Today, I am on disability. A couple years ago, however, I was fairly productive, working at a job that paid low but was good and reasonably matched my skills. What happened? What happened is that something that people think will save money and not have any extra costs actually ended up costing everybody a lot.
I am a transgender woman who has been for most of my life very dysphoric regarding my male genitals. For me, sex reassignment surgery is a necessary solution. I worked at a decent job and the insurance at the job actually paid for my hormones, even though they were billed GID. I wanted to try to get surgery. This was something that had worried me for a long time, because I was not sure if I could ever get it. Some might say, Why don't you save for it? But my issues are that I am very poor when it comes to working over long time horizons and even simple organization. I knew that unless I made a hefty income, I would probably never be able to save for it. It would have to be made available to me, like it is to people in many other developed countries.
The summary plan description for my medical plan mentioned nary a word regarding sex reassignment They were paying for hormones, so I wondered: Would they pay for my surgery? I called them up and they said that nothing regarding transgender care was supposed to be covered, which I didn't buy because they covered the hormones under the diagnosis of GID. I had checked that with my endo's billing office and they confirmed that yup they were billing GID. I spoke to the corporate office, since this medical plan was self-funded, and they said what's on the summary plan description was supposed to be complete. Wanting to make sure, I spoke to a lawyer from a trans advocacy organization and he said yup they should cover surgery as long as it is medically necessary.
I found a surgeon to perform the surgery who was in network and then worked with my mental health professionals. I got surgery letters from both my psychiatrist and my psychologist. I also doubled-checked with my endo and he thought I was good to go, and also wrote me a letter. I submitted the letters and my insurance information to the surgeon's office in February, 2014. It would take a while before the info came back as there was a back log at the surgeon's office.
On April 24, 2014, I got the notice back that it was denied. This was very heavy for me and I began to feel incredible anger and despair. I started becoming unable to work and had to take leave. The lawyer helped me out more, but I eventually got the message that surgery was excluded, and they gave me the page from the Evidence of Coverage that said that. They had simply neglected to mention that on the summary plan description. My motivation was zero at this point. I would go on leave for good in August 2014. I applied for Social Security Disability and was awarded it. I also began receiving long-term disability for work. But before I could qualify for all these, I had to run up my credit card for my living expenses. I had to spend time in a mental hospital later that year.
Today, I am still on disability and have incredible resentment over the lack of access to surgery, not because I was unqualified but because I didn't have the money and no one else would pay for it. There is lingering anger that comes and goes, but for the most part I have become quite indifferent to life. Currently, I am in a state of anger which has motivated me to write this, but it will probably give way to indifference again at some point. Basically I am not working and I am receiving payments so I can live. My productive capacity was quashed and now quite a bit of money has to be paid to me. How much does that cost, all you out there who complain that sex reassignment surgery would cost too much to cover?