I’ve been busting out some of my oldest t-shirts this summer; some of them I haven’t even looked at in years – I have them stored in a box. Others I see, but don’t touch, every day – they are on a hanger, on the wall, like fine art. After having top surgery earlier this summer, I have been getting to know my collection again. And, it includes some really old gems, including band t-shirts from the 1980s.
Like this one:
This was taken 10 years ago, as part of a drag photo shoot. It was most likely the last time I wore the shirt. I can wear it again, now, if I want! Although, maybe I better keep it in nice condition – I found the same shirt, in a muscle-t style, selling online for $71.82. And my other The Police t-shirt (not pictured) is selling for $134.23.
I got this shirt for $5. There is this amazing local record store that has tons of gems, but it’s really hard to locate anything. The store is a mess, but in the 1990s, it was even worse. There was literally a mountain of t-shirts, starting from on the floor in a space that may have been about 8ft by 8ft – it was sectioned off by railings, like a bull pen. You would walk onto shirts and just start digging. I found this, plus these shirts, and more (another The Police, Echo and the Bunnymen, David Bowie…):
They were all $5. In the early 2000s, I went back to uncover more treasures, and I was horrified to find that they were all organized neatly on racks and hangers, alphabetically. And none were under $20. Suddenly. And I would have probably bought more at that price, but it looked like it had been picked through extensively. I couldn’t find any I’d actually want to wear or display. Bummer. I guess the influence of online selling had swept in, and cleaned up this mess. For the worse. Still, I am glad I was able to get a piece of it while it lasted.
P.S. The Honeydrippers were a band from 1981-1985, formed by Led Zeppelin lead singer, Robert Plant. It was kind of a part of that resurgence of 50s style music, in the 80s. Other memebers included Jimmy Paige, Jeff Beck, Paul Shaffer, Brian Setzer, and a bunch of others. They only recorded one EP.
This post is part of a series. Here are the previous ones:
Yesterday, I wore a t-shirt to work for the first time! It was glorious. I have been back to work for two weeks now, after being out for 9 weeks recovering from top surgery. It has been going more smoothly than I could have possibly imagined! Physically, I’m back to 100%, and in terms of work dynamics, I’m right back where I left things, which is better than I could have hoped for. I pictured I might be the odd person out, after being away so long, but everyone genuinely seems happy to see me. Our supervisor even got muffins for the day I came back!
So, work uniform: We have four styles of shirts we can wear – all of them are navy blue with the school district’s seal embroidered in yellow. The choices are:
long sleeved button-down
short sleeved button-down
Every 2 years, we can order 5 more. I had been down to only 5 total, though, for years, because I continually ordered more and more size S short sleeved button-downs, and they kept being too big. I had 5 that my spouse had tailored and hemmed (thank you!!!), and that was it. I had 2 t-shirts and one polo shirt, which I had ordered at some point, but never wore. Until yesterday!
Why didn’t I just wear a t-shirt immediately upon returning? This might be mild paranoia, but I didn’t want to change things up immediately for fear of fanning whatever rumors might be going around about the type of surgery I had. I only told 2 people at work, and I didn’t really want to talk about it. The short sleeve button-downs have pockets with buttons that just happen to fall right where my nipples are! Haha. So, I looked pretty much the same before and after surgery, in those shirts. I wanted a little time to pass before I moved on to what I really wanted to do: Wear a t-shirt!
I gotta say though, t-shirts are not as conducive to this hot weather. (It is soooooo hot in the school.) They are 100% cotton, and they get wet with sweat. The short sleeved button-downs are cotton/poly blend, and they are billowy and wick away moisture.
Once it’s fall, winter, and spring, I am going to be loving it though. I just need more shirts though! I think this is one of the years we get more – I’m going to order 5 small t-shirts!
In other work related news, I added a new page to my blog. It is called, glossary of janitorial words and phrases. I’m sure I’ll be adding to it as I think of more. Check it out – it might make you laugh (or possibly gross you out)…
The title says it all, but here’s the details: Prior to surgery, I put a lot of effort into trying to figure out what I might be able to get reimbursed for. I was on the phone with customer service for a long time one day; I scoured my insurance’s webpage; I tried to figure out codes and what they mean; my therapist called multiple times on my behalf. I oscillated between feeling hopeful I might get partial coverage, and being convinced that there was no chance.
Ultimately it seemed like there was no chance. I found a promising document at one point called, “Gender Reassignment Surgery Medical Policy,” followed by criteria to prove it is medically necessary. Then I was told that that applies to some insurance policies with my insurance company, but my particular policy excludes this coverage, and that was the bottom line.
Still, people told me that it’s against the law to deny coverage, on a state by state basis, and my state should cover it. I paid out of pocket, first for the surgeon’s fees in advance, and then for the surgical center, the day of. After the fact, I asked my surgeon’s office to send me an itemized bill of what I’d paid for, and I submitted that to my insurance company, without much hope. I figured it’d get denied, then I’d appeal and take it as far as I could. Maybe I’d get some advice from my local gay alliance, etc.
About 2 weeks later, I got a piece of mail. I didn’t open it because I didn’t care to read the bad news. My spouse and I were leaving for vacation last Wednesday, and I figured I’d better open it before we left. In case there was some deadline for appealing it. I opened it up, and it was a check for $2,800.09!!!! I yelled at my partner about it, the excitement of it, which must have been jarring because I almost never yell. What an amazing way to start our trip!
That’s 47% of the surgeon’s fees (including 100% of the accommodations – staying at the surgeon’s guest room!) I really could not believe it – either the person on the receiving end wasn’t paying attention at all, or they knew exactly what it was and had some strong personal beliefs of what should get to be covered!!
Now I’m just deciding if I should also get an itemized bill from the surgical center and try to get more money back… Maybe I don’t want to push my luck…
It really paid off to just try, even though I didn’t believe anything would come of it!
Here’s a post I wrote earlier on this topic:
In February, I wrote GID: exclusion for top surgery coverage
Yesterday, I went out in a t-shirt, without the ace wrap I’ve been wearing for 3 weeks, for the first time! It felt seriously amazing. (I still have sterile pads over my nipples because they are still sloughing off gross stuff, so it’s going to get even better, once that’s over!) I don’t know when I last wore just a t-shirt, out – 10 years ago? 12 years ago? Sometime in there, before I started feeling overly-self-conscious about my chest.
I had my 1 month appointment via Skype, with the physician’s assistant, and it went pretty much how I imagined it would. I focused mostly on what to do to continue healing, which is going slowly, and also to change my return-to-work date. Whenever I brought up a concern about an aspect of the appearance, I was told, “Right now it is ______; in _____ amount of months, it will be healed nicely. Your final results won’t be visible until a year from surgery.” It felt like I was being fed stock answers. I can live with that for now, but I doubt things are going to change enough for it to actually look good. I’m not happy with the results. Some of it seems like no big deal – it can be fixed. One thing though does have me worried: it seems to me that some muscle may actually have been taken out, along an axis crossing through the nipple, on the right side.
I’ll just continue to document the changes or lack thereof. Such as: neither areola is actually a circle. I’m being told that they will change into circles. I highly doubt that. I’m concerned that down the road, it’s going to be a struggle to get anyone connected to this surgeon to acknowledge that I might need revisions. If that’s the case, I envision myself getting opinions from other surgeons, and going from there…
All this is far away though. Right now, I’m enjoying focusing what I am happy about: wearing t-shirts!!! This was the number one thing I was looking forward to. I’m thinking I’ll start a short series where I write about some of my favorite t-shirts. Here’s one (this is the one I wore out, yesterday):
It says, “MUSIC LIVES ON TDK.”
I have found that to be true – most of the blank tapes I’ve gotten to make mix tapes have happened to be TDK! I found this at a thrift store about 12 years ago. I used to wear it a lot, under flannels and hoodies. Nowadays I rarely wear it, not because I stopped liking it, but because it started to get pretty threadbare, and I don’t want to wear it out. I have a couple of t-shirts like that – I love them and have worn them too much and now I don’t really get to wear them. (Largely because they were worn so much before I got them, too. I’d guess this shirt is at least 30 years old.) It is 50/50 (so soft!), which is way better than 100% cotton, in my opinion, but I wonder if that contributes to it not holding up so well. Also, it is a size large, which always gets to me with vintage clothing, because people used to be so much smaller back then?!? I am a present-day small.
I just did a google search for this t-shirt, and found one on etsy selling for $146.06 Canadian dollars, which is currently $113.34 US dollars. Dang! That’s a keeper.
Content Note: vanity.
When I first saw my chest, looking down while everything was being unwrapped, I was pretty happy. Everything looked good, except for the fact that the left side was larger than the right. I was assured it was due to swelling, and everything would even out.
Now that another week has passed though, I’m not feeling it. I am more and more skeptical that there is much, if any, swelling going on. My spouse agrees. Regardless, I’ve been taking arnica and bromelain… using ice packs a little bit.
Right now, there is not enough symmetry, in multiple regards. The areolas are different shapes, and they are too large (not “nickle sized,” like we discussed). The nipples are also too large, but it’s kinda hard to tell what’s going on there (they’re currently being smooshed flat, and will continue to be for another 2 weeks.) The biggest thing, though, is, I have different sizes going on, which contributes to the areolas/nipples being not in the same place, on each side. I don’t like that!
All these differences are fairly subtle, but definitely noticeable. I know it’s way too early to be coming to conclusions about how things look, but, so far, not so good.
I’ve been in a pretty negative space. I’ve felt so negative at times, in fact, that it was hard to feel motivated to do all the showering and “nipple care” stuff. This has gotten better over time. Everything could change a lot, as I heal; I do recognize that. It’s not all bad. Every time I have the sterile pads and binder off for a little while (to let things air out), and I put on a t-shirt (carefully!), I think, “This could work!” Excitement is there, somewhere. Sometimes I push down the good stuff, and remain guarded and reserved.
There is something here though: When picking a surgeon, I wasn’t going off of a whole lot. I mean, I pored through what was available on transbucket, for sure, and searched resources, youtube, and the like. But I didn’t really entertain all the possibilities very much, in my head. I had a gut feeling about one route, and kind of just stuck with that.
This isn’t the first time I’ve made huge, life-changing decisions in this manner. But I kind of hope it might be the last time. (I know it won’t be, haha.) There are better ways to go about narrowing down all the options!
There is one resource that I just learned about a couple of days ago, because a fellow blogger pointed the way. Gabriel wrote a post called Getting Started With Top Surgery. He mentioned “top surgery Facebook groups where people share their results and stories with their surgeon as well as the price quotes they’ve paid.” Oh yeah! Facebook. That had not even crossed my mind, unfortunately. So I just joined an FTM top surgery group, and wow, this is where all the good stuff is. Wish I had known about it 6 months ago.
Edit: My spouse suggested I stop looking at the FTM top surgery page for a while. That sounds like a good idea – I was starting to get obsessive about it. She said wordpress is good. Stop going on facebook. Haha. I agree.
I feel torn about whether I will post pictures or not, and if so, where. Before surgery, I was sure I would not post pictures on this blog, but I would post them on transbucket, when I feel ready. (They can be accessed if you create an account on transbucket). This still sounds like what I’m going to want to do. I do not plan on ever being shirtless in public. So, in regards to aesthetics, the most important thing is how everything looks while wearing a t-shirt. Other than people looking up pics as a resource, the only people who are going to see my chest are my spouse and me (and medical professionals, when necessary). So is it important what it looks like? Ultimately, yes. But for right now, as long as I can wear whatever I want, I will be happy enough…
During my most recent therapy appointment, right before surgery, I had said, “I’m worried my chest won’t look as good as it does now.” As opposed to saying, “I’m worried my chest won’t look as good as I envision.” That, to me, says a lot.
In other news, I had a great time in Philadelphia with my mom, after my follow-up. We went to a brewery and record store. We met up with friends at the Philadelphia Trans-Health Conference and went to two workshops. Wish we could have stayed longer!
Also, my spouse and I went to a wedding this past weekend, and it was a lot of fun! Their ceremony reflected who they are, a lot, and everything was casual and laid back. After the ceremony, I was asked to sign the marriage certificate, as one of the witnesses. This was a total surprise! I felt honored. I asked the officiant if it had to be my legal name, and she said it didn’t matter. Awesome!
Going into surgery, I was in pretty rough shape. I felt sick (although I didn’t want to say so, specifically, to anyone other than my spouse… I kept saying “slight head cold”) and exhausted. Luckily, my cold symptoms were not too worrisome, medically: no fever, no chest congestion / trouble breathing. Other than the cold, I felt mentally prepared. In retrospect, I totally was. But, not so much prepared for the recovery process…
office/home/guest rooms mansion
Surgery Day: We arrived at 6:15am, surgery was from 7:30-9am, I was sleeping till about 10:30, and we were leaving by 11:30. At which point, I felt a lot better than I had for days – it even felt like my cold magically disappeared.
Everything went smoothly, except for the fact that the surgeon was about to do the wrong procedure. I was afraid this was the case because during the entire process including the consultation, the paperwork continually listed “double incision mastectomy with free nipple grafts.” Even after I called a month ago to verify we were on the same page with the peri-areolar procedure and was assured that we were. So when she came in and said, “Double incision.” I said no, and luckily wasn’t phased by the mix up. She said peri-areolar, I said yes, and she drew circles around my areolas. I talked to her about nipple size, saying I wanted them small. She said, “They’ll be smaller. Your nipples will be nipple-sized.” That was not very reassuring, but after she left, and before the anesthesiologist came back around, my spouse clarified that she had said, “your nipples will be nickle-sized.” That sounded better.
If you want to read a more detailed account of what it’s like, here’s a good one someone wrote just a few days ago: Surgery. It was a lot like that. Back at the guest room, we texted with some people, a Philly friend came and visited for a while, we watched Seinfeld, and we went to sleep early. I was up a lot that night, ravenously eating snacks and just not able to get comfortable. I was sleeping sitting up, at the foot of the bed, a lot.
Day after surgery – The next day, we were driving home. And I was in bed by 6pm. My cold symptoms were back, and I was not feeling so good anymore. I’ll bet that first day, I had a good mix of adrenaline and endorphins flowing, plus whatever they put in the IV. And then I crash.
2 days after surgery – I sat outside for a while. A friend came over, and we chatted for about 30 minutes before my spouse and they went thrift shopping. We listened to some podcasts. I read a book about subway art, written in 1984, a book I had found in the trash at school. We watched 2 episodes of Mad Men.
3 days – Podcasts, Mad Men. I stopped taking the pain meds (Percocet) because they were causing OIC (opioid induced constipation). The pain increased throughout the day, but it’s not like Percocet was all that effective anyway. We went to my spouse’s parents’ house, which did not go so well (I could not bear being social, especially once a family friend came by – I just went and sat outside.) We went to the grocery store on the way home – that was OK.
4 days – Glad to be off Percocet – realized that there are other pain meds (D’uh!) so I took an Alieve. I feel like 95% of the pain now is due to this fucking surgical wrap I have to wear for 7 days. I can only take shallow breaths; I can’t laugh or yawn or cough; it’s digging into my ribs and underarms; it’s way too tight; it just fucking sucks*. There’s a reason I didn’t bind! We went to the movies – nice to get out of the house. Also, one of our cats got suddenly freaked out by my Frankenstein walk (even though I’ve been doing it for days), and she bolted off the table, knocking a bunch of my records onto the floor. It was loud. Also, I had a mini melt down about hating asking for things that are so basic, telling my spouse that I keep doing things because I would rather do them than ask – open and close doors, get ice trays out of the freezer, pour water from our britta, reach up high for a Q-tip, carry my laptop… I gotta stop so I don’t mess up my healing process! She was on it and strategized a bunch of new ways to make things easier!
5 days – My spouse went back to work. Our refrigerator was making a loud noise this morning and stopped working. That was stressful! I called a repair person, then changed my mind because we should just buy a new one because this thing is super old. My spouse’s mom came over to save our freezer items for us, store them at her house. Then the fridge started working again, so it feels like less pressure – we’ll still get a new one, but it doesn’t have to be today. A friend brought over lunch – I liked that! My mom stopped by after work. I felt anxious and lightheaded for a lot of the day. I was feeling really confined/claustrophobic, as if this binding thing were made of plaster of paris, or steel. I had a serious melt down (I got an all-too-real glimpse of what it could feel like, if I lost it right now – I felt in danger of becoming more and more triggered), and told my spouse we need more people around us, helping. She called her parents to make that happen. We talked and I felt a lot better.
6 days – That’s today! I only managed to sleep 3 hrs. I’ll be spending more time with people today. I’m just going to try to relax. I also gotta start preparing for going back down there tomorrow, to get this fucking binding off. Oh, and the drains. I’m going with my mom.
Overall, I’m in more pain than I thought. And I’m way less out of it than I thought (like, I didn’t get to be in a fun pain-killer induced haze, haha). And I don’t like TV that much and I’ve been up and about a lot. I hate not doing things because it reminds me of being depressed.
* Note: this may be the only time I’ve used swear words on this blog (in reference to the surgical binding). It’s that bad. Also, though, I appreciate this thing because it reminds me of where the limits are and also it’s preventing me from coughing stitches open or anything like that.
My spouse and I are leaving shortly, to drive down and arrive by mid-afternoon, to then get ready for surgery in the morning. I hope. I’m saying, “I hope,” because I came down with a cold 3 days ago, and I still feel stuffed up. I’ve searched the internet for, “Can I get surgery if I have a cold?” and there really is no consensus. It’s a good sign that I don’t have a fever, and I don’t have a cough. But ultimately, it’s up to the surgeon. It feels like I have a 50/50 shot here.
And I haven’t been able to get in touch with their office any earlier because of the holiday weekend (I did email a heads up though), so I’m going to have to call while on the road, once their office is open… When I call, I am going to act as though everything is proceeding like normal, just want to let them know about this development. Because I really really really just want this to happen. Tomorrow. And I don’t know what I’m going to feel if I’m told, “Don’t bother coming. …We can schedule you for the last week of June.” Or something like that.
Between this and shingles, it feels like my body is trying to say, “this is not happening.” I’m angry with my body. I was so super careful – eating well, sleeping well, I don’t recall being around anyone who was sick… I wasn’t even feeling stressed or anxious. And this is super strange for me too – I don’t generally get sick often. I used to, but not anymore. I don’t get headaches. I don’t get queezy. I don’t throw up easily. So what’s with the shingles (which have thankfully cleared up in time) and the cold?!?
I currently don’t feel stressed about the surgery. I feel ready. I feel stressed about the cold, but not about the surgery.
So, I guess I’ll know what’s happening within a few hours. Let’s hope next time I write, it’ll be good news!!!
One week feels about right – it neither feels like it’s approaching too quickly nor like it cannot come soon enough. I already have everything that the surgeon’s office needs turned in; my to-do list now consists of things I’m trying to think I want to get done before I won’t be able to do stuff for a while: cut my hair, cut my spouse’s hair, cut the grass, purchase extra cat litter because I won’t be able to lift that, do laundry, install the air conditioning unit in our bedroom window… I know my spouse can do a lot of this stuff as it needs to get done, but I guess it feels good to be getting as much out of the way now, while I can. I do not look forward to not being able to do things. I’m going to have to accept it.
I’m also thinking about what, specifically, I will miss. I’m going to take some pictures, but, what’s impossible to capture is how that part of my body feels – both the shape and the sensations. I’m resigned to the fact that I will most likely lose sensitivity in this area, and I wish I could remember it how it is, somehow…
Last Saturday night, my spouse and I went with friends to see The Man Who Fell to Earth. Without giving any spoilers, there was a scene in which David Bowie’s character is undergoing surgery while conscious. Doctors are cutting into his areola with a scalpel, and he is yelling for help. This was like whoa. Unexpected. Hitting a little too close to home. Not making sense, story arc wise (the story arc was less of an arc and more of a jagged pattern-less wave anyway).
I don’t really feel anxious or excited, at least not yet. I’d be into the idea of getting through this without either or those emotions – we’ll see. It helps to read other accounts of impending surgery thoughts and feelings. Such as this post: Last Minute Concerns, from over 5 years ago. And recountings of the process, such as this post, from yesterday: It’s Never Too Late.
I only have 3 more days of work. Then I won’t be back till probably August. That’ll be weird. I wonder what my days will look like, once I’m recovered enough. Will I feel like being creative and getting stuff done, or will I end up just hanging out? We’ll see – I’m not going to make it be anything in particular.
Other stuff has been going on too. My spouse and I visited some extended family on my dad’s side last weekend, most of whom she had not yet met. I sent an email to as many people as I could in advance just mentioning my name change and that I go by male pronouns. I received only one reply, and my expectations were pretty low. Surprisingly though, everyone who said my name used my new name, and there were zero slip ups. It was awesome. I think this’ll help my dad get on board! (He is getting there, slowly… … very slowly…)
About 10 days ago, my breast tissue started to feel inflamed and tender. It wasn’t in line with my menstrual cycle, and it hurt way more than that would, anyway. As it got worse and not better, I wondered if it was some strange manifestation of a psychological reaction to my upcoming surgery. I wasn’t feeling stressed or anxious about it, but was this psychosomatic? Then a patch of skin below my left armpit started to really burn and sting, as well as the skin around my shoulder blade.
Then 3 days ago, I broke out into a rash in those areas… and my boooobs still hurt a lot. I was able to get in to see my doctor yesterday, and… it’s shingles. She said that would also be causing the breast tenderness, because of where it is. Shingles flare up along a line of nerves starting at your spinal cord, and wrapping around to the front of your body – so that you only get it on one side, within a range of area. It’s like chicken pox, redux. Everyone I’ve mentioned this to says, “You’re too young to get shingles!” All I know about it really is that Carrie Brownstein got shingles while on tour (from reading her memoir, Hunger Makes Me A Modern Girl,) so I guess I’m in good company.
I got 2 prescriptions to help with the pain and the duration. We’ll see – it should start clearing up within a week… I’ll be going back in 2 weeks for my doctor to take a look. If this had happened close enough to my surgery, it would have had to have been postponed. That would have made me really upset! According to this timeline, I should be OK. It’s just so mind bogglingly coincidental that this suuuper painful inflamation occurred right in the area I’ll be having surgery. I’ll let you know which ends up being more painful – this or surgery!
Other than that, I feel relatively prepared. I just had my pre-op appointment via phone call a week ago, and that has put things into motion for getting everything ready. I got a huge packet in the mail of things to sign (informed consent), directions for when to do what, etc. I made a checklist to make it easier.
Pay surgeon – I still have to do this. I exhausted all info about my insurance plan, and there is no way insurance would pay for any of it. I expected as much all along, so, no big blow there…
Get parking permit – In process. My spouse and I will be in Ardmore, PA for close to 48 hours, and we need a temporary parking permit to park in the municipal lots.
Get therapist letter – In process. My therapist just sent me her draft last night, and it looked good to me, so she should be faxing it at some point today.
Get prescriptions filled – Done. This could be done well in advance, so your meds are ready for you when you need them. I needed to get a pain med and an antibiotic.
Get lab work – Done. I did it yesterday morning.
Go through a pre-op appt. with primary care physician – Done. I did it yesterday morning. I killed 2 birds with one stone – this plus shingles diagnosis all in one. She will be filling out a form to clear me, despite the shingles, and faxing it in.
Send in consent forms and everything else that needs a signature by me – I gotta get this together. I think I need to re-print certain pages and figure out what I still need to read through.
Take photos of chest – I did this for the surgeon already, but I might want to re-do it. Not while I have these shingles though!
I feel ready for surgery, mentally. Emotionally, I’m wondering if something is going on (shingles are brought on by stress, which I’m not actually feeling). I set up an appointment to see my therapist (who I haven’t been seeing lately), just to cover all my bases. It can’t hurt!
When I started moving forward with the process of getting top surgery, I did so with the assumption that I would be paying in full out of pocket. My therapist had looked into coverage a while back, for me, and told me it was not covered. Still, though, times are changing, and I had a sliver of hope that my insurance plan might have been updated. In my state, government funded health care now fully covers transgender related treatment and surgeries. Maybe mine would, by now, too?
Yesterday, I was on the phone with a customer service person for over an hour. At first it seemed promising. I gave her the category number – F64.1 (gender identity disorder in adolescents and adults) and the code for the surgery type – 19304. She said, “Double mastectomy?” and I said, “Yes.” She then proceeded to try to find out whether the surgeon was in network or out of network. She told me that if she’s in network, I would be paying a total of $70. If she was out of network, I would be paying a $750 deductible, and 80% would be covered beyond that. I started to get my hopes up – either of those would be awesome! – but also remain skeptical. The customer service rep made calls to my surgeons office, to the surgical center, and to some other places. She determined in the end that it would be out of network.
At that point, I said, “OK, I just want to make sure you’re doing this through the category of gender identity disorder? It is a gender-related surgery.” She responded, with a blankness in her voice, “That’s an exclusion under your policy.” I replied, as my heart sank a little, “OK so nothing will be covered. So it doesn’t matter whether she’s in network or out of network?” “Correct.”
I was mad that she overlooked the category I gave her, as a first piece of information, and moved forward as if there would be coverage, only to let me down. And that once I made it clear, she didn’t have anything more to say to me that might be helpful.
I asked her about the appeals process. She said I would pay for and get the surgery, the office would submit the claim, the claim would be denied, and then I could work toward getting some reimbursement.
I brought her attention to a 7 page document that is called Medical Policy, Subject: Gender Reassignment Surgery. It lists criteria that need to be met in order for a surgery to be deemed “medically appropriate.” I asked her what this was, and what would happen if I gathered enough information to move ahead with this. I told her it was difficult to understand exactly what I was reading. She said she was reading along with me, and that yes, these policies are confusing. She then put me on hold again, and when she came back, she completely derailed that conversation – she steered me back toward the exclusions. She added that not only was the procedure excluded on the basis of gender identity disorder, it was doubly excluded because it falls under “cosmetic surgery.” The conversation was basically over at that point. I stayed on the line to complete a survey about the call, and I gave her good ratings because she was way more helpful (making multiple phone calls on my behalf) than I was expecting.
I keep going back to this medical policy document. I don’t know for sure, but I have this feeling that it’s the loophole for filing a grievance. That if I can prove it’s medically necessary, I have a shot at getting at least partial coverage.
However, the criteria are so extremely binary in nature. Some examples