Life Insurance

I just wrote an email summarizing my experience thus far with attempting to get life insurance, so I figured I’d also toss it up here.  I wrote this email to a regional advocacy group, seeking advice in case they have seen experiences like this before.  I first wrote about this issue back when it happened in the beginning of 2012.

 

 

I was wondering if you have had any experiences with transgendered persons being denied for life insurance for reasons related to their transition?  

I transitioned female to male in 2009-2010.  During my transition I completed a MS in physical chemistry and began teaching college-level science and technology courses full time.  I saw a therapist regularly for nearly 2 years and participated in a FTM support group at the <place I’m not mentioning>.  There were no complications from my top surgery and I am physically fit.

I applied for life insurance in October 2011.  After a delay, State Farm’s underwriters denied my contract in December 2011 for the following reasons:

– I was within 1 year of my top surgery (January 2011)

– I had mentioned in therapy sessions that I might be getting a hysterectomy in the future

– My initial gender identity disorder diagnosis was accompanied by a mild depression diagnosis, which gave them cause for concern of a “suicide risk”.  This diagnosis was removed by my therapist when I began hormones in March 2010 and was able to function fully.

– They were concerned I was not “well adjusted” or “functioning normally”.

I have decided that I do not desire a hysterectomy and am attempting to clarify their other items of contention.  I had an appointment with another therapist at the <place I’m not going to mention> recently in an effort to show that I continue to “function normally”.  I am concerned, however, that the underwriters may still pick and choose details from my medical file.  

It took some time to get back to trying to get life insurance because it is so frustrating that I did nothing but help myself become mentally healthier for 2 years and the insurance company is holding that against me.  As my wife and I continue our life together, it is important that I do have a life insurance policy.  

If you have any advice or resources that might be helpful that would be much appreciated.

I have my emotional energy back and am determined to get life insurance taken care of before my 28th birthday (October this year).

A New Insurance Plan

Part of the fantastic territory that is working for 1 company full time is “benefits”.
When I graduated from grad school, I had a few months before my insurance from the university lapsed (health partners). Fortunately, I had enough cash saved up for a temporary insurance plan- so I would avoid trying to get a new insurance plan while completely uninsured with a “pre-existing” condition (“gender identity disorder”, the medical code for my XX chromosomes).
At any rate, my current insurance provider is Cigna. Immediately I knew to run through the same old song and dance… find the “coverage criteria” etc for myself and verify coverages. While Cigna does offer coverage for GID procedures and hormones, they very explicitly state that most of their plans do not extend to those nether regions of neverneverland. What wonderful trans-ignorance.
So… my employer’s plan doesn’t cover anything anywhere near GID.
What this means for the immediate times is that I’m going to need an extra $500+/yr for blood work and a check up. The testosterone itself isn’t that expensive, compared to the medical care, running $55 for a vial and enough syringes to go 19-20 weeks on 50mg/week.
In the long run I am going to look into having my “t checkup” covered as a “preventative care” checkup, and see if any other indication could cover the blood work. Also, at this point my cholesterol, blood sugar, etc, have all been stellar for every single test. Even the lady giving me a checkup for *life insurance* said I have great blood pressure.
More importantly, I need to contact the HR department at my work and talk to them about reversing the exclusion in plan years to come. I will eventually be facing a hysterectomy, and the entire mentality of the exclusion is disturbing to me as an employee. At this point I am essentially not out at all at work, not something I have a huge plan for changing on the local level anytime soon.
A future option may also be to join the health plan of my fiancé, then wife- if her plan includes the coverage. It has been moderately discussed, but not explored at this time. This is not a completely foreign idea as I a) know many people who put both partners on one plan, gay/straight/queer/trans/cis/whatever, b) have a friend who’s top surgery is now covered by his wife’s insurance,

I am a huge proponent of trans-inclusive health coverage. It was that inclusion that allowed me to begin my transition with the support of not only a therapist, but a close-knit group of transguys at various stages in their transitions, as well as a general care doctor with extra knowledge of trans-medicine.

Success (Appeals Process, 4)

I’m nearly completely speechless.

Pretty much all I can do is feel my smile curling up the side of my face, the warmth of many emotions in my eyes, and the blood pumping with excitement.

I came home today to find a letter from my insurance company stating that they are approving my request for coverage of top surgery.  Tomorrow morning, I will attempt to schedule surgery.

I can afford it now.  It’s going to happen in the next few months.  After a lot of frustration and disappointment… finally, success.

Hope: A Second/Third Appeal

It’s a powerful thing.

Hell, Obama built an entire damn campaign on it.

I’m not sure when the last time I had any real hope for surgery was, but suffice to say that it is finally back. My health insurance company sent me the official denial of appeal letter on my birthday almost a month ago, and it felt like the icing on a very very bitter (birthday) cake.

At that same time, I investigated using a different surgeon, Dr. Buckley.  She is also local to Minneapolis and my consult went very well.  I had her submit a request for coverage to my insurance company.

Which they lost.  Well, at least member services had not a shit clue where it went.  So I had Buckley’s office send over another copy of all the paperwork.  Which also disappeared down the rabbit hole.

Just under a month later, I put my angry voice on and called my insurance company and found the rabbit hole.  The appeals department.

All of the information about me and chest reconstruction surgery had been compiled into one file, and they are going to look it all over AGAIN.  At this point, my file very explicitly says that I want to have surgery in early January, when I will have been living as male for a year yadda yadda yadda.  However, according to my friendly appeal representative, my file looks much more promising at this point.

And she expects that it will be looked at later this week and very possibly have a new decision on Friday.

Dare I hope to get good news? I’m pretty sure this is the first time in a long while that I felt like there was any positive momentum towards getting surgery… July maybe?  Best. Christmas present.  Ever.

Ever.

Insurance: Infinite Loop

In programming, there is a dreaded mistake.  An infinite loop.  Generally caused by a mistake in the rules that would allow the program to satisfy the requirements for exit.

I seem to be inappropriately stuck in a loop with the insurance company.  Fortunately, it is not an infinite loop.  Unfortunately, it isn’t infinite, just a frustrating setback.

The insurance company claims that I will be eligible for surgery after a year of “real full time experience living male”.  1) Expecting people to live a year while binding C cup breasts and then pat them on the head with mediocre insurance coverage is like bitch slapping them.  They deserve a fucking party.   2) That means that if I were to have surgery in January, it should be covered by my insurance company.

HOWEVER, to have surgery in January, I need to be scheduling it now.  To schedule it now, I need to have an insurance company that agrees that they will cover the surgery in January.

Except my insurance company is dragging their feet/being assholes/wrapping me up in red tape.  I have phone calls to make to them and am starting to considering contacting OutFront Minnesota for legal aid.  There’s a flaw in the system and I’m not going to let them ignore it.

I’m starting to worry about not having surgery in January, and how that will seriously impact the summer.  I want to be better in time for softball.  I want the scars to be healed enough for direct sunlight.  I don’t want to waste another hot day in two binders.

Second Consult, Part 2 and Appeals Process, 3.

My secondary (new surgeon, Dr. Buckley in Minneapolis) consult was originally scheduled for tomorrow morning.  Just as I was finally starting to get nervous about it after ignoring it all weekend, I got an email from my school that took me from nervous to very complicated (once again).  It was regarding the results of the FAFSA form I recently submitted.

Yes, I realize that I submitted the FAFSA way late… I don’t like to ask for money that I don’t need, but with all the trouble I had securing a medical loan this last summer (ugg, summer 2010) I wanted to investigate a federal loan.  Lo and behold, I was approved for a federal subsidized (oh thank heaven) loan.  Essentially, the problems I had securing the money that I will be reimbursed for by my insurance company ahead of the surgery are completely gone, should I accept the loan.

Of course, after I find out about the new loan and start questioning the money issues and price I’m putting on my chest, I get a call from Dr. Buckley’s office to inform me that there was a scheduling problem that pushes my consult back to the first week in October.  More time to contemplate, I guess.

I still need insurance approval.  In the long run, I could go without it if I scrimp and save- but that’s ridiculous.  They have a policy that dictates that my surgery should be covered and this bureaucratic paper pushing is annoying.  I have officially submitted an appeal at least in an effort to obtain more information regarding how much they would cover and when the request would actually be covered.  I’m just waiting on a bunch of people that see me as a file folder of records.

The biggest question I’ve got now, with a loan sitting in front of me to essentially have which ever surgeon I want and not worry about it for several years… is what price do I put on my chest?  If I go with Tholen, I could be paying $3000 out of pocket or more.  I could be paying $1000 out of pocket, I don’t know yet.  Is any reasonable amount worth the lesser experience with Buckley?

Buckley is a surgeon.  I’m not questioning that.  What I’m saying is that Tholen turns out amazing results again and again while Buckley’s are varied much more often.  What I’m saying is that Tholen’s office staff treated me like a human being, a guy, while Buckley’s office staff treated me like someone with an interesting skin condition that they didn’t know how to discuss.

I’m going to walk on a beach without my shirt on.  I’m going to go for a run without my shirt on.  I’m going to sit around the house on a warm June day without my shirt on.  I’m going to get dressed without layering multiple shirts.  I’m going to associate waking up in the morning with coffee or breakfast instead of 4 layers of compression fabric.  I’m going to let my partner touch my chest.  I’m going to let my baby listen to my heartbeat as they fall asleep against my chest. I’m going to mow the lawn without my shirt on.  I’m going to breathe a deep breath without a pain in my side.  I’m going to have scars that represent 23 years of my life that are as much a part of me as the moment that I’m touching the scars. I’m going to live with my chest for countless years to come.  I don’t think there’s a price for any of that.

Chromosomal Discrimination

That’s essentially what health insurance companies do when they evaluate men’s claims for male chest reconstruction surgery.  Here’s how it spins down, at least for my health insurance company… you know, the one I love so much. Hmph.

Alas.  There are types of men that the insurance company sees differently- those who bear XX chromosomes and those who have the XY chromosome pair.  Both type of men can develop a chest with feminine-looking breasts at any point in their life from adolescence on.

In XY-men, this is termed “gynecomastia” and is not always easily treated.  Though extra fat deposits in all types of men result in enlargement of the chest, this is not what I’m discussing.  Gynecomastia is essentially enlarged growth of the mammary glands.  It’s not masculine.  This can be extremely distressing, especially for pubescent boys.  Generally, after treatment for a pathological cause for a term of 6 months, surgery is recommended.  This is all covered by insurance.

In XX-men, development of a feminine appearing chest is very common as they progress through adolescence.  However, obtaining coverage for the health care necessary to treat the enlarged chest is much more difficult.  The mammary glands will develop fully if not halted with hormone blockers during adolescence.  Instead of a simple 6 months of hormonal treatment being necessary prior to surgery, the demands are much sharper.  Generally, after 12 months of hormone treatment and 12 months of living in conflict with the feminine chest, surgery is covered by insurance.

Why the difference in coverage criteria for removal of feminine chest features?  Yes, the chromosomes of these two types of men are different.  However, both types of men naturally grow chests with enlarged mammary glands, a distinctly feminine quality.  Only those men without the XY chromosome pair are demanded to be mentally evaluated by two mental health professionals before they are allowed to remove the offending feminine features.  There is a 6 month time delay difference between the chromosomal sets before coverage of surgery, which doubles the waiting time for men with XX chromosomes.

So.

I’m a guy.  I have an average testosterone level for men. I wear boxer briefs.  I will be a great husband. I use the men’s restroom. I’m legally male.

The reason why my request for chest reconstruction surgery is delayed is because I have XX chromosomes.

Second Consult, Part 1.

Holy crap on a cracker.

“What are you wanting to do?”

“Female to male chest reconstruction surgery.”

“Uhhh. *pause* You want them off, right?”

“Yes.”

Ok. I know that the whole FTM, MTF, xTx notation is a little confusing… but seriously… clarifying what I want my body to look like can be done with more sensitivity.  But alas, it gets better.

“and you’re still at <insert my address here>?”

“Yes.”

“It looks like you had one before and canceled it.”

“Yep, and I’ve received mail from you all before under the wrong name, so make sure that Drew is the only one in your system.”

“That’s what I pulled your record up under.”

I wasn’t rude in my request, but she was completely befuddled by my request.  We’ll see if I get ANOTHER packet of mail from this clinic to my female name. Would surprise me, because again, it gets better.

“So I’m scheduled for <day>, at <time>, correct?”

“Yes sir.  I mean ma’m.”

“It’s sir.”

REALLY? Not even my vagina get’s ma’m-ed. I really hope I get to have a chat with this receptionist when I go in for my appointment, but I doubt I will be so lucky.

All in all, I’m really looking forward to this consult.  I’m going to feel even more confident about whatever I end up doing having more information, and while my official appeal is going through the insurance company to just get more information on how much money they will cover, etc, it’s nice to check out my options.

Why am I putting up with the blatant ignorance of trans identity from medical staff?  Because through this surgeon/hospital, I would end up paying ~$300 including pain pills, post-op vests, and deductible for the surgery.  Not to mention, what a great opportunity to educate people before they make someone else’s life miserable.

I want to have all the information I can have before I work everything out for top surgery. It’s going to take a little bit more time.

All I want for Christmas is to be getting my flat chest soon.

Video: 5 Months on T

If you don’t generally watch the videos, I suggest you watch this one, because I talk about my decision regarding top surgery. It’s a big deal for me, so huge it’s hard to fathom, but I’ve decided that it is in my best interest down the road to wait and not put my future in jeopardy by fighting the insurance company at this point.

Appeals Process, 2.

After taking my case back to the medical director with the indication that I am on hormones, HealthPartners has decided to uphold their decline of my request for authorization on the grounds that their criteria for coverage are meant to all be met.  While this is bullshit, because they designed the criteria directly from the WPATH Standards of Care which take special consideration for FTM top surgery as a more necessary procedure earlier in the timeline… yet HealthPartners claim that chest and genital surgeries should be taken with the same regard.

This was not an official appeal so I still have that option.

In two days, I’ve been on testosterone for five months.

In one month, I have to be back in the classroom.

In two months, I turn 23 and mark my 1 year anniversary of choosing to live everyday as myself.

In 66 days, my written exam/masters thesis is due.

I’m not sure when I’m going to have surgery.