When I finished grad school, I thought I was done with having to do research. Boy was I wrong!
I shared on Facebook last night that I had failed a visual field test I took a couple of weeks ago. Failing this test was a very good thing because it means my health care insurance will be paying for an eyelid lift surgery to help improve my vision. The plastic surgeon who is going to do the surgery has also said he will do whatever he can during that surgery to help feminize my eyes since it won’t require any additional time or equipment. He was great and was like, “We can use this surgery to help give you a look that better reflects who you truly are inside.” I was amazed when the doctor told me that.
But knowing this surgery has been approved carries even bigger implications for me. I explained this on Facebook yesterday, but I know some of you here don’t follow my SL Facebook, so I apologize if you are hearing this again.
Shortly after my first appointment with the plastic surgeon who will do my eye surgery, I met with another plastic surgeon about possibly getting breast implants. I knew that insurance won’t cover THAT surgery but I wanted to start getting a “price list” together of procedures I would like to have if money were not a factor. When the second plastic surgeon asked me what my wish list for gender affirming surgeries was, I told her. What was included on my list was:
- Hair transplants to thicken my hair
- Rounding out my jaw line
- Reducing my brow line
- Breast implants
- Some filling out of my hips and butt
Now, insurance will pay for my “bottom” surgery, so I didn’t include that on my wish list. But these procedures, each of them, costs a significant amount of money and are not covered by insurance. And the prices you see if you research online don’t reflect the full cost of these procedures.
For example, if you look online, they will tell you that getting breast implants costs $5000-$10,000 US. That cost ONLY includes the materials needed for the surgery. That cost does not include the fees paid to the surgeon and the anesthesiologist. It does not include your fee for reserving the operating room. It does not include the recovery room fee or the pre-op fee. These fees can run anywhere from $15,000-$20,000 US. When I had my knee surgery, which only lasted like 45 minutes, the bill before insurance kicked in was $23,000 US…if that tells you anything.
Soooooo…I met with this second plastic surgeon and I gave her my wish list. At that point, she proceeded to tell me how I could save a fortune on gender affirming surgeries. We ended up talking for about an hour and let me tell you, she is an amazing doctor. Not just because she did so much to help me, a fellow employee, but because she makes these same recommendations to others who are transitioning. She is more worried about helping someone like me feel congruent in my own body than the money she would get paid. This is one of the joys of getting a lot of my care at an academic medical center. Teaching is part of her job requirement. Let me explain further.
The first recommendation she made to me was to have the plastic surgery fellows do any procedures other than the eyelid surgery. Since insurance will be paying for my eyelid surgery, let them pay for that attending physician and let him do the surgery…but for all my other procedures that insurance won’t pay for…let the fellows do the surgery. These are doctors in training who are close to becoming board certified and the attending physicians are always right there observing, guiding them and ready to step in immediately if need be. And since the fellows aren’t yet board certified, they cannot bill for services. What made her argument even more compelling was when she said that the fellow she was going to refer me to…she would let that surgeon operate on her own children. That spoke volumes to me.
The second recommendation she made was to talk with the plastic surgery fellow about lumping as many procedures together as possible with my eyelid surgery. She explained it like this. Insurance is going to pay for my pre-op, anesthesia, OR room and recovery room fees for the eyelid surgery. If I schedule other procedures to be done in the same procedure, I will not need to pay those fees out of my own pocket later on. Yes, there will still be costs. I would still need to pay for my actual breast implants and the specialized equipment used for anything else…but those base fees would all be paid by insurance. Cha-ching! Money saved!
Additionally, she explained how much could be “lumped” together into one day of surgery. In case like mine, surgeons are willing to group procedures together up to an estimated time under anesthesia of six hours. At eight hours, that is when the risk of complications begins to dramatically increase, so if they plan for six hours, that gives them a two hour window in case there are any problems or delays that occur during surgery. Now, I don’t know yet exactly how many gender affirming procedures could be lumped in together in that six hour window. I have to meet with the plastics fellow next month in clinic to discuss that. I also am not sure if I could have certain procedures done at the same time. Like, I don’t know if I could have the brow reduction done at the same time as the eyelid surgery. Those are all things I am trying to research and discussions I will need to have at my appointment.
Its a lot of information I need to absorb and I am doing research on it all. There will obviously still be out of pocket costs for me. I need to figure out what the total costs might be…which procedures can be done together…ill the hospital let me set up a payment plan? So many things to think about. So much to figure out. Hence why I am buried in research again.
I think one thing that is important for me to say here is that deciding to do these things…its not about vanity. Its about feeling congruent in my own body. As I said on my Facebook post, even with my HRT, there are still days I want to claw my own skin off so I can crawl out of it and find some new FEMALE body. Additionally, while I have had obvious changes from my HRT, due to my age the changes are limited. Only so much will happen. And…I am at the point where the majority of the changes have at least slowed significantly, if not stopped all together. I have never wanted nor needed to be a model. I’m not looking to be some bombshell. I just want to be able to pass as a woman you might see walking down the street every day. I know I am going to have my spare tire and flab in areas. I actually appreciate the majority of the wrinkles on my face as they reflect all that I have survived in life. I don’t want massive breasts. I just want to be able to walk down the street and not have my gender questioned by the random person passing me.
That is the essence of congruence versus vanity.
THAT is why so many of us consider gender affirming surgeries.
THAT is why it is absolutely ridiculous that so many insurance companies ONLY focus on the “bottom” surgery and don’t take other gender affirming surgeries into account for those of us transitioning.
See it on Flickr.
Diversion – Low Key 3m
Coffee & Muffin
ARIA & The Loft
Devon book pile and glasses
Brown Cat – Sitting – Full Perm
Grey Tabby Cat Lying – Mesh – Full Perm
Coastal Couch (Monotone) ADULT
Tap That App – Laptop