My Transmasculine Top Surgery Saga/Slog Continues

Let’s start with this: In my state (Washington), it is illegal to deny a duly-certified transgender individual  gender-affirming transmasculine top surgery. Period! End of story.

 

Yes, there are a few hoops an individual needs to jump through to be declared transgender. FtM individuals like me have to present and dress as the gender we know ourselves to be for two years prior to surgery, and we have to have two professionals (a certified mental health counselor and a medical doctor) certify that we are indeed, presenting as transgender and are entirely comfortable doing so.

 

If I were opting for bottom surgery at this time,  too, I’d be expected to be on testosterone for a period of time before I could undergo that transition.

 

For MtF individuals, there are additional hoops, including a regimen of estrogen (and perhaps some other) hormones. (I haven’t fully researched this side of the issue.)

 

I have navigated the waters I needed to so I have (and have provided) the required documentation to pull the trigger on having top surgery.

 

But here’s the bottleneck…

 

Medicare won’t confirm their coverage of transmasculine top surgery in advance of the procedure, and they won’t guarantee they’ll cover it after the surgery.

 

The procedure will apparently have to be “appealed” in every case because these things are determined on a case-by-case basis.

 

So, if I schedule myself to go under the knife, I will have to sign a document accepting financial responsibility in the event the appeal to Medicare (and hence to United Health Care, which automatically covers the remaining balance of whatever Medicare doesn’t cover) doesn’t go my way.

 

And get this: the doctor’s office in Seattle said that if the appeal is denied, the surgery suddenly becomes ten thousand dollars more expensive (from $15K to 25K)!!!

 

I don’t have that kind of money, and I have no intention of signing a  document that declares I’m financially responsible if Medicare denies my claim.

 

Now, granted, the chances may be slim to nil that, on appeal of my case, coverage of the surgery would be denied, since I have all my ducks in a row and even have written a book on my transgender life story.

 

But this is what’s known as red tape–the malarkey that puts additional stress on already-stressed people.

 

Someone either has to get Medicare to rule on my case before I have the surgery (which, really, is that asking too much, if I can provide the proof they need to make a decision???), or I have to — what? — create a GoFundMe account and hope to get the $25K in case Medicare denies my claim?

 

This is f***ing insane!

 

Medicare ought to be able to tell me in advance

whether or not the procedure will be covered BEFORE I have it done. 

 

They’ve been given the documentation by the Seattle doctor.  They know my story and my status, including the book I wrote, and that it’s being used by professionals to help the families of transgender children understand what it’s all about so they can relax into the experience and not have a meltdown if/when it happens to them.

 

I’m just at a loss to understand why this is the impasse, the barrier, the obstacle (other than the current COVID crisis) that’s keeping me from naming and proclaiming my gender physically once and for all that I’m a HE, not a SHE. Every day that passes and I’m identified by strangers as “she”, “her” and “ma’am” is another day of frustration. I hate these bulbous appendages with every fiber of my being. I want them GONE!

 

I cannot understand why Medicare gets to dangle my hope before me while denying me the right to know if it will honor my truth and pay for the surgery that will set me free to be me for the first time since I was nine years old and these atrocities erupted on my chest.

 

It both saddens me and pisses me off.

 

I want to thank Congressman  Denny Heck and his team for going to bat for me to get the result I’m at now. I have submitted an official complaint to the Insurance Commissioner’s office to see if they can procure a decision from Medicare for me in advance of the procedure. Fingers crossed! That’s all that’s standing  between me and the goal I seek.

 

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