SRS and HRT

[Teri Jean]

Okay I am going to be brief as I don't want to blow a gasket,:Angry3:

Today I am feeling so good and the estrogen is starting to be slightly realized after three weeks when I get a phone call. My endrocrinologist calls me to tell me the estrogen I'm on is not covered by my plan as it is gender specific. Females only! My option is an appeal with my carrier to get it included and while they are reviewing it how about the other meds I may need.

Now my medical and drug carriers are not the same but both plans were designed by the same panel of people. So the thinking is they felt that they should cover the SRS but not the HRT you need before hand. In essence they are as uneducated as the rest of society and for that point as much as I was a year ago.

Have any of you had simular experiances and if so any help?

Teri:hugs:

[Veronica Nowakowski]

I am only considering HRT, so no I haven't been through it. However, I would suggest you take them at "gender." It's a psychological, not a biological, term. You're of the female gender, so you are due the coverage.

[Teri Jean]

Veronica I hear what you are saying and yes it is in my appeal letter. I do think they are saying genetic gender. Thanks, insurance companies seem to be our best enemies even if theyare only doing what they are charged with.

[Veronica Nowakowski]

Well, their job is to charge you premiums and not pay for stuff. There's individuals who have jobs just to look for any reason to deny coverage or even drop you from the plan. You have to be serious about defining gender as psychological and sex as biological. I imagine some medical dictionaries may make a clear distinction.

After looking:

The medical dictionary defined it strictly as sex and not what we consider gender to be. The psychological dictionary defines it precisely as what we consider gender to be. Use a psychological dictionary.

[GypsyKaren]

Just have your doctor prescribe generic estradiol, it's only a few bucks at Walmart.

KS

[Jessinthesprings]

as Karen said with out insurance HRT is totally doable. The sprio which is not gender/sex specific is my biggest expense and your insurance should cover that. $10 covers me for 3 months for the estradiol at wal-mart.

[Stephenie S]

As Jessie and Karen have said, estradiol and spironolactone are drugs that are produced by the millions. They are cheap, cheap, cheap, especially at WalMart. You don't need insurance to pay for hormone therapy.

Stephie

[Veronica_Jean]

Mine is really silly.

If I get shots from the doctor, it is covered (I pay a small amount) but I cannot get the vials of estrogen from the pharmacy because that is not covered.

Veronica

[pamela_a]

Teri, I believe your employer is self insured and the "insurance company" is merely acting as the administrator so their decisions are based on what they are instructed to do.

You may have better results talking with your employer about the issue since they ultimately should be the ones who make the final decision.

[Suzy Harrison]

In Australia if you need it, you can get it on the public health system. No insurance is really necessary (I don't have any)

[Teri Jean]

Thank you ladies. I will be in touch with my doctors and see if this is an option I can use.

Teri

[Stephenie S]

Sweetie, your doctor just gives you the prescription. Then YOU take the prescrpition to WalMart. Estradiol and spironolactone are BOTH on their formulary. It costs $4 per month (30 day supply) or $10 for a 90 day supply for each prescription. You can find $4 in the cushions of your couch. This keeps your insurance company right out of the loop. Your therapist can bill them for "Personality Disorder", and your gender issues need not come up at all. This is good because MOST insurance companies get out the big red pencil when they see ANYTHING relating to gender problems. I know my insurance specifically excludes it right from the gitgo.

Lovies,
Stephenie

[carolinoakland]

I had the same thing happen, I just shrugged and payed it, I mean you're lucky they'll pay for SRS, mine won't. But here's what happened. I'm on two hormone's and a t blocker. They would pay for the t blocker and one of the hormone's but not the other. Until I had a form filled out by my endrocrinoligist that allowed my to change the gender marker on my licsence. Then they covered the second hormone. I would have thought they'd stop covering the t blocker but they still do... go figure. Oh, and I didn't know that the full hormone effect doesn't kick in for about six months.

[Faith_G]

I think (correct me if I'm wrong, Teri) Teri is just irritated at the illogic of an insurance plan that will cover the very expensive SRS, but won't fork over $20 a month for hormones. I don't think she's concerned that she will have to choose between hormones and her house payment.

I'd be appealing too because the situation is just ridiculous.

[Stephenie S]

My apologies.

S

[Teri Jean]

Faith you are so right in that it does not compute to have something like SRS covered (even if at a 20-80%) and that can mean as much as $35K. Now you would think as a logical reasoning they would cover everything but SRS. I'm not complaining about this stroke of luck but the reasoning still baffles me.

Now to all the help I have gotten here from so many wonderful ladies, I want to offer a tearful thankyou. You are so wonderful.

Hugs and kisses Teri

[Teri Jean]

I stopped in at our local Walmart and they took the time to look at my situation and recommended an option that is affordable. Now I need to check with my endrocrinologist for a substitute prescription and take it to Walmart. Thank you all for your help.

Teri

[stacie]

Just get the genetric estrogen. It has work for me for three years and I only pay 10 bucks for a three month supply. Like Karen said, Walmart has it and I get mine from Kroger.

[EnglishRose]

Target also does $4 generics, don't know if these are part of the program though.

[Hope]

Target also does $4 generics, don't know if these are part of the program though.

The Target $4 formulary is available here:

http://sites.target.com/site/en/health/page.jsp?contentId=WCMP04-040590

It looks like spiro and a couple of different E options (and dosages) are available.

See! - there really is no reason to patronize the yellow butt-hole.

[luvSophia]

There are a lot of pharmacies that are all charging the same price these days for generics. I pay $12 at Costco for a 90 day supply of my estradiol. I think the only one you will have a problem with is if you are taking Proscar, even the generic version is expensive.

[Teri Jean]

I am on the Vivelle Dot patch, I have asked for a generic prescription. If my doctor decided to put my on an oral estrodial I could get them from Walmart much cheaper. Time will tell but I am looking forward to the changes.

Teri

[Traci Elizabeth]

Neither Walmart nor Target carry the patches. Only pills. For my age group, I don't have the luxury of taking oral.

[EnglishRose]

Neither Walmart nor Target carry the patches. Only pills. For my age group, I don't have the luxury of taking oral.

That's related to heart disease, thrombosis and clotting? I've read around that ~40 is the cutoff age, is that right?

Sorry if this seems impertinent or rude. My own age is prompting the question.

[luvSophia]

Neither Walmart nor Target carry the patches. Only pills. For my age group, I don't have the luxury of taking oral.
My doctor does not place any value in age alone as a determining factor in whether or not to use patches or pills. She runs a very busy woman's health clinic and has a lot of older females who are safely taking estradiol tablets.

You need to perform your own due diligence on this (along with your own doctor) but I believe that most of the studies regarding age and problems with HRT were performed with Ethinylestradiol and Premarin, both of which react differently in the body than 17-beta Estradiol. I started out self-medicating with the patches because of what I had heard through the rumor mill regarding age and HRT. When I came out to my doctor she switched me over to the pills.

Again, that is just me and my doctor. You and your doctor need to come to your own conclusions and comfort level.

[Teri Jean]

Today the journey in getting my prescription is finished and the patches were ready tonight. I am happier than the other day and now I can focus on other things. Thank you all for your help. Huggs Teri

[Traci Elizabeth]

My doctor does not place any value in age alone as a determining factor in whether or not to use patches or pills. She runs a very busy woman's health clinic and has a lot of older females who are safely taking estradiol tablets.

You need to perform your own due diligence on this (along with your own doctor) but I believe that most of the studies regarding age and problems with HRT were performed with Ethinylestradiol and Premarin, both of which react differently in the body than 17-beta Estradiol. I started out self-medicating with the patches because of what I had heard through the rumor mill regarding age and HRT. When I came out to my doctor she switched me over to the pills.

Again, that is just me and my doctor. You and your doctor need to come to your own conclusions and comfort level.


Actually my wife is on the pills as well. Yet my doctor felt that for a Transgender at my age, I should not place an additional burden on my liver trying to process the pills. My doctor takes a conservative approach.

[Teri Jean]

Traci, I have the patches from Walmart but they are still not covered by my insurance. We are appealing it as we speak. So the cost to me is $38 dollars per month, one patch per week. I am 61 yrs old and although in relatively excellent health my doctor wanted me on patches as it is a less impact on the liver.Down the road if the pills would be an option and I can get them much cheaper then I will cross that bridge. Thanks fo5r the input.

Teri