Thursday, September 11, 2014

USA: Expansion of SRS coverage: The catch

As I'm certain many are aware, most Canadian provinces cover SRS (comprising as many as 95% of the national population), and as far as I can tell the surgeon Canadians are sent to under their public health plans is one man: Dr. Brassard of Montreal.  Coverage of SRS is something that has been in place for quite a while in many Canadian provinces.  Reading anecdotal reports from Canadians, they generally don't have to wait very long, generally less than a year from when their SRS is approved.  They also don't have to pay upfront in full for the surgery.  According to the CIA World Factbook, the Canadian population is almost 35 million.

Now, let's look at the USA.  Currently, most insurance and public health plans categorically exclude SRS, but what would happen if and when coverage is expanded?  According to the CIA World Factbook the U.S. population is nearly 320 million, almost 10 times that of the Canadian population.

I have researched multiple surgeons and only two surgeons will accept insurance upfront without requiring full payment for SRS beforehand, Dr. Bowers and Dr. Kuzon of the University of Michigan at Ann Arbor.  Dr. Bowers appears to be the more popular of the two and already has yearlong waiting lists, even with the paltry level of coverage we have currently.  Dr. Kuzon unfortunately is not well-known or popular in the community, evidenced when I asked on Reddit about Dr. Kuzon and I received warnings that the quality of his work is poor.  Very few people, it seems, have gone or are willing to go to him.

Another surgeon, Dr. Kathy Rumer, had also accepted insurance upfront without requiring full payment beforehand, but according to her office she ceased accepting insurance at the end of last year and started requiring full payment for the procedures ahead of time.  (That news was a big blow to me.)  I have researched all other surgeons in this country that I could find (about half-a-dozen or so) and they are all the same: Full payment beforehand, submit to insurance later.

This basically makes our surgeon situation not much different from Canada: Dr. Bowers is our only Dr. Brassard.  Unfortunately, as stated previously, our population is nearly 10 times that of Canada's and, unlike in Canada, there is likely a lot of pent-up demand for SRS, because many poor and working-class people can't afford paying for it upfront.  Were full coverage of SRS provided to all trans people who need it in this country, we could be looking at multiple year-long waiting lists with the one to two surgeons who bill to insurance without expecting full payment upfront.

I've heard Dr. Bowers discuss this issue before in a video on transgender health care earlier this year, but it doesn't seem to be getting the attention that it needs.  Expansion of coverage for the poor and working class is futile unless and until we get more competent surgeons that bill to insurance and don't require full payment upfront.

Unfortunately, I don't see any sign of that happening any time soon, even with Dr. Bowers discussing it.  We simply don't have the number of surgeons billing to insurance without requiring full payment upfront needed to make nationwide coverage of SRS feasible.

I find it sad that surgeons like Dr. McGinn, Dr. Nguyen of Oregon, and Dr. Rumer don't seem to give a flip about providing access to poor and working-class trans people through insurance.

Writing this essay has depressed my mood quite a bit.

tl;dr: Here I discuss the problem with the low supply of SRS surgeons in the U.S. who accept insurance and don't require full payment of SRS upfront and how expanding to nationwide SRS coverage is not feasible while that supply of surgeons is low.

Clarification: By SRS, I'm referring to bottom surgery.

1 comment:

  1. Dr Bower's also discussed the issue at the Transgender Health Conference in Philadelphia back in June. She talked about how it's going to be a serious problem when more and more insurance companies in the US will begin to cover SRS. There is a shortage of good surgeons for SRS and it's only going to get worse as begin Transgender is becoming more accepting in society and more insurance providing coverage. There are very few places for surgeons to learn the skills for SRS as its not something that is taught in medical school. For myself, I'm hopping to be on her waiting list sometime early 2015.

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