Where have I been?

To say I have not posted much recently would probably be an severe understatement. I was going along so great with my blog. I was posting on a regular basis, keeping things going, really feeling into it. Then, I went full time, work went super busy, and life just plain got in the way. It was like I no longer had anything significant to say anymore. I was too bust living life to stop and write about it. I also think I began to feel that sitting here writing about what I was doing and what was going through my mind was almost like an exercise in narcissism. I began writing a few posts, and, after rereading, lost interest in them.

They were just too mundane and boring. Boring to me at least. It’s not that I lost interest in writing, it’s just that I lost interest in writing about every little thing that I did. It became clear to me that I no longer cared to write about the details of my transition, my feelings in certain situations, or what the next steps are for me. I just plain lost interest in that.

So, I sit here tonight trying to figure out where I am going with this. Is this a worthwhile endeavor for me? I feel that it is, but what is it I want to say here. I have always felt that my most satisfying posts were those that focused on issues. My all time favorite being the post I wrote about medical benefits for trans people. That was a post and a topic that are still near and dear to my heart.

This was brought home even more by the fact that I have three friends who just underwent GRS, and used three different methods to finance their surgeries. One cashed out retirement funds, another took equity out of her home, and a third will be covered by insurance. What these three stories show is that we are finding any way that we can to pay for transition related expenses. How many of us have maxed out our credit cards for hormones, hair removal, or surgeries. How many still are struggling to figure out how to pay for all of this. The person who is covered by insurance likely would not have been able to get GRS if it were not for coverage recently added by her employer. In fact, she was a scheduled for an orchi when the benefits were announced. She was pretty much resigned to the fact that surgery was just a pipe dream.

So many of us are in that boat. We reach a point in transition where we just cannot afford any more. Where does this leave us? What of the broken dreams of fully aligning our bodies with our minds? The fight needs to continue. We need to continue to expand health coverage for transition related medical expenses. Of course it is a hard sell right now. Not only are we hurting in this economy, but so are many of the employers we work for.

So many times, trans health benefits are carried only by companies that self insure. What exactly does that mean? Well, it means that if an employee takes advantage of let’s say GRS, the surgery is not paid by the insurance company. Rather the employer pays for it through the insurance company. In other words, the insurance company acts merely as a middle man in the transaction, accepting the claims, evaluating them, ensuring they meet the guidelines, and then making payments.

Unfortunately, so many times that benefits are also not paid until after the procedure. What does this mean for us? Well, if we don’t have $20K to pay for surgery, we likely do not have $20K to pay up front and wait for reimbursement from the insurance company. There needs to be better benefits coordination when those benefits do exist. The whole purpose of medical transition benefits is to remove financial barriers to transition. In many instances, these benefits do not remove the barrier, but rather jut changes the barrier.

I would also say that the surgeons need to become more flexible when it comes to insurance coverage. There operate on a cash up front basis, and often are not willing to wait for an insurance company to pay after the surgery has been performed. Essentially, we are forced to pay for the goods before we receive them. And, what choice do we have? There are so few doctors that perform the surgery, so they set the rules. No cash up front, no GRS. In many ways, they help maintain the financial barriers to surgery.

There is a long way to go to fully remove the economic barriers to transition. Medical benefits for transition should be universal, plus there needs to be ENDA in place to help ensure we can keep our jobs so that we can have benefits to help pay for transition related medical expenses. There is a lot of work to be done in both of those areas.

Now, as for my blog, where is it going. I’m not sure right now. It may become more issue focused, exploring the many issues that we all face, with brief glimpses of what is actually going on in my life. I really don’t think it will be the diary/journal it was before. I have move past that in many ways. But, I will forge on, trying to keep this going.

OK, a few quick updates. Work is still going fabulously well. The fact that I am trans is a non-issue, almost never comes up, and nobody treat me any differently. I’m working my butt of in my manager training program so I can get my own branch next month, which is very exciting, and a hell of a lot of work. I am actually managing two branches this month, and doing it well. Oh yeah, speaking of surgery, I am scheduled for my GRS next July in Trinidad. Hoping insurance coverage at my company will be worked out more by then, I cannot exactly put up the money up front and wait for reimbursement, but we shall see. Other than that, I am just enjoying life, though I am really trying to figure out a few things, ad figure out more about who I am. I neglected myself for so long, that I need to get out and finally enjoy being me. It’s time to relax, let down my hair(now that I have hair to let down), and have some fun!

I’ll try and check back in more regularly, but no promises here!

Access to Health Insurance

I want to start off by just apologizing for being a little haphazard in my posting here. I am hoping to get on a more regular posting schedule. I have had I lot of different things going on, and I have had a lot that I have wanted to write about but little time to do it. I do appreciate those who have stopped by to see what is going on here, and I look forward to writing more and engaging in some discussions of the topics and issues.

I just got off the Town-Hall conference call with Donna Rose, Jamison Green, and Becky Allison. I thought it was a good start, and I hope there can be more opportunities for our community to come together like this. I think one of the major benefits of calls like this is the breaking down of economic barriers. Todays topic was essentially health care, and underlying the need for coverage is the need to break down economic barriers. Far too many in our community are unemployed or underemployed. For many, making the journey to a conference may not be possible for economic reasons. Calls such as this will help those members of the community to be able to reach out and interact with the Transgender community at large. I think this will also be of value to those who may live where there is no trans community to speak of. 

Now on the topic. I think most of us have heard about the AMA resolution in June and the WPATH statement in July. These were both significant statements. I would like to start with the AMA statement, which was actually three statements related to removing barriers to care, removing insurance barriers, and removing financial barriers. The one thing that struck me was the repeated use of GID throughout the statements. They did, however, reference GID as a medical condition, and referenced not only the DSM but also the ICD. Now, I was not familiar with the ICD until this evening. I would appreciate information about it if anyone knows a little more about it, and how GID is treated in the ICD. I think that it is positive that the AMA referred to GID as a medical condition as opposed to a mental disorder. I am curious about how this statement in conjunction with the WPATH statement and other papers could serve to help legitimize our need for treatment if GID were removed from the DSM.

I am behind Kelley Winters’ efforts, my only concern being that we have another avenue by which can can continue to gain the medical treatments necessary to transition. I know some have argued that they do not want to be medicalized. To those I would argue, how can one justify medical treatment in the absence of a medical condition. I want to be medicalized, I just don’t want to be pathologized. I believe that part of our process towards equal health coverage is strengthening the medical need and the recognition of GID in the medical community as a medical condition.

I rather liked the fact the the WPATH statement included things such as chest reconstruction and FFS. A Jamison mentioned, many chest reconstruction is the only surgery that many FTM’s want at this time, and for many of them, this surgery is very validating for their gender presentation. The WPATH statement acknowledges that the path to transition is about more than GRS. There are other surgeries and procedures, which some consider cosmetic, that go a long way towards helping to affirm ones gender identity and help make a transition more successful and less emotionally painful (I think anyone who has been through laser or electrolysis knows these don’t reduce physical pain!). 

I think one of the most powerful things in this statements was the AMA’s statement of dispelling the myth that treatments, procedures, and surgeries for trans people are cosmetic or experimental. For us, these procedures are necessary for us to be able to live a life that is more genuine and more true to who we really are. These procedures reduce the emotional stress that can cause so many other health problems. When it comes to insurance companies arguing about cost, I have a few examples of my own situation. Prior to coming out and beginning transition, I smoked almost a pack of cigarettes a day and I was borderline high cholesterol. Within days of coming out, I quit smoking. I stopped cold turkey, now that I was on the road to being me, I didn’t need that crutch. I also changed my eating habit and reduced my stress levels significantly. I was no longer eating the bad foods we eat when we stress eat, fast food, high fat foods, high cholesterol food, you know that stuff that tastes so good but is horrible for you. Since then, by cholesterol is half of what it was before. Not smoking and reduced stress are also significant. Essentially, I likely saved my insurance company easily hundreds of thousands of dollars by transitioning. I greatly reduced my risk of heart attack and stroke, reduced my need for cholesterol and blood pressure reducing medications, slashed my cancer risk each year that goes by, and greatly reduced the potential costs if depression were to lead to suicide of suicide attempts and the related hospitalizations. You tell me, which is better. I think I would take the road of paying for therapy for a few years, GRS and a few other procedures, and HRT. Over my lifetime I bet that it will cost them a lot less then the bypasses and other procedures I was headed towards! 

Another thing I did take away from this was the need to education, Educating our employers, the insurance companies, and the insurance brokers that our companies deal with. There were several stories of brokers discouraging Trans benefits, or pricing them too high to be affordable. I worked in the insurance industry for a brief period of time, and when you are a smaller company, you have little or now ground to negotiate when it comes to benefits. It all comes down to what can I and my employees afford, and what do we have to give up this year. The education has to start with the insurance companies and the larger companies that have the negotiating power. If every company listed in the Fortune 500 index said we want full coverage for out trans employees, I am sure that the insurance companies would take notice.

I find it interesting that many insurance companies offer full benefits to their trans employees, and yet make it difficult and expensive for other companies to provide the same benefits. I wonder about the concept of creating and index that would measure and rate insurance companies not only on the benefits they provide their own employees, but also on how they make the same benefits available to subscribers. Imagine being self employed and having to shop for health insurance with trans benefits, I am sure that is impossible, and if possible prohibitively expensive. 

We need insurance companies to recognize trans benefits as a fundamental part of any group or individual plan. Spread over a sizable group, the costs are negligible. I believe one study showed that it was pennies per premium. I will find that presentation and post it later, I think it was from and Out & Equal conference. If this is part of every policy, cost would not be an issue, and we would finally have equal access to health insurance and the procedures that we need. 

I look forward to future calls, and the discussions and actions that they will generate. There are a few things out there that are dividing some of us, we need to concentrate on many of the things that bring us together. We will always have differing opinions on how to tackle a particular issue, but I think we need to respect the diversity of opinions in this community. We are an educated community, and we need to realize that there is more than one way to approach an issue. Good night to everyone, and hope to talk about some of this more.