All good! It’s indeed crap! 
Sadly, this is probably true. Fucking hell. 
I mean, on one hand it’s pretty amazing and impressive that people are able to get this covered by insurance at all! Like, hooray for progress! On the other, they still want to shove people in narrow little boxes and there are so many requirements upon requirements that it’s insane. UGH.
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y u p.
I think it’s possible to get prior auth as a trans guy who goes through and does all the Right Things. So that’s good. I’m glad for that!!
But I’m not going to lie. I’m not a trans guy. I think that should mean I still get treatment from what I’m pretty sure I can now call many years of dysphoria. I bought my first binder in 2013. I’ve day dreamed about getting early stage breast cancer (horrible thing!!) in order have them off for many years.
But I’m not willing to lie about who I am in order to get treatment, although I would judge no one for doing what they had to do.
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It might be worth also looking into coverage parameters around reduction and how much of a physical/psychological diagnostic history is required.
I feel a bit asshole saying that.
But maybe there are ways to get 100% reduction because “this excess tissue I do not want is interfering with my health and daily life regardless of my gender” is relevant to you.
I feel like there’s got to be a path, when my friends who have had full mastectomies for cancer weren’t questioned at all when they chose very very different paths for reconstruction (or, not reconstruction at all: not a single one elected to go back to same size). Like, if that is a choice, to not have boobs – which there is clearly a precedence for apart from trans health, and apart from cancer therapy, because it’s not always done at the same time – it should be a choice regardless of the reason.
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I would not have trouble lying to circumvent a system rigged against me. That, to me, is a white lie.
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I’m sure this varies by region, plan, etc., but a part of proving eligibility for gender affirmation surgery in my province is living as the opposite of your gender-assigned-at-birth for a year and doing hormone therapy and a bunch of other stuff. It’s not just checking a box on a form or lying to a bureaucrat.
Even if it were so simple, it’s still a complicated moral issue that each person will approach differently. The bureaucracy might be evil, but do you give up being who you are to trick them or appease them? Is there a way to be true to yourself and meet your goals? I think every single person will behave differently in this situation.
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I think that could be a solution for some people, but I’m not sure what options you’d have in terms of surgeon skill and experience for different constructions. Here if you do a medical reduction for BNS pain you often get a surgeon who isn’t equipped to leave an attractive end result of any kind. Just less mass.
Whereas if you go for a deboobaning you can choose different kinds of construction and gender signaling and and and.
And as per smacky’s response, here if you are applying for top surgery as trans, you need to be referred after doing your year+ of living, counseling, hormones. And if you are not well represented the burden of proof can be heavy. And often inaccessible for people who aren’t trans binary*
*I think I just made it up. Does it mean what I want it to mean?
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I guess I was thinking more of insurance coverage rather than provider. Providers bill whatever CPT code they want as long as it’s reasonable to the procedure they performed.
My last procedure was billed as something different so that it was covered instead of out of pocket. That type of thing. So, same provider of choice, billed through insurance through different hoops jumped through.
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It is all so confusing! Why? (Not a real question because not the place for it)
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If it means folks who don’t identify as the gender they were assigned but don’t want to hop the solid, bold, binary line to the other gender, then I think you’re using it correctly.
There’s a lot of reinforcement of the binary within some trans communities which is incredibly upsetting. Our (USA) healthcare system also only seems to recognize services as being valid if you want to go from one extreme to the other.
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Yes! That is what I wanted to say and I didn’t know if it was real words or not.
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I haven’t heard it expressed as a term before but I’ve had conversations about it more recently.
My enby sib (not really but we look like we could be and I love them so much 
) is trying to balance their self administered T while still producing estrogen to find a comfortable balance without the help of docs because they’re not trying to “actually transition.”
It’s pretty messed up. We should be able to get the help we need to live the lives we deserve in bodies that we love.
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You are all wonderful people. I didn’t have the bandwidth to participate in this conversation last night, but I’m so happy it occurred.
@katscratch I will discuss with my doctor what she thinks my chances are of getting approval as a non-binary person looking for surgery when I see her next week to discuss HRT. I will also ask her about reduction as a different coding and how that would… work. I don’t have high hopes.
@Illathrael I’m so sorry your enby sib has to manage on their own. Wishing them safety and luck finding a skin that feels good. 
There are doctors who get it, but there are many more who don’t. Hugs.
Re: managing a rigged system:
It’s absolutely a personal choice. 
But yes. I feel that for me this journey is 100% about finding a better way of being myself, and I don’t want to jeopardize that personal experience in any way, and that includes presenting as a gender that isn’t right, just a different “not right” than current, in order to get treatment. It could be a non-issue for someone else, but for me it doesn’t suit.
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I’m talking with a friend who is in the trans services field in town. 
They are wonderful and making me think it’s at least possible?? to do this through insurance again. There are resources. Not at all convinced and won’t have a real feeling of likelihood until the 12th (when I see my primary care doc in person to get an idea if she’ll be an advocate for me or more on the passive side of things).
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In sum: my insurance is notorious for being very mediocre specifically about trans stuff. But if I do POS versus HMO (an extra $1,200 per year, plus an extra $750 in deductible) I can avoid at least some of the issues (them denying referrals to outside people)
I only make ~33K/year so this is a question I will need to think about carefully. It makes absolute sense to do if I can get better care out of it, just unsure if that’s true yet!
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Update Friday!
Interpersonal:
I have officially broken the news to my mom that I’m pursuing this surgery. She’s being a Very Good Mom and is concerned for me-- about the surgery, about me making a rash and very permanent decision, etc.-- but is loving and caring even though she doesn’t really understand (yet). This is still very new to her. The conversation is opened up now. I have not yet talked to my dad, and will let my mom open the topic with him first.
Practical:
I have started making calls to surgeon offices. 
I have a consult with my first choice local surgeon for July 3rd, and a consult with a surgeon I haven’t researched as well who is also local in a few weeks. My first choice local surgeon is … quite quite busy. Yikes!
Timeline:
- Next week see primary care doc, discuss options for getting top surgery covered by insurance, discuss microdosing HRT as a possibility.
- Feb 20th - consult with local surgeon B - get idea of procedures and price he offers
- March 4th - intro therapy session, confirm therapist’s ability and willingness to write letter of readiness for me for surgery
- July 3rd - consult with local surgeon A
- OTHER???
After I pick a surgeon, it’s anywhere between a month or two to 3-5 months to actual surgery after consultation depending on who I go with.
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I always feel like a surgeon being busy is good? Like people trust in them and want them to perform their surgeries? Glad you are moving along with the process.
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Yeah. Starting the ball rolling instead of continuing to circle the ball feels good.
Both my parents officially know that the ball exists and is moving, to continue the metaphor. They’re being… fine?
I want to start off by saying that I love my parents and they love me. That said, they’re not super aware of stuff like this and are very nervous on my behalf. Principally they appear to be invested in maing sure I am aware that terrible awful things can happen in elective surgeries and there’s no thing as a risk-free operation.
Which… thanks? I guess? The part where they care deeply about my well being is nice. The rest is … kay. I’m aware of all that, thanks, in the multiple months of reading and research I’ve done. Which, I can say, is greatly more than the multiple minutes of reading they’ve done. I also know while nothing is “100% safe” this is a procedure that has been done many many times.
My mom in particular was also concerned I’m going to look weird. I haven’t really talked with them too much about any gender shiz, because that seems Next Level and I’m not ready for it. I explained that I want to go about my life more neutrally, without being auto-put in the femme camp just by my chest alone. And I explained that I’ve never sat happy with my chest, ever. At best I’ve felt neutral about it. At worst, I want it off off off off offfffff.
She thinks this is extreme.
I can see how she’d think that, but it makes me sad that she doesn’t also understand that sometimes extreme is the logical next step.
SO yeah.
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It’s a feelings day.
Second guessing how much I “need” this as today is one of those “neutral” days about my chest. Mostly these parental discussions have left me tired and wrung out.
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Lol. Also, my mom suggested I try loosing weight instead.
Because that will work.
True, it might shrink me a half cup size, as I’m slightly larger now and my chest has come along for the ride. But I’ve always been “busty” as my mom calls it. wtf.
kay.
no.
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