Previously I have posted that I have completed my transition so then too I would have completed my postings to my blog, “Sandy’s Transition”.
Ah were that the case. The last few weeks have left me stressed out, anxious, and depressed as ever I have been in my life.
If you have been following my story, you will have read that I was one of the fortunate few whose insurance coverage actually did cover not only my orchiectomy, but also my Gender Confirmation Surgery as well.
You may have also read that while it was “covered” it wasn’t *covered*. Something to do with my insurance company (Blue Cross/Blue Shield HMO of Illinois) not covering cosmetic surgeries, but the only way to list my referral for GCS was as cosmetic. Catch-22. (And why in the world would you list as “cosmetic” something that good girls don’t go around showing off is beyond me!!!)
My doctor, surgeon, and therapists all sent in recommendations that this surgery wasn’t cosmetic, but was a life saving operation. And only after my doctor talked to the insurance company directly and submitting over three hundred pages of notes and documentation, that the insurance company relented and approved my referral.
But since the operation was out of network, I had to pay for it upfront, then, I was assured, I would be reimbursed. I proceeded to take out a loan with near loan shark rates assuming that the interest rate wouldn’t matter that much since I would be paying it off in a reasonably short period of time after I received my reimbursement.
Ok, let’s fast forward through my trip, surgery, and return. It’s posted on the blog for those who want to relive those wonderful days with me. (I still recall the moment my plane took off for Philadelphia with a wistful fondness.)
Ok, back home and now trying to put my life back on track after a two year process to change every part of my being. One of the details was to start submitting the paperwork to the insurance company to get my reimbursement.
I contacted the person at BCBS about submitting the required information. I was told that there was a form on the website and that I should fill it out and submit that and the relevant invoices to the insurance company.
I did that and didn’t hear anything for a few weeks. I called and after going through the usual mind numbing phone menu and being put on hold so long that I actually started liking the musak that was playing in the background and could recite all the phone-on-hold commercials by heart… backward.
I finally talked with someone and they said that the documentation that was submitted was not complete. They required an itemized invoice including standardized procedural codes and diagnostics.
Ok.
I called the surgeons office and contacted someone from admin. Fortunately the also had been contacted by the insurance company and they had requested the same things. But I would have to contact the hospital to get that information as well as the anesthesiologist.
Ok.
I worked through this process over the next few weeks. Regularly contacting the insurance people as well as the billing and admin people at the surgeon’s office, the hospital and the anesthesiologist.
I then receive a note from BCBS stating that my claim wasn’t covered because they do not cover GCS.
Arrgghh!!! Scream!! Cry!!!
I contact the insurance people and they tell me that the never covered that surgery and even though I had a proper referral it wasn’t BCBS’s responsibility to pay it. I was welcome to contact the medical group to see if they would pay for it, but their responsibility was at an end.
Arrgghh!!! Scream!! Cry!!! Arrgghh!!! Scream!! Cry!!!
After I dried my eyes, actually the tears ran out. I contacted the medical group.
I then had to go through the exact same submission of documentation that I went through with BCBS.
Following that, I was told that even though I submitted the proper information I would not be reimbursed. The medical group only reimburses the hospital and they should have submitted the information directly to them in the first place.
With a calm and demeanor rivaling that of Job, I explained to this person that I had been told that I HAD to pay for it out of pocket since it was out of network and that I was SUPPOSED to get reimbursed! I had been told that by several people at BCBS (accent on the BS!), the medical group, and my physicians office!
This person again told me that the policy was only to reimburse the hospital after they submitted the proper documentation. That person refused to even look at my referral.
At that point, I had a proper and satisfying meltdown. I yelled at them that they were an idiot and I wanted to speak with their supervisor!
After a few minutes I was put in contact with the supervisor and I explained the situation again.
This time, the person actually reviewed the case and said that actually everything seemed in order. My referral was proper, and my documentation was complete. She thought it was just a matter of examining the data and making a determination who would pay what.
I started sobbing on the phone. I was so relieved to get even that response that I lost all control. The lady said that she would review the information and would be getting back to me. She even gave me her direct line so that I wouldn’t get ear calluses wading through the phone menu.
I thanked her profusely and hung up, feeling more relieved than I had in several weeks.
A few days later, the lady from the medical group did call me back and said that she had to contact the surgeon, hospital, and anesthesiologist but she had all the information she needed. She said that there would be two checks sent out. One would come from the medical group, which would pay for the surgeon, and the other would come from BCBS who would be paying for the hospital stay and the anesthesia.
By this time my spirits were lifting considerably.
A few days following that, I did receive a check from the medical group. After waiting another few days, I still had not received the check from BCBS. I was starting to get worried that they would renege on their agreement. I called the lady at the medical group back and asked if she had heard anything. She said no but would check into it.
No sooner had I hung up from her, I got a call from the billing department at the hospital where I stayed.
She told me that BCBS had sent them a check for my bill. She said that she would personally walk the check over to Accounts Payable and have them cut me a check that very day!
I was over joyed!
However after several more days I still had not received the check. I call the lady at the hospital back and asked if she had heard anything. She checked with AP and the said that they had FedEx’d the check and it was recorded as delivered!!! (A signature had not been asked for)
Arrgghh!!! Scream!! Cry!!! Arrgghh!!! Scream!! Cry!!! Arrgghh!!! Scream!! Cry!!!
In all my years of using FedEx and other services, I had never had a lost item. Why did it have to happen with this one!!!! I felt that I was being toyed with by the fates. It seemed that I had to keep leaping to get to my goal, but it would be pulled out of my reach at the last moment. This last twist to this really had me undone.
I told them that I had not received it and that they should put a stop on the check and could they send out another? (Pretty please???)
The nice lady and her partner at AP said that they would overnight the check to me and require a signature.
The next morning, finally, the replacement check arrived. I was so relieved!
I just deposited it this morning, and bring to a close this last major chapter of my transition from man to woman.
It has been a very short time for me since I started down the path to confirm my true nature. I have been truly blessed by the way my transition has gone. My family loves me, I was not discriminated at work, and the financial needs have been taken care of. Though I do feel that I have had to mortgaged my future to save my present. But in all likelihood I would have probably not lived long enough to enjoy my future were I not to transition.
Just this evening I was sitting at the dining room table with Pat and I was feeling very content. And I looked down at myself then at Pat, and I asked myself what the big deal was. I was finally as much of a woman as far as medical science could make me and I felt so normal that I couldn’t remember what the crisis was when I had male genitals.
Then I thought about having a penis again and I was overcome with revulsion. I guess I really was a transsexual. So many times we wonder if we have made the right decision to transition. I now know I made the right decision!
-Sandy
Ah were that the case. The last few weeks have left me stressed out, anxious, and depressed as ever I have been in my life.
If you have been following my story, you will have read that I was one of the fortunate few whose insurance coverage actually did cover not only my orchiectomy, but also my Gender Confirmation Surgery as well.
You may have also read that while it was “covered” it wasn’t *covered*. Something to do with my insurance company (Blue Cross/Blue Shield HMO of Illinois) not covering cosmetic surgeries, but the only way to list my referral for GCS was as cosmetic. Catch-22. (And why in the world would you list as “cosmetic” something that good girls don’t go around showing off is beyond me!!!)
My doctor, surgeon, and therapists all sent in recommendations that this surgery wasn’t cosmetic, but was a life saving operation. And only after my doctor talked to the insurance company directly and submitting over three hundred pages of notes and documentation, that the insurance company relented and approved my referral.
But since the operation was out of network, I had to pay for it upfront, then, I was assured, I would be reimbursed. I proceeded to take out a loan with near loan shark rates assuming that the interest rate wouldn’t matter that much since I would be paying it off in a reasonably short period of time after I received my reimbursement.
Ok, let’s fast forward through my trip, surgery, and return. It’s posted on the blog for those who want to relive those wonderful days with me. (I still recall the moment my plane took off for Philadelphia with a wistful fondness.)
Ok, back home and now trying to put my life back on track after a two year process to change every part of my being. One of the details was to start submitting the paperwork to the insurance company to get my reimbursement.
I contacted the person at BCBS about submitting the required information. I was told that there was a form on the website and that I should fill it out and submit that and the relevant invoices to the insurance company.
I did that and didn’t hear anything for a few weeks. I called and after going through the usual mind numbing phone menu and being put on hold so long that I actually started liking the musak that was playing in the background and could recite all the phone-on-hold commercials by heart… backward.
I finally talked with someone and they said that the documentation that was submitted was not complete. They required an itemized invoice including standardized procedural codes and diagnostics.
Ok.
I called the surgeons office and contacted someone from admin. Fortunately the also had been contacted by the insurance company and they had requested the same things. But I would have to contact the hospital to get that information as well as the anesthesiologist.
Ok.
I worked through this process over the next few weeks. Regularly contacting the insurance people as well as the billing and admin people at the surgeon’s office, the hospital and the anesthesiologist.
I then receive a note from BCBS stating that my claim wasn’t covered because they do not cover GCS.
Arrgghh!!! Scream!! Cry!!!
I contact the insurance people and they tell me that the never covered that surgery and even though I had a proper referral it wasn’t BCBS’s responsibility to pay it. I was welcome to contact the medical group to see if they would pay for it, but their responsibility was at an end.
Arrgghh!!! Scream!! Cry!!! Arrgghh!!! Scream!! Cry!!!
After I dried my eyes, actually the tears ran out. I contacted the medical group.
I then had to go through the exact same submission of documentation that I went through with BCBS.
Following that, I was told that even though I submitted the proper information I would not be reimbursed. The medical group only reimburses the hospital and they should have submitted the information directly to them in the first place.
With a calm and demeanor rivaling that of Job, I explained to this person that I had been told that I HAD to pay for it out of pocket since it was out of network and that I was SUPPOSED to get reimbursed! I had been told that by several people at BCBS (accent on the BS!), the medical group, and my physicians office!
This person again told me that the policy was only to reimburse the hospital after they submitted the proper documentation. That person refused to even look at my referral.
At that point, I had a proper and satisfying meltdown. I yelled at them that they were an idiot and I wanted to speak with their supervisor!
After a few minutes I was put in contact with the supervisor and I explained the situation again.
This time, the person actually reviewed the case and said that actually everything seemed in order. My referral was proper, and my documentation was complete. She thought it was just a matter of examining the data and making a determination who would pay what.
I started sobbing on the phone. I was so relieved to get even that response that I lost all control. The lady said that she would review the information and would be getting back to me. She even gave me her direct line so that I wouldn’t get ear calluses wading through the phone menu.
I thanked her profusely and hung up, feeling more relieved than I had in several weeks.
A few days later, the lady from the medical group did call me back and said that she had to contact the surgeon, hospital, and anesthesiologist but she had all the information she needed. She said that there would be two checks sent out. One would come from the medical group, which would pay for the surgeon, and the other would come from BCBS who would be paying for the hospital stay and the anesthesia.
By this time my spirits were lifting considerably.
A few days following that, I did receive a check from the medical group. After waiting another few days, I still had not received the check from BCBS. I was starting to get worried that they would renege on their agreement. I called the lady at the medical group back and asked if she had heard anything. She said no but would check into it.
No sooner had I hung up from her, I got a call from the billing department at the hospital where I stayed.
She told me that BCBS had sent them a check for my bill. She said that she would personally walk the check over to Accounts Payable and have them cut me a check that very day!
I was over joyed!
However after several more days I still had not received the check. I call the lady at the hospital back and asked if she had heard anything. She checked with AP and the said that they had FedEx’d the check and it was recorded as delivered!!! (A signature had not been asked for)
Arrgghh!!! Scream!! Cry!!! Arrgghh!!! Scream!! Cry!!! Arrgghh!!! Scream!! Cry!!!
In all my years of using FedEx and other services, I had never had a lost item. Why did it have to happen with this one!!!! I felt that I was being toyed with by the fates. It seemed that I had to keep leaping to get to my goal, but it would be pulled out of my reach at the last moment. This last twist to this really had me undone.
I told them that I had not received it and that they should put a stop on the check and could they send out another? (Pretty please???)
The nice lady and her partner at AP said that they would overnight the check to me and require a signature.
The next morning, finally, the replacement check arrived. I was so relieved!
I just deposited it this morning, and bring to a close this last major chapter of my transition from man to woman.
It has been a very short time for me since I started down the path to confirm my true nature. I have been truly blessed by the way my transition has gone. My family loves me, I was not discriminated at work, and the financial needs have been taken care of. Though I do feel that I have had to mortgaged my future to save my present. But in all likelihood I would have probably not lived long enough to enjoy my future were I not to transition.
Just this evening I was sitting at the dining room table with Pat and I was feeling very content. And I looked down at myself then at Pat, and I asked myself what the big deal was. I was finally as much of a woman as far as medical science could make me and I felt so normal that I couldn’t remember what the crisis was when I had male genitals.
Then I thought about having a penis again and I was overcome with revulsion. I guess I really was a transsexual. So many times we wonder if we have made the right decision to transition. I now know I made the right decision!
-Sandy
