Dugi at OHSU in Portland Oregon?

[Jani]

Hello Erin, 

I've read some good things about Dr. Dugi.  

 

I didn't see you pop in!   Why you post an introduction?  We'd love to hear from you.  

 

Cheers, Jani

[ErinLeach]

Jani, I am an old member of this forum, Ladyinker. However, the new forum seemed to dump my old profile so I had to make a new one.

 

Erin

[Jani]

My Goodness!  I recognize you now from your photo.  You look great.  I'm glad you are back as I enjoyed your conversation and commentary.  

 

Jani

[Angelgrlsue]

Now, that I am back on the forum, their was some hickups with my account, I can reply to your responses. Thank you all for your expert advice and suggestions.  Maryellen, I did not give up, infact I fought, like I always do. Through my advocate, I found another surgeon in Los Angeles that will do the surgery for me with my insurance.  I saw him last week for a consultation and he explained the procedure with me and everything else. He will be doing my surgery in two stages, he also wants me to have a CT scan done next week to see what is going on inside my body since I had bladder cancer surgery, he will have to use part of my colon to build the cavity in the second stage of the procedure. 

 

Susan

[Jani]

Very good!  I'm glad you were successful, with persistence and a little help from friends.

 

Jani