Talk me down off the cliff

[Suzanne F]

Ok it's been a rough day. Looked at email in airport and saw message from my dr office. Insurance refuses to pay for my breast augmentation. I call the office and say what happened and they tell me 3 weeks from surgery that they were just notified that my insurance has an exclusionary clause saying they do not pay for this. Ok I will fight this in the mean time what do I need to pay I ask. Well if out of pocket then we send you to another hospital. Ok I say. Oh but that would come with another date! wtf I say! No there will be no other date. Ok they will get back to me tomorrow.


Ok regroup Suzanne. Then I check in referral for electrolysis for genital area. Oh that hasn't been approved yet!! I fought last year for this and won only to be told yes we will cover but not until you have been in hormones for a year! So I started on my own and now need to charge them for it. Several calls yield no results. So no progress.

I have made all kinds of plans including a friend flying to Cali to take care of me. I thought I had it all in place. I just feel insane! Like everything is falling apart. I couldn't get anyone to understand the urgency of it all today. No one gave a damn it seemed. Ok I know I should breathe. I am just emotional the day after the grueling marathon and I need to get home.

Suzanne

[steftoday]

I hope that things work out for you, Suzanne. To have this a come up right at this time really sucks. I'm not sure what else to say, but best wishes to you in getting it all straightened out.

[I Am Paula]

Oh crap! Aweful news indeed. I hope you get it all straightened out. I feel your pain.

[jentay1367]

Suzanne,
In the words of Steely Dan.....Everything that falls apart, falls together again. Take a deeeeeeeep breath...re-group and push forward. A year from now this will just be a story you're telling about how they put walls up and you kicked them down. Keep your head straight and move forward. Good luck. Lisa

[Badtranny]

Relax.

Shit happens. Life sucks. You are a proud trans warrior who just ran a damn marathon.

Maybe your plans will fall apart, maybe they won't, but in the end it's nothing more than a delay. A setback, a stumble, a bump in the road. It's nothing.

I commute into San Francisco everyday on a motorcycle through some of the worst traffic in the US, and some people don't like me splitting lanes so they try to pinch me off. It's futile. I'm faster, I'm more agile, I'm not afraid, they will not stop me. I will get around them, I will leave them sitting in traffic and their own angry bile.

Use your power, use your brains, rely on your courage, look around, find your lines. Find your way.

[phylis anne]

What bad tranny said , do not be deterred go get em ,


hugs phylis anne

[Angela Campbell]

It's easy to get frustrated with all of this. Things go wrong and you have to regroup sometimes. Hope you find a way to get things back on track.

[Eringirl]

Wow, that does suck! I hate bureaucracy run amok by pure number crunchers! So much for humanity.

You're stronger than this. It will work out. Stick to your guns. You can do it!!

Big hug!!

[Lorileah]

I knew my insurance wouldn't cover BA. Most don't as it is considered cosmetic for us. I don't understand the change in hospital part though. I assume they had GRS and BA already on the docket?

But I do empathize with you about things changing with every person you speak to. I am holding my breath that mine is set in wet cement and will harden in 7 days. Hang on. The doctors can't control the providers. I just keep thinking 2 years ago NOTHING was covered.

You have this. You know it. Positive attitude. We will talk in a week (if you want)

[Suzanne F]

Ok one positive development today. The health insurance company called to tell me that the electrolysis referral was approved. I should hear more about surgery tomorrow. Thanks for the support. I will prevail!
Suzanne

[donnalee]

Try resubmitting the claim, hopefully from a different avenue. Sometimes it's just the luck of the draw as to who you get and how helpful they are. California, to the best of my knowledge, requires health insurance to cover trans issues, so the California Insurance Commission might be one of those avenues.
Best wishes; I hope all goes well for you.

[Kate T]

I'm glad your electro was approved. That would have been a pig.

I'm not trying to tell you how you should feel about your body or the surgeries you need but I would say two things about the BA.

Firstly, it was my understanding most surgeons strongly advise NOT to get a BA prior to being on HRT for 2 yrs. The reason as I understand it is that you can still get some growth in the second 12 months of HRT that can displace implants and produce an poor cosmetic result.

Secondly I would say do you NEED BA? There are many natal women out there with A cup chests, one breast or no breasts even due to various reasons. They are no less women because of that. I have one friend locally a natal woman who had both breasts removed due to breast cancer and she thinks it is an absolute blast. She doesn't have them bouncing around when she plays tennis / sport and when she does go out she just slips in the breast prosthesis that is the right size for whatever dress she wants to wear, smaller for a slinky halter neck / shoestring strap job or bigger for a sweetheart or fitted neckline!

If you really need BA for your own psychological health and wellbeing then I say go for it. It won't make you any more of a woman. You already are a woman. I just think we really need to make sure we ask ourselves if we are getting surgeries such as BA done for us, or is it so that we conform to some sort of socially imposed norm of what an idealised woman should be. Because if it is the latter then I'm out sorry.

[PretzelGirl]

Suzanne, I am catching up after a few days off-line here. I hope the swirl of initially hearing this is settling and you are able to go in attack mode. We are survivors. You hit it and get the best results then bounce back and fill in the gaps. I hope you are able to finish getting this re-looked at in time.

[Jennifer-GWN]

Suzanne... Like sue just catching up after gallivanting across Europe and getting my head back into things locally. The apparent roller coaster of beaurcratic indecision can get overwhelming. Consistancy and clarity on policy and coverage would that be asking too much of these folks. I have learned chatting with others in the US so much of this is handled on a case by case exception'ish basis which is completely unfair. We're dealing with not 10's of $ but 1,000's often $ we just don't have so when they jerk us around it creates significant stress and undo hardship.

I hope things work out for you, takes unnecessary persistence and not taking no for an answer when gotten for one person, try another... Goes to the consistency of support issue.

Bloody hell I feel for you on this one!

Jennifer

[Suzanne F]

The insurance company formally denied my BA Friday. I will be filing an appeal but it won't be decided before my surgery date. Ok my surgeons office called and said out of pocket total for BA will be 10772.00. Ok I was a victim for a few hours. I have moved on. I researched and found out I can apply for hardship withdraw from my 401k. This would also allow me to escape taxes on the withdraw. However the owner of my company has to agree to this. I have heard he has denied this in the past. I do not know the circumstances to that though and I am determined to succeed!! In the end I also realized something else. I am a woman whether I have A cup or D cup. If in the end I have to postpone the BA I will survive and regroup and succeed later. It is going to be a busy week!

[PennyNZ]

Go for it Suzanne. You will prevale

[PretzelGirl]

Suzanne, I looked at BA with my surgery and it was about $9500. Local BAs ranged in $5-5500. So I am not doing it with surgery and will wait and see if the surgery kicks in. A consideration although I can get not wanting to wait. Also, does your 401k allow low interest loans? That could be another thought vs something that may be denied. Mine allows that and it doesn't show a decision making process, just about 7-10 days processing time.

[Badtranny]

I spent ALL of my 401k over a few years for surgeries and whatnot. Remember that health expenses are all tax deductible INCLUDING Transgender related procedures no matter what they are. FFS may not be covered by insurance but it IS tax deductible and also eligible for HSA/FSA spending too. So if you have 5k in an employer sponsored healthcare account somewhere, you have 5k toward a BA.

A natal woman can not pay for a BA this way, ...but Yes We Can. Thanks Obama!.

[PretzelGirl]

Good input Misty! Sorry you had to go that far as that is likely far more than loans.... Probably not helpful for Suzanne, but to complete the thought for others.

I talked with my accountant who also told me I could write off the surgery itself. She even modeled it based on this year's 1040 so I knew what to expect. But she also told me I could write off the following travel and expenses:

Tax Write-offs.
$50 a night for me, $50 a night for my wife
Meals not written off unless special meals directed by the doctor.
Save travel information. ~18 cents a mile or plane fare (the mileage changes every year)
The total surgery and travel minus $10k is a write-off

Please just use that for interest and don't take it as professional input. See your own accountant.

[Suzanne F]

Ok it is all worked out. I took the hardship withdraw from my 401k. I will pay fees this week while I begin my appeal with the insurance company. I was insane working it out but I have returned to sanity. Now to get things ready!
Suzanne

[Heidi Stevens]

So glad you got things worked out for now. Did the 401k administrator present the option of borrowing against the fund? This option is overlooked by a lot of people who thing withdrawal is the only way to use these funds. Keep up with everything medical as others have suggested. You'll meet the limits for deducting costs easily. Don't for get bandages, aspirin, special clothes, car trips to treatment or rehab, etc.
We're looking out for you Suzanne! Worry about your upcoming surgery and the rest of us will find you the ways to get it paid for. Good luck, dear!

[Suzanne F]

So one more hurdle. I had an abnormal EKG that I thought was a routine presurgery task. Tomorrow morning I have a stress test to determine what is going on. Just 9 days to surgery and everything is in jeopardy. Faced with the possibility that it might be delayed or even not happen at all I have realized something. I need this body fixed. I was sure before but now I am desperate. Ok that's enough. I will prevail!!!!!

[Jennifer-GWN]

Suzanne the moon and stars will align and you will come out of this victorious!

For all, preface those transitioning in their mature years; although not statistically aligned but this is number 3 in our group here who have experienced an "abnormal" ekg. Knowing what I went through back a year ago which all turned out fine it is a call to those pursuing srs to get their ekgs checked well in advance.

For me my abnormal ekg is considered my normal and as a result I carry a copy of it with me on all my travels. This just in case if something were to happen a local dr is not lead astray based on suspicious results at the time.

Obviously I'm no medical specialist but do know the added stress that a failed ekg can have and the associated battery of tests that often come with it which takes time particularly here in Canada.

[Starling]

Suzanne, my thoughts are with you. I have an abnormal EKG as well, which caused me to panic when it was first discovered. That was about 14 years ago, and since then I have had several surgeries that called for general anesthesia, including two quite major procedures. And just last week I had an outpatient surgery which required it. Best of luck!

:) Lallie

[Hell on Heels]

Hell-o Suzanne,
Years ago my SO and I were snuggling in bed, her head on my chest, and she noticed
my heart skipped a few beats. I had noticed it in the past and never felt it to be a problem.
She had me have it checked out (you know she has a few medical connections) EKG probes
attached to my chest, yards of that paper printout tape stuff, and the Docs took a look at it…
Yep! no worries, its nothing to worry about.
Apparently, there are some heart arrhythmia's that are accepted as "no problem" , and then???
I think your "marathon" mind may be set on getting to the finish line. BUT……...
Please, please, please be sure to get this sorted before you have any surgery.
I'm sure you're Doc's won't touch you if there's a question, but you need to really be the one in control.
Proactive trumps reactive!
Much Love,
Kristyn

[Suzanne F]

I am happy to report that the stress test was all good!!!!!! I will be having surgery in 6 days!!!!!
Suzanne

[Nigella]

Glad to hear that, hoping for a speedy recovery after the surgery too :hugs:

[Eryn]

One factor in getting a BA approved is "medical need." Normally the procedure is considered to be cosmetic unless it is a reconstruction, but if a psychiatrist deems it as being needed for your mental health then insurance should pay. Have you tried that approach?

I'm about a year into HRT and so far I'm just an "A". I'm hoping for a bit more, but I might be facing the same fight soon.

[Jennifer-GWN]

Tick tick tick... The sound of the count down. I just can't imagine. In fact much of this whole process is often unimaginable in the end. Wished for, dreamed about, while still unimaginable that it can be possible and real. Fulfillment in life and happiness in yourself. Priceless.

I wish you well Suzanne.

Cheers... Jennifer

[Starling]

Hooray, Suzanne!

:) Lallie