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  #1  
Old 12-19-2004, 08:38 PM
Mr. Blue Sky Mr. Blue Sky is offline
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How much does a sex change cost

Once a person has made the decision to have a sex change, what is involved? How much does it cost? How much "maintenance" is involved and how much does that cost? How much, if any, is covered by medical insurance?

Am I safe in assuming that a female-to-male change costs more? Way back in the late 70's, CBS ran a series called "The Body Human" and one episode covered this topic. One doctor said, in a rather frank way, "It's easier to cut one off than it is to put one on."


Before you ask, I'm not planning on an operation. I'm just curious.
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  #2  
Old 12-19-2004, 09:02 PM
kimera kimera is offline
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Well, people don't normally just get sex-changes and that's it. The process of being coming the opposite sex involves a lot more than one operation. Tons of hormones, maybe other types of surgeries are also involved not to mention the cost of the psychiatrists that are required before any ethical doctors will operate.

Here is the online listings provided by one doctor.

Most people go to Thailand, like this person.

I don't think SRS is covered under most people's insurance, although I think it should be.
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  #3  
Old 12-19-2004, 09:11 PM
Mr. Blue Sky Mr. Blue Sky is offline
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Quote:
Originally Posted by ava
Well, people don't normally just get sex-changes and that's it.

That's why I asked about what's involved. How long does it take to get to a point (on average) where a psychiatrist gives someone the okay to have the surgeries?
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  #4  
Old 12-19-2004, 09:15 PM
kimera kimera is offline
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Found more info.

Quote:
For male-to-females (MTFs) the total costs are staggering, according to Kaufman; lower surgery can cost between $15-20,000. For surgery to feminize facial features people can pay as much as $30,000. For tracheal surgery to reduce the size of the Adam's apple for MTFs the cost runs between $32-3500. Add to that the cost of breast enhancement surgery and regular electrolysis treatments and the bill quickly exceeds what most people can afford.
This person estimates a total of $34,920 for a M2F.

I haven't been able to find a general average for a F2M surgery since those are rarer.
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  #5  
Old 12-19-2004, 09:25 PM
kimera kimera is offline
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Quote:
Originally Posted by Mr. Blue Sky
That's why I asked about what's involved. How long does it take to get to a point (on average) where a psychiatrist gives someone the okay to have the surgeries?
Sorry, didn't read your OP very well.

Normally people can't afford it, so it depends on how much money they have around. Most of the transgendered people I know were taking hormones illegally and getting electrolysis long before they saw a psychiatrist. Cost also depends on how much work you need. People that start the transition at a younger age have to get less surgery than those who start later. Also, some people just naturally have faces that are more masculine or feminine and may need an extra bit of surgery.

This page talks about after care. After aout 10 to 12 weeks, the person can have normal sexual intercourse.

As for how long it takes to get an 'okay' from the psychiatrist, that depends on the psychiatrist, but I think it is a minimum of 2 years.

Most of my info is from googling and what my transgendered friends and exes have told me, so hopefully someone who's actually had the surgery can give us better details.
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  #6  
Old 12-19-2004, 09:29 PM
Mr. Blue Sky Mr. Blue Sky is offline
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I knew it was expensive, but, wow!

I think insurance should cover at least the surgery.

How about post-surgery?

What's the regimen like? I'm sure there's regular hormone treatments and such.
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  #7  
Old 12-19-2004, 09:43 PM
kimera kimera is offline
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Quote:
Originally Posted by Mr. Blue Sky
How about post-surgery?

What's the regimen like? I'm sure there's regular hormone treatments and such.
How much you spend on hormones depends on where you get them. You can buy them really cheap online from overseas companies, but this is very dangeous and unsafe. The amounts you need depend on your size and how much your body naturally produces.

Hair removal is pretty expensive and can take a long while. Electrolysis' costs are between $2,000 and $20,000. Again, it depends on how much hair you have, how the hair reacts to the treatment and the local costs of the beautician. I've heard it is less expensive to get work done on the west coast than on the east.
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  #8  
Old 12-19-2004, 09:58 PM
Una Persson Una Persson is offline
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Quote:
Originally Posted by Mr. Blue Sky
I knew it was expensive, but, wow!

I think insurance should cover at least the surgery.

How about post-surgery?

What's the regimen like? I'm sure there's regular hormone treatments and such.
It is a very, very rare insurance policy indeed that covers any transsexual-related treatments, medicine, or procedures. I have heard of *one* but never seen an actual policy to know if it was typical Internet BS and lies.

The cost can vary wildly, from under $20k to above $70k. A principal reason is "additional" procedures. Some women are naturally, before any treatments, very female in form and take to hormones very well - they could pass with just clothing and makeup before they took their first pill. Others (especially the ones of large build) need quite a bit more hormone treatment, and often many, many other surgical treatments.

You know, things like laser treatment - I know a woman who only needed about $500 of lasering to become less hairy than just about any natal woman. And I also know other women who after $15,000+ of lasering and electrolysis still need work to get to where they feel they should be. Some women respond very well to hormones, and develop full breasts. Others feel they need augmentation, or implants. Some go to terrible extremes - tracheal shaving/shaping, implants in the bottom and thighs, I've even read of (unconfirmed) cases of ribs being removed - it sounds urban legendish to me, but there you have it.

Sometimes the surgery itself is the problem - some surgeries go very well, and after the follow-up labiaplasty the results are perfect. Some women are very dissatisfied with the initial results, and return for further and further re-shaping. Sometimes there are problems with the vagina that is created, and it needs to be...re-opened (shudder). Whether or not vaginaplasty is done also greatly varies the amount of cost - and the maintenance required.

Anyhow. The point is, because there is a wide variation in starting points, and a wide variation in ending points, and a wide variation in-between, the costs vary.
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  #9  
Old 12-19-2004, 10:02 PM
Eats_Crayons Eats_Crayons is offline
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Quote:
Originally Posted by Mr. Blue Sky
How much does it cost? How much "maintenance" is involved and how much does that cost?
On another message boards (oh, about 10 years ago) there was a m-f transgendered person who underwent the surgery and kept the board updated with her progress. Quite fascinating, and she provided link to photos of the surgery (not her surgery, but her surgeon had a very detailed site that also contained very graphic photos -- not for the squeamish). I'll see if I can find the site (if it exists) and I'll be sure to follow the two-click rule with lots of disclaimers.

The end "product" (to use a rather gauche expression) was stunning. Part of the glans was used to create the clitoris so that the patient coudl still experience decent sexual sensation and pleasure, and I would never have guessed that the patient had not been born a woman.

She had breast implants first, then the genital reconstruction a few years later. And her post about the first time she showered and was really able to feel on all female body was such a marvelously well-written post it brought tears to my eyes.

Anyway, I recall that an important part of the post-op maintenance was very regular "dialtions" of the newly formed vaginal canal. Basically they were a set of, well, dildos, each with a different girth. She had to insert them several times during the day for specific durations (I can't remember the details). This was to help prevent some kind of collapse. She said it was only uncomfortable at first when there was post operative swelling and bruising.

Alas, I don't remember how long that was required.

Lemme see if I can find her doctor's site (if it's still around -- it was 10 years ago, remember). It was incredibly informative and had detailed instructions about post-operative maintenance.
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  #10  
Old 12-19-2004, 10:17 PM
Eats_Crayons Eats_Crayons is offline
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Hm. I think I found her surgeon's website but it has changed to some Flash thing that is less informative. However, there's a good journal that covers the six months of post-op care.

(No images at all, just text. But big TMI warning for those who are squeamish about their parts or about surgery stuff.)
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  #11  
Old 12-19-2004, 10:47 PM
Eats_Crayons Eats_Crayons is offline
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Oh, duh. Forgot FTM.

IIRC, the surgical procedures still don't yield the greatest results.

A metoidioplasty will create a normal looking but very small penis. Results vary depnding on the individual's response to hormone therapy -- the clitoris will enlarge under hormone therapy (lotsa testosterone) and surrounding skin is released from the pubis to give a greater appearance of length. A scrotoplasty can be done to form a scrotum and (after balloons are used over a period of six months or so, to stretch a scrotal sack), permanent testicular prosthetics can be added. The ureathra can be lengthened and the vagina removed (IIRC you can get a hysterectomy and your ovaries removed but I don't think it's required -- NOTE: I may be mistaken about that.)

Again, the final results do NOT produce an adult sized penis. You can pee standing up, but not engage in satisfying vaginal intercourse if you have a female partner. You get a small uncircumsized-looking penis.

Again, that's ten-year-old info so things may have changed.

FTM also usually includes a mastectomy. Many surgeons will do "Top" only.

I don't know what the maintenance times are requirements are. If you google "metoidioplasty journal" you might get lucky.

And I have no idea of the cost of these things. I never asked and I'm not in contact with the MTF woman I used to know on that other board. I expect it varies greatly depending on which parts you wish to get rid of and which parts you get. As well as all the postoperative care, hormone therapies etc.

No idea about long-term maintenance either.
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  #12  
Old 12-19-2004, 11:04 PM
Spezza Spezza is offline
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Or you could join the Canadian army and get yourself a free sex change.

(I do not know if this is still procedure. However, it did make headlines, obviously, awhile back.)
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  #13  
Old 12-20-2004, 04:11 AM
BleizDu BleizDu is offline
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The cost of top surgery for FTMs varies greatly, it depends if you go to one of the "Big Names" surgeons or not, the range is 5000-10 000 USD.

An Hysto and oopho alone is about 10 000 I think.

That's also about the price of a meta (short for metoidoiplasty) with testicle implants (some surgeons use indeed expanders to stretch skin, others not) and urethral hook-up, (in this case you had to have an hysto yeah), you can also just free up the former clitoris to gain more visible length, it's about half the price.
Size of meta ranges from 4 to 10cm.

For a phallo the latest prices are about 40 000-50 000 USD for a sensate phallo made with forearm skin. Usually you can also at the same time get top surgery and a hysto is done if this hadn't been taken of before, it's included in the price for some surgeons.
The amount of sexual sensations, orgasms post-op depends a lot on who did your surgery and what exaxtly was done to the former clitoris when building the phallo. (let on top or between the shaft and scrotum, buried in the scrotum, integrated to the shaft and the nerves connected along the shaft, etc)
Top is name for phallo is often said to be Monstrey, in Belgium, he seems to yeild the best results sexually wise and it's pretty realistic looking, compared to other surgeons.

(I'm keeping a ressource site for FTMs in my country so I try to stay updated with prices and techniques and all)
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  #14  
Old 12-20-2004, 11:38 PM
KellyM KellyM is offline
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Quote:
Originally Posted by Una Persson
It is a very, very rare insurance policy indeed that covers any transsexual-related treatments, medicine, or procedures. I have heard of *one* but never seen an actual policy to know if it was typical Internet BS and lies.
This simply isn't true anymore. More and more insurance companies are covering services relating to transsexualism, up to and including SRS (but almost always excluding hair removal). Exclusions for sexual reassignment surgery are illegal in California and in Minnesota; in Cook County, Illinois; in New York City; and in countless other places where employment discrimination on the basis of gender discrimination has been outlawed. Lawsuits enforcing these rules are being won more often than lost, and the list of places where such lawsuits have been won grows frequently.

In practice, your chances of getting at least some financial assistance from an employer-based insurance plan are actually pretty good these days, as long as you and your caregivers follow the Standards of Care (and your underlying mental and physical health are such that you aren't excluded from receiving services for reasons not related to the financial).
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  #15  
Old 12-21-2004, 01:14 AM
matt_mcl matt_mcl is offline
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Until a few years ago (Harris government), SRS was covered by Ontario medicare. It's also theoretically covered by Quebec medicare but, from what I've been told, no actual payouts have happened for years -- they just find reasons to reject everybody.

Many transsexuals, I understand, end up going to other parts of the world (e.g. Thailand) where costs are lower and the approval process is easier. At their own risk, of course.
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  #16  
Old 12-21-2004, 03:55 AM
PaulFitzroy PaulFitzroy is offline
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OP:
Quote:
How much does a sex change cost
Depends on whether you want male to female or female to male.

If it's male to female, it costs however much a good, sharp razor-blade will run you these days.
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  #17  
Old 12-21-2004, 04:57 AM
Broomstick Broomstick is online now
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I presume you were trying to be funny, but there is considerable difference between a eunnuch and a woman
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  #18  
Old 12-21-2004, 08:18 AM
Una Persson Una Persson is offline
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Quote:
Originally Posted by KellyM
This simply isn't true anymore. More and more insurance companies are covering services relating to transsexualism, up to and including SRS (but almost always excluding hair removal). Exclusions for sexual reassignment surgery are illegal in California and in Minnesota; in Cook County, Illinois; in New York City; and in countless other places where employment discrimination on the basis of gender discrimination has been outlawed. Lawsuits enforcing these rules are being won more often than lost, and the list of places where such lawsuits have been won grows frequently.
My point is that the companies are still excluding the SRS and pre- and post-SRS treatment. Anyone can sue any insurance agency, and possibly get a court to decide something is covered. And depending on which City/State one is in, there may be local laws governing coverage as well. When I was helping a friend and ex co-worker out I could not find any companies that did not have an exemption - not a single one. Now, perhaps this could have been a result of the actual negotiated policy with the company (which can be more or less exclusive than the general policy), but still, we could not find a single one.

Which big name companies provide for coverage of SRS?
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  #19  
Old 12-21-2004, 09:26 AM
Eve Eve is offline
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Quote:
Originally Posted by KellyM
This simply isn't true anymore. More and more insurance companies are covering services relating to transsexualism, up to and including SRS (but almost always excluding hair removal). Exclusions for sexual reassignment surgery are illegal in California and in Minnesota; in Cook County, Illinois; in New York City; and in countless other places where employment discrimination on the basis of gender discrimination has been outlawed.
My company uses Aetna and Oxford insurance, and neither of them will cover any transgender-related procedures, which they consider to be "elective plastic surgery."

I, of course, think that's a crime, and that any insurance company that will pay for, say, repairing a cleft palate or club foot should pay for sex-reassigment surgery. What, they think if it's covered, millions of people will suddenly go, "hey, that sounds like fun—I'm going out to get a sex-change at lunchtime today!"

But with the religious right taking over the country, the odds of the transgendered gaining any more rights are not bloody likely.
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  #20  
Old 12-21-2004, 10:04 AM
Bosda Di'Chi of Tricor Bosda Di'Chi of Tricor is offline
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Ummm....shopping for people on your Xmas list, Mr. Blue Sky ?

I'd be happy with a nice, red tie, if it's all the same to you....
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  #21  
Old 12-21-2004, 11:25 AM
Thudlow Boink Thudlow Boink is offline
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Now I'm reminded of the old Don Martin cartoon from Mad Magazine, where a guy walks up to a "CHANGE" machine, puts in a dollar bill, and...
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  #22  
Old 12-21-2004, 11:30 AM
Fiver Fiver is offline
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Quote:
Originally Posted by PaulFitzroy
OP:


Depends on whether you want male to female or female to male.

If it's male to female, it costs however much a good, sharp razor-blade will run you these days.
Unhelpful, thoughtless, insensitive, and unfunny.
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  #23  
Old 12-21-2004, 11:53 AM
DocCathode DocCathode is online now
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Paul Fitzroy
When faced with the cost of counseling, hormone replacement therapy, and the various surgeries, some mtf transexuals come to the same conclusion. They castrate or emasculate themselves using kitchen knives and other unsafe, unsterile household items.

Dilators

AFAIK, dilators aren't used to prevent collapse, but tightening (OTTOMH IIRC stenosis) and shrinking of the neovagina. Dilators are medical devices. However, after the surgery has healed sufficiently, appropriately sized fingers, dildoes, vibrators, and penises are recommended by many doctors.
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  #24  
Old 12-21-2004, 12:30 PM
Larry Griffin Larry Griffin is offline
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Quote:
Originally posted by Fiver

Quote:
Originally posted by PaulFitzroy

Depends on whether you want male to female or female to male.

If it's male to female, it costs however much a good, sharp razor-blade will run you these days.
Unhelpful, thoughtless, insensitive, and unfunny.
PaulFitzroy, your comment was rude and uncalled for.

Consider yourself formally warned.

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for the SDMB
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  #25  
Old 12-21-2004, 04:51 PM
Mr. Blue Sky Mr. Blue Sky is offline
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Quote:
Originally Posted by Bosda Di'Chi of Tricor
Ummm....shopping for people on your Xmas list, Mr. Blue Sky ?

I'd be happy with a nice, red tie, if it's all the same to you....

Oh no. I like everybody as they are (and so do they).

I was just curious. I knew it wasn't cheap. I think insurance should cover some of these costs. Even if a person had to pay a high premium, it would still be a lot cheaper than having to foot the entire bill.

Dealing with insurance companies all day, I know one of them could come up with some kind of policy.
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  #26  
Old 12-21-2004, 06:44 PM
KellyM KellyM is offline
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Quote:
Originally Posted by Una Persson
Which big name companies provide for coverage of SRS?
IBM. SBC. Microsoft. The City of San Francisco. Kaiser Permanente (for its own employees; not necessarily for all of its covered individuals). AT&T.

This is just a sampling; there are many others.

Every Blue Cross/Blue Shield of Illinois PPO contract I've seen provides for coverage of SRS at the out-of-network rate.

The classification of SRS as "elective cosmetic surgery" was recently shot through pretty badly by a recent IRS ruling that effectively establishes that (for tax purposes) SRS is not elective cosmetic surgery when the SoC is followed. That ruling will have significant influence on further rulings in insurance matters.
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  #27  
Old 12-21-2004, 07:59 PM
paperbackwriter paperbackwriter is offline
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Unless you know something I don't, this IRS ruling isn't binding on insurance companies. The ruling was strictly concerned with the eligibility of SRS as a covered health expense for Health Savings Accounts. The IRS gets to say what is and isn't eligible for these accounts because they have taxable income implications.

The HSA can be administered by any number of different organizations, financial institutions, insurance companies, employers, etc. To that extent an insurance company administering a HSA would have to follow the IRS guidelines, then, yes, this ruling is binding. To the extent that this ruling affects what coverages a health insurance company offers, it does not.

It may become influential in establishing coverages, but it cannot(*) force them. The IRS makes psychiatric benefits eligible for HSA coverage, but my health insurance does not. What coverages you get is mostly a matter of economics -- are the premiums high enough to recoup the costs of extending coverage for that type of service. IOW, you get what you (or your employer) is willing to pay for.

Take IBM, for example. They have 330,000 employees. If the rate of 1:100,000 is accurate, then that's 3 people they have to cover. It would be a drop in the bucket for their health plan(**), so they can afford to cover it.

My company is much smaller, so it can afford to cover less. Since about half the workforce is employeed by small businesses, this is a significant portion of the potential populaiton.


*Again, to the best of my knowledge.
** The numbers quoted here are in the same realm as multiple-bypass surgery, which IBM covers a lot more of.
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  #28  
Old 12-21-2004, 08:08 PM
Una Persson Una Persson is offline
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Quote:
Originally Posted by KellyM
IBM. SBC. Microsoft. The City of San Francisco. Kaiser Permanente (for its own employees; not necessarily for all of its covered individuals). AT&T.
Forgive me if I seem dense, but only Kaiser is an insurance company, and I was thinking of companies that offer it as their "standard level" of coverage. And although I do not have them myself, the benefits book I have from Kaiser (since they send me all the benefits books for the various plans I have access to) says that transsexual-related treatments are specifically not covered. Scanning through the PDF, I see the other 5 companies I have access too also all have a denial for that as well. These are all big-name companies too.

Like I said, I think a lot of it has to do with the negotiated plan between the company and the insurance company. If the company is willing to pay for it, then the insurance company is willing to oblige, I imagine.
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  #29  
Old 12-21-2004, 08:21 PM
KellyM KellyM is offline
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Originally Posted by paperbackwriter
If the rate of 1:100,000 is accurate, then that's 3 people they have to cover.
That rate is almost certainly wrong. Opinions vary, but the rate is probably somewhere between 1:1000 and 1:25,000.
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  #30  
Old 12-21-2004, 08:27 PM
KellyM KellyM is offline
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Originally Posted by Una Persson
Like I said, I think a lot of it has to do with the negotiated plan between the company and the insurance company. If the company is willing to pay for it, then the insurance company is willing to oblige, I imagine.
In a lot of cases, the reason for not including the exclusion is that the company does business in a location which forbids gender identity discrimination in employment.

As I previously mentioned, Blue Cross Blue Shield of Illinois seems not to make an exclusion for reassignment surgery, at least on its PPO plans. Neither my prior employer's plan nor my current employer's plan have exclusions. I know a few people who have successfully obtained compensation from BCBSIL for SRS.

Getting prepayment is as much an issue with the surgeons as with the insurance company; no insurance company will not pay in advance of services being rendered and all SRS surgeons require at least substantial payment in advance.
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  #31  
Old 12-22-2004, 04:57 AM
Broomstick Broomstick is online now
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What is and isn't covered isn't solely up to the insurance company, it's also up to the customer. And the customer in this case isn't you, it's the employer buying insurance.

SRS is something that can be excluded from coverage in an attempt to lower premiums without pissing too many people off. One in 25,000 might be furious, but the other 24,999 will either not care very much, or not care at all. And the employer spends a fraction less on those premiums, which are rising every year.

If an emloyer wants to offer the coverage, though, the insurer will do so - for a price determined by actuaries to yield enough money to cover the increased costs. For a big employer, this price increase is probably a much smaller fraction of the whole than for a small employer.
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  #32  
Old 12-22-2004, 08:23 AM
Eve Eve is offline
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Well, I work in a huge company in NYC, and our insurance carriers (Aeatna and Oxford) definitely will not pay for any sex-reassignment related procedues. I checked, believe me, the brochures. It's considered "elective cosmetic surgery." Idiots.
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  #33  
Old 12-23-2004, 08:09 AM
Fiver Fiver is offline
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But you are fully post-transition, aren't you, Eve?

Not that you wouldn't still be interested, of course...
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  #34  
Old 12-23-2004, 11:07 AM
Eve Eve is offline
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Originally Posted by Fiver
But you are fully post-transition, aren't you, Eve?

Not that you wouldn't still be interested, of course...
Yes, but I am thinking of the Younger Generation--with a thousands of employees, this surely impacts on one or two of my coworkers or their dependents.
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