The search for genital justice... - Exerpts from a recent letter

Hello <3

 

I am writing to request a referral to a University Physicians Network provider for gender reassignment surgery.

 

I am a transsexual woman who has been on hormone replacement therapy since June of 2005.  I have been performing the "inguinal tuck" (storage of the gonads within the inguinal canals) daily since early in 1999.  My physical anatomy has gradually changed to almost completely resemble the exterior of a natal female's body when I am properly tucked, but for several reasons, I require further medical intervention to promote my long term physical health.  

 

Firstly, living and working as a female 24 hours a day often requires me to remain tucked for more than 10 hours a day.  This has resulted in problems not limited to abdominal pain, skin rashes, skin discoloration, and external sores from the pinching of my underwear if I slip out somehow during the day.  Secondly, as an atractive adult woman I have had several opportunities for relationships.  However, my sexual life is negatively impacted by an inability to have regular intercourse.  While I am capable of recieving as much as 5" of the male organ through my inguinal canal, the few males I have tried this with were not able to achieve full penetration, thus requiring the extensive use of alternatives such as oral and anal sex.  There are additional problems with anal sex, including discomfort afterwards and hemorrhoid issues. Furthermore, there is a distinct difference in the sound when I urinate in a public toilet from the sounds of a genetic female doing so, due to the difference in our respective position and shape of the urethral opening, and this has caused some social discomfort when I am required to share public restrooms with natal females, not to mention the additional stress of worrying about wether or not my genital status should be discovered while using a public facility such as a changing room.  Also, it is difficult to find appropriately concealing undergarments (they have to be fairly snug to hold the tuck in place), pants (they can't be too snug or they will show a very slight difference in the shape of my crotch), and especially bathing suits (I have not been swimming in public in over 10 years).  

 

For all of these and many more reasons I wish to complete this final phase of my transition.

 

The most critical reason for my writing you today is opportunity.  It seems that the University of Washington's Undergraduate Student Health Insurance Program has recently removed the exclusion for "SRS" from their list of exclusions under the Student Health Insurance Plan (SHIP).

 

According to Mary Ann,  of the WPAS claims office ((206) 441-7574 x 3508), the SHIP will cover the following CPT procedures for patients undergoing gender reassignment:

 

Vaginoplasty (she gave me the code 57335, but I think this may be in error since it seems to be a precedure for intersex infants, and don't let me get started on how messed up it is that our insurance plan will pay for children to be mutilated without their prior informed consent, but won't allow me to get the same surgery now that I, as an informed adult, am actually requesting it....)

 

Labiaplasty (which she could not give me a CPT code for)

 

Now, I should be able to cover the costs of surgical supplies for aftercare, and travel and lodging costs, and the out of pocket maximum of $1,750.00 on my own.  As a single parent, full-time student, and part-time self employed bookkeeper, my total budget is only about $5,000.

 

However, the cost would be prohibitive if I am required to go out of the University Physicians Network, as the out of pocket maximum will go up to $5,000.00, and since they don't cover a large part of the practical costs involved in receiving this operation I would not be able to do this for at least several more years.

 

But wait, are there additional procedures that would be billed for that would not be covered by my insurance provider?

 

Amongst the various issues, is wether or not I have to remove the hair from the region of the skin graft prior to the operation (as Dr. Marci Bowers has recently begun requiring) since SHIP also does not cover ANY kind of electrolysis, apparantly even surgically necessary electrolysis prior to covered surgical services.  Meanwhile, some surgeons are still following a procedure to remove the hair from area of the skin graft during surgery either with some kind of electrolysis or with a scraping of the inside layer of the skin after removal of the graft, and of course I am not sure if all of this can be billed under "57335" or some other covered CPT procedure code.

 

Is/can orchiectomy be covered under a charge code of "57335"?  The WPAS claims office has already stated that while they will cover vaginoplasty for MTF transsexuals and phalloplasty for FTM transsexuals, they will not cover hysterectomy or, as in my case, orchiectomy.  (Of course it boggles my mind how they would expect to put something in there without taking what is there out first, but perhaps I misunderstand the billing process? or is this just another example of someone attempting to make a buck off of a patient population that has already been heavily discriminated against?)