Transmasculine Top Surgery Saga Update Part Two

Hmmmm.  Got a call yesterday from Phillip with SHIBA, an arm of the Washington State Insurance Commissioner’s Office, to whom I sent all of my transmasculine top surgery documentation and the latest letter from Noridian (the entity that administers the Medicare program here in Washington State and a few other western states).

 

Phillip called to tell me that I have all my i’s dotted and all my t’s crossed–all my ducks in a row–and that I should feel confident that Noridian will rule in my favor and that I should go ahead and schedule the surgery.

 

He said that even if I’m denied coverage at first, there is an appeals process that can go up as high as five levels, and that only at the top levels would an attorney be required.

 

But he doesn’t think my case can be questioned by Noridian after seeing my documentation and book–but confirms that Noridian doesn’t have  to (and decidedly won’t) review it ahead of time to confirm coverage; there would have to be a rule change legislatively to make that additional step an option. (And get this: Denny Heck is running for Attorney General in Washington State now, and if he gets the position, I will indeed see if he can get the rule changed! He’s already well aware of my case and understands what the problem is.)

 

So… I carried this news to my sister yesterday and she’s concerned, because my financial fate can impact hers. “I wouldn’t trust the government to do what it’s supposed to do.”  (This from a Trumpster! Perhaps there is light at the end of the tunnel!)

 

I feel similarly, but with Phillip confirming that I have everything I need to prove my transgender status, he says there is no way Medicare can refuse to cover the surgery. It’s state law that insurance must cover this procedure as long as it has been deemed medically necessary for my mental health and well-being, and I have letters from a mental health counselor and a medical doctor  confirming their decision that the surgery is necessary.

 

So… I have sent all this info to the doctor in Seattle and asked her a few more questions (since two requests that her office made of me are what sent me on this wild goose chase to begin with). I need to know why she asked me to get preapproval of coverage for a procedure that one can’t get preapproval for, and why she asked me to confirm that Medicare worked with the U of W. My question to her was, “why didn’t she know this stuff already?  If they’ve done a number of these procedures (which her office assured me she had) why didn’t they know I couldn’t do what they asked of me?  This leads me to question how many of these transmasculine surgeries she has actually performed, because I don’t want her practicing on me if I’m among the first!  (I know she has done breast reconstruction surgeries, but this isn’t that.)

 

I have a short list of other transmasculine top surgery physicians in Seattle, so I can always put myself on a waiting list for them if need be, but I’d hate to start from scratch again with someone else. If she can convince me she’s a member  in good standing of WPATH (World Professional Association of Transgender Health), I’ll feel a lot better about it…

 

I just looked up WPATH surgeons in Seatte/Tacoma. I’ll check them out…