Doctors & Insurance

One of the many things that trans-people worry about is going to the doctors and finding a doctor who is okay trans-patients. In Scientific American they have a blog about this,

For Transgender People, a Good Doctor Is Hard to Find
By Allison Bond
February 20, 2014
[…]
The discomfort among physicians and other clinicians when it comes to caring for transgender patients stems in large part from a lack of knowledge, said Safer [a faculty member and physician at Boston University School of Medicine], although some clinicians’ personal prejudices may also influence their willingness to provide care.

“The physicians with whom I come in contact act biased when they know nothing” about caring for transgender people, “but when they are informed they become more open-minded,” Safer said. “That leads me to believe the fundamental issue is a lack of knowledge, rather than a social bias that we wouldn’t be able to overcome.” He recently co-authored an editorial in the journal Current Opinions in Endocrinology, Diabetes & Obesity that called for more awareness and greater access for transgender people to healthcare, primary care physicians and specialists.

The lack of knowledge stems from the fact that the basics of transgender care are not taught in most medical schools. To change that, three years ago Safer implemented a one-hour lecture within the month-long endocrinology course for second-year medical students at Boston University School of Medicine. The goal of his lecture is to establish from an early stage of training that transgender care is just as much a part of conventional medicine as the treatment of any other group of people.

At a local college I attend a LGBT seminar for 2^nd year medical students; it is only about 3 hours long. They get a lecture from a doctor on how to make their practice LGBT friendly, we have a Q&A session for another hour and then we break up into small groups where the Q&A session continues until they run out of questions.

But there is another problem that we are facing that is just starting to surface now that we have insurance; finding doctors who take insurance. In Huffington Gay Voices there was an article about this back in September, “Transgender Health Insurance (Part 2): Why Coverage Is Only the Beginning” and the problem is money.

When we finally connected, my surgeon diplomatically assured me that I wasn't to blame for her decision: Each of her five insurance cases a year was equally taxing on her reception staff, and, more to the point, the insurance company wouldn't pay her more than one fifth of her asking price. I nodded silently, unsurprised that the choice boiled down to money.

"I'll still help patients fill out reimbursement paperwork; a lot of other doctors won't even do that," she responded apologetically.

I was momentarily appeased, until I considered that my insurance company only accepts pre-approval. This Catch-22 rendered her compromise useless for those insured by plans unwilling to reimburse. Moreover, reimbursements have proved inadequate for the large number of patients who only receive back a fraction of the thousands they paid upfront.

In sum: There are still surgeons who accept insurance for transitional surgeries, but even among those, the ones who take insurance upfront face business pressure to no longer do so. It's less risky and arduous to accept payment first and have the patient be the only one waiting on whether or not their coverage will be approved.

So the insurance companies say they will cover surgery but because of what they pay many of us cannot still afford to pay the out-of-pocket expenses.

Rumor has it that Medicare and Medicaid will cover transgender health care in the near future (last December the Appeals Board recommended coverage), but it is my guess that we will still face the fact that we will have high out-of-pocket expenses and it will probably be more than private covers.