so THATS what people mean

[JanePeterson]

so... this journey is really driving home some of the things i had always taken for granted. example:

Went to get my first round of bloodwork today... And since *my employer* would fire me for being trans, I faced the situation of paying for my test out of pocket. After taking my info, the tech informed me that a basic electrolyte, estrodiol, and male testosterone panel would cost me $491!!!!!
After some digging, we determined that I made too much money to qualify for their corporate discounts... Then they figured out my amazing doctor had a deal with their labs to subsidize some of the cost so it only ended up being $160.
I am sooo thankful to have a job that allows me to eat a few hundred every now and then to fund my own healthcare, but honestly it is troubling to imagine what folks less fortunate/financially stable than I must go thru to get basic care.
Meanwhile, about 10 miles from here, folks of all kinds in Canada enjoy a single payer system where the basics of healthcare are covered! Where did we go so wrong?

[AllieSF]

Interesting Jane. How would your employer find out about your specific medical care, since all that info is supposedly patient confidential? I am just curious, unless you are worried about an unfortunate or purposeful leak from the insurance carrier to your employer? Good luck.

By the way, I was born and raised on your side of the River, NW burbs.

[Lauri K]

Jane,

I hate to hear that your job is or could in jeopardy just for being trans , you did not share enough details for me to offer any advice there, but I would probably say to take a look at Transequality.com there is a lot of information regarding employment protections / rights.

On the medical stuff, you are protected by Hipaa.........your employer cannot or should not find out your medical information unless you have given them written consent to obtain that information from your medical provider............if you want to read up on Hipaa go over to the US Dept. of Health and Human Services website there is a ton of Hipaa information showing you your rights and how it all works.

I know at my PCP there was a form that I had to fill out regarding who if anyone other than myself could obtain my medical information, I am sure each state has it own junk, but Hipaa should be universal in the lower 48 i would assume.

In my case my PCP has no trans experience so I am still in neutral.

Good luck and I hope some of this information will give you some comfort in knowing how the laws work regarding medical information, and by the way I am not a expert in law or anything I am just learning like the rest of us.

[JanePeterson]

Just to clarify, my job requires me to wear a uniform and I work for the federa govt. if that helps... And my particular position is one where I am under a bit of extra scrutiny - less of an issue for me really, just SHOCKING how much it can cost on your own

[LeaP]

1) Negotiate up front, or,
2) Go to one of the Any Test, Any Time labs.

The worst I ever did was go to a hospital for my labs. My doctor sent me there after I went out cold - twice - in her office. It was a gazzilion dollars AFTER the insurance!

Oh well, as least the hospital folks know their stuff. An Oncologist can find a 3 inch vein in a mosquito, and hit it on the first try.

[Heidi Stevens]

Sounds like you're still making things happen no mater what blocks they're tossing at you, Jane! I got two visits to the clinic run by the Ob/Gyn that monitors my HRT before my insurance caught on. Your cost of $165 is not far off from my $135 that I have to pay now to cover my bill. I'm having great luck with HRT, hope you are too!

[PretzelGirl]

No amount of money is a good amount. Probably your insurance would have paid for you as it pays for mine (I am assuming you wouldn't be within range of an appropriate hospital). This is part of what we are fighting for, total healthcare. You add an extra element to it, but we can still run into barriers. I watch a Facebook group of the local community and regularly see those quoting prices for the HRT as they are out of pocket too and normally tests are not affordable. I am glad you are able to test as it is just as important as being under regular care.

[MissDanielle]

I just saw the insurance mailing for my initial bloodwork--with the insurance repricing, $750 became $130 and I owe just under $100 of that.

Of course, therapy is where it's really going to drive the price.

[Georgette_USA]

I am sympathetic to all the costs and troubles people go thru today but. I have been rebuked by some because I said this is all so easy now-a-days, meant easier.

Hard for me to talk costs, as I never kept good records. In the dark ages of TS of the 70s, we were the guinea pigs.

I think cost of SRS is about 15000-20000 now, in 1977 I self PAID 5000. With inflation of late 70s-80s, I think that is very reasonable. I paid 3000 for 1973 car, today would be about 20000. It seems the big cost now is all the FFS stuff. Only heard of people getting nose and Adam Apple back then. I think BA has gone from 1000 to about 7000 now. I was lucky to get reimbursed for 50% of SRS under Psychiatric clause in insurance. Remember I think it was in DSM III GID, that one could be suicidal.

My partner and I did our own Electrolysis so that wasn't bad. All HRT was my own till after SRS, then could get that like a post-menopausal female.
Pyschs, lawyers and odd/ends doctors were also self payed. Surgery centers only required Pysch letters, that was our Therapy if we so needed. In the dark ages "testing blood we don't need NO stinking testing". Surgery centers didn't care. DSM III was the guidance.

I kept all the preliminary costs secret, as NO HIPPA back then, and sure did not want to alert work until I was ready. Remember NO legal protections back then either.

Yes it would be nice if all insurance companies payed for all this, but there are plenty of stuff insurance doesn't pay for. Oh and wouldn't it be nice if we had a NHS like UK, and let everyone pay for all our medical expenses. I have friends in UK who wait many years for all those services.

All medical costs have gone up since than.

[JanePeterson]

Thanks Paula! Actually, my doc in her exquisite coolness started me on the sauce about 6 weeks ago, so this is my first test to see where my initia dose has landed me...

I guess the big eye-opener for me is more how much healthcare in general costs when you have to walk away from insurance- and it ticked me off that there are these hidden prices you have to hassle to get. Part of me wonders how it would have gone if I had been presenting female yesterday and my tech didnt approve, would she have worked to get me that reduced price? Who knows...

Just getting a taste for how hard this must be as a young and/or lower income person having to do this on their own / it's one thing to academically support the principles of trans healthcare and equal access, quite another to catch a glimpse for yourself

[Angela Campbell]

I think I am up to around $60,000 to $70,000 so far including electrolysis, ffs, srs, therapy, legal fees, and hormones. All out of pocket.

[Kaitlyn Michele]

welcome to the club

woo hoo!!!!

[I Am Paula]

I'm here in Canada. Excluding hair removal, and drugs (which are very reasonable,read-cheap) everything is covered here. Drs. blood, SRS, therapy, you name it. The system is SLOW, but it gets you there. Getting on hormones is easy and fast, but the waiting list for surgery is tedious.

[LeaP]

The financial hit hasn't been TOO bad for me yet, at least by Angela's scale! I'm out of pocket about $11k for electrolysis. My tech is very reasonably priced - currently $70/hour and was $65/hour for roughly my first 100 hours. Therapy was $20 co-pays until my current job, which raised psych co-pays to $40/hour - but I haven't gone as much since changing jobs. Meds? I self-paid until my current coverage kicked in. Honestly, there isn't a lot of difference between the co-pays and self paying if you shop around. I picked up my monthly meds yesterday. HRT costs were $29.00. I didn't submit HRT costs against my flexible spending account because I didn't want it associated with my insurance company's records, but do now, so the roughly $350/year cost is offset by the tax savings.

I have NO IDEA what FFS will cost. The insurance company's relationship rep for the account counseled me on submitting letters on medical necessity and network adequacy, but no telling in advance what, if anything, they will wind up paying. SRS is covered.

But the freakin' blood tests are expensive! I don't think I've EVER been out of pocket for less than $100 or so. And a few times considerably more. I haven't had blood testing done since trans insurance coverage kicked in this year. Basic panels in connection with an annual visit have always been fully covered, but tests in conjunction with other visits have not been. Plus, hormones testing has *never* been covered. If it isn't next time, I'll escalate it. Worth it, though, as it turned out I need close potassium monitoring.

[Angela Campbell]

At this point I only pay $8 a month for estrogen. $20 for dr twice a year

[arbon]

It is always a bit depressing when we start talking about the costs. I did the cheap transition and still pull my hair out when I think of it.

[LeaP]

In what sense, Theresa? For SRS at least, you went to Dr. Chet. in Thailand. A lot of people consider him one of the better surgeons to use. I know you've had some problems, but that might have happened with anyone.

[arbon]

I just mean less expensive transition. I skipped doctors and therapists for the most part through the first few years, skipped blood tests, imported my hormones for 5 years. Have only spent around $5000 for hair removal, surgeries in mexico and thailand....all told maybe around $33000 spent to date. That is cheap compared to what most on here and others that I know end up spending. Indirect costs - lost income, loosing house and all that are something else though.

[Janice Ashton]

WoW

I feel so sorry for you ladies overseas, Thank God for the National Health Service (NHS) in the UK.
Doctors, Consultants, Clinic appointments, Estradiol (HRT) (under age 60 you have to pay a prescription fee but its very small), T Blockers, Full Range Blood Tests, GRS Full Surgery if you qualify? all of which is FREE!!! compared to what I am reading above (you do have to pay National Insurance in the UK but not over the age of 65). We really don't know how lucky we are on this side of the pond!! Oh yes' and there is an allowance for Electrolysis if you use an NHS approved clinic. It must be very difficult for people who live in countries where they cannot get financial medical support.. I am very lucky... and I know it!!!

[arbon]

Yeah but you all can end up waiting for years to get through the system (or to just get into the system!) and your under their control and having to jump through their hoops. no thanks.

[Janice Ashton]

Hi Arbon,

Yes, to some extent you have a valid point, but in consideration of cost against time I find it good for me, and you can't have it always. Some people want it all now and some are happy to go with the flow so to speak. If you have the money it may not be a problem to get all the medical attention you want, if you don't have the available funds, you can take the alternative in the UK. It appears to me if you don't have the funds for the medical intervention you seek living overseas you don't get anything. I agree to disagree in some sense but I think we both have a good point to make.

[Rianna Humble]

This thread is not about what people see as the advantages or disadvantages of the NHS nor about how it compares to any other healthcare philosophy.

Any further discussion along those lines will be deleted.

Any attempt to take this further into politics will result in moderation.

[Kate T]

Honestly I think you should be debating what seem to be some outrageous costs for your pathology work in the US. It costs somewhere around $150 for me to get a full electrolyte and hormone (Estradiol, Total Testosterone, Free Testosterone, Progesterone) panel done for an animal patient (in Australia). The technology and consumables are not that much more expensive for humans. You need to pay a tech to pull the blood but really it doesn't need a doctor to take the blood, I've trained my 15yr old daughter to take blood. So total cost really should be less than $200 full cost, that excludes any insurance or government subsidy programs. There is no doubt that the costs that some of you guys are talking about are likely to cause significant discrimination in access to appropriate medical services and that at the very least there appears to be some price gouging by some companies involved.

I am glad things are going well so far for you Jane and I hope they continue to.

Disclaimer: My experiences and knowledge are based on the Australian macroeconomic environment and products and services. There may be differences between countries that are not obvious though it is bloody hard to see what they could be from here!

[LeaP]

There is testing available in the US at or below the $200 price point for hormones assays. A quick search found a walk in lab offering a suite of tests including T, E, etc. for $169. Even that, however, can be too high for someone on a restricted income.

[JanePeterson]

My doc had a pre-negotiated rate of about $150, but I had to ask/hassle. The Estrodiol test was the big cost at $80