What I have in my hands! It's PRICELESS! I just got the letter from my insurance stating that "based on the information received from your treating health care professional(s), _______ has determine that service(s)/care that you requested below on ________ is medically necessary."
It then goes on to say that to keep all parties informed they have notified my surgeon and the big name insurance of the decision.
Then after some more blah, blah, blah it says,
"Upon Recosideration, information justifies acute care admission for your genital/urological surgery for post-operative care."
So basically I am approved to have surgery AND approved to stay in the hospital post op since in the initial letter I got from these crazy people they basically said " We will approve surgery but you dont need to stay in the hospital post op."
It has the surgeon's name, my name, my insurance companies name, the hospital name where I am having surgery and then Tentative date.
This letter is MONEY! *Does happy dance*
Monday, June 14, 2010
Progress- Goal reevaluation June 13th, 2010
I posted this in a journal ealier this year. I decided to repost it showing appropriate corrections. I am soooo happy I have achieved so much so far for 2010.
January 19th, 2010- My wife and I got to meet our daughter.
January 22nd, 2010- Our Daughter came to my wife and I.
February 1st, 2010- Hysto Consult (Surgeon agreed to do my hysto I just need full clearance since I was in the hospital for 2 weeks back in December ).
February 7-9th, 2010- Contacted Several bottom surgeons to get most recent price Quotes and SERIOUS discuss surgical planning
February 16th,2010- Submitted insurance request with one surgeon for a meta
Febrarury 26th,2010- (PENDING) Followed up with specialist regarding me being sick back in December, 2009 and hopefully get got clearance for hysto and bottom surgery.
March 8th, 2020(PENDING)- Followed up with GYN re my hysto and set a solid surgical date (contingent upon me getting clearance on February 26th, 2010) Date set for April 6th, 2010.
March 16th, 2010(PENDING)- Wanted to have an answer from bottom surgeon whether I got prior Authorization from insurance for my metoidioplasty.
*Update- Answer as not received by this date things were still pending
Between March 16th,2010 and April 30th,2010 (PENDING)- Get my Hysto
April 6th,2010- Got my Hysto. *Happy dance*
April 7th,2010- Heard back from Surgeon's office regarding prior Authorization more info needed.
Between August 2010 and December 31st (PENDING)- Get my meta (if insurance covers it I will do it closer to August. If not then closer to December).
Insurance Decided to pay so I will be getting my meta in August 2010! *Another happy dance!*
I'm getting there slowly but surely! I am so happy I have one more goal on my list that I wanted to acheive!
With all of that out of the way I need some new goals
Some ideas are:
-Get a Driver's License (I live in a big city with good public transportation there was no need to drive)
-Save more for a house
-Complete my MBA program
-Build my organization more and take it to the "next" level
January 19th, 2010- My wife and I got to meet our daughter.
January 22nd, 2010- Our Daughter came to my wife and I.
February 1st, 2010- Hysto Consult (Surgeon agreed to do my hysto I just need full clearance since I was in the hospital for 2 weeks back in December ).
February 7-9th, 2010- Contacted Several bottom surgeons to get most recent price Quotes and SERIOUS discuss surgical planning
February 16th,2010- Submitted insurance request with one surgeon for a meta
Febrarury 26th,2010- (
March 8th, 2020
March 16th, 2010
*Update- Answer as not received by this date things were still pending
April 6th,2010- Got my Hysto. *Happy dance*
April 7th,2010- Heard back from Surgeon's office regarding prior Authorization more info needed.
Insurance Decided to pay so I will be getting my meta in August 2010! *Another happy dance!*
I'm getting there slowly but surely! I am so happy I have one more goal on my list that I wanted to acheive!
With all of that out of the way I need some new goals
Some ideas are:
-Get a Driver's License (I live in a big city with good public transportation there was no need to drive)
-Save more for a house
-Complete my MBA program
-Build my organization more and take it to the "next" level
Friday, June 11, 2010
Logistics of surgery
I am still on cloud 9 after getting surgery approved and officially having a surgery date!
HOWEVER I still need to work out the logistics like booking a hotel, booking a flight. Getting my medical leave forms in so I get PAID while I'm out. I also need to figure out how much time I am going to even have to be out for.
Time to get that paperwork done!
HOWEVER I still need to work out the logistics like booking a hotel, booking a flight. Getting my medical leave forms in so I get PAID while I'm out. I also need to figure out how much time I am going to even have to be out for.
Time to get that paperwork done!
Tuesday, June 8, 2010
Im so happy I can cry!- June 8th, 2010
After much calling, praying, more praying and more calling I got THE call today. Stating that the surgeons office got the letter stating that I will be able to get surgery and wont have to pay $11,000 up front. The surgery is in a few weeks and I only need $2000 to be set. I am SOOOO happy I could cry.
Thanks to all the guys (and gals) who kept me in their prayers, sent good vibes and wished me well. I plan to pay it forward when I am done.
Thanks to all the guys (and gals) who kept me in their prayers, sent good vibes and wished me well. I plan to pay it forward when I am done.
One step closer to lower surger- June 6th update
A few days ago I posted here about my journey so far with insurance and getting lower surgery covered.
Well my latest update is really AWESOME. While I was at the Philly Conference I got a call from the Surgeon's insurance person saying that I may not have to pay as much as I originally thought. She is waiting to talk to some people then will get back to me.
Fastward to today.
I spoke to the woman from the Surgeon's office and she stated that the Surgeon and the Hospital is covered by a Small ass insurance and they have contracts with BIG NAME INSURANCES and one of the BIG NAME INSURANCE companies has a contract with my WHACK ASS INSURANCE. After calling around and speaking to some folks she was able to verify that under this random chain of contracts that the surgeon is In Network with my WHACK ASS INSURANCE. This means that I will only have to pay the co-pays and/or deductibles which last I checked for my insurance are $0 which is right in my price range!
Today the woman from the claims department for my insurance also called (The one I made nice with) and stated that the matter was being resolved and someone should call me soon. The person who was supposed to call me called about and hour later stating the same thing about "How the surgeon is used to working with Small ass insurance and they have contracts with BIG NAME INSURANCES and one of the BIG NAME INSURANCE companies has a contract with my WHACK ASS INSURANCE." She stated that they contacted Small ass insurance who should be contacting the surgeon's office to give the exact rates that BIG NAME INSURANCE uses which will be what my WHACK ASS INSURANCE will honor.
I had a date for sooner and one for later in mind. I officially took the later date while waiting for this matter to be resolved but now that things seems to be a go I plan to utilize the sooner date which means I need to start pumping to prepare for my surgery which may be in the next 2-3 months!
After all is said and done I plan to share more details regarding the surgeon and the insurance companies. While going through this I feel more comfortable not posting all the details on the net about the companies just yet.
I am doing the biggest happy dance EVER!
Cris
Well my latest update is really AWESOME. While I was at the Philly Conference I got a call from the Surgeon's insurance person saying that I may not have to pay as much as I originally thought. She is waiting to talk to some people then will get back to me.
Fastward to today.
I spoke to the woman from the Surgeon's office and she stated that the Surgeon and the Hospital is covered by a Small ass insurance and they have contracts with BIG NAME INSURANCES and one of the BIG NAME INSURANCE companies has a contract with my WHACK ASS INSURANCE. After calling around and speaking to some folks she was able to verify that under this random chain of contracts that the surgeon is In Network with my WHACK ASS INSURANCE. This means that I will only have to pay the co-pays and/or deductibles which last I checked for my insurance are $0 which is right in my price range!
Today the woman from the claims department for my insurance also called (The one I made nice with) and stated that the matter was being resolved and someone should call me soon. The person who was supposed to call me called about and hour later stating the same thing about "How the surgeon is used to working with Small ass insurance and they have contracts with BIG NAME INSURANCES and one of the BIG NAME INSURANCE companies has a contract with my WHACK ASS INSURANCE." She stated that they contacted Small ass insurance who should be contacting the surgeon's office to give the exact rates that BIG NAME INSURANCE uses which will be what my WHACK ASS INSURANCE will honor.
I had a date for sooner and one for later in mind. I officially took the later date while waiting for this matter to be resolved but now that things seems to be a go I plan to utilize the sooner date which means I need to start pumping to prepare for my surgery which may be in the next 2-3 months!
After all is said and done I plan to share more details regarding the surgeon and the insurance companies. While going through this I feel more comfortable not posting all the details on the net about the companies just yet.
I am doing the biggest happy dance EVER!
Cris
Philadelphia Trans Health conference- My feelings
It was AWESOME!
I got to meet people I have been talking to online for years! I also got to catch up with some friends and acquantances.
The workshops I attended were awesome. I am proud of the turn out for the workshops I did.
I officially am planning to do a lower surgery show and tell next year and plan to start drumming up guys willing to participate from NOW. I plan to be able to have something to "SHOW" by then. ( I will talk about that in another blog).
I realized how much I impact peoples lives. I met several guys for the first time who I have helped via the net. One guy got emotional which made me get emotional but I held back my need to get teary eyed due to there being over 1000 random people walking around (and probably because T makes it almost impossible for me to cry anyway!)
I am excited that the "To Be stealth or not to be stealth" workshop had a HUGE turn out. By huge I mean over 94 people were in ONE ROOM! It was crazy and beautiful at the same time.
The "Finding affordable ways to transition" workshop also had a good turnout despite being put at 8:30AM.
I left feeling like it was the best PTHC I have ever been too. This weekend did give me a sense of "community" and I think that had to do with the people that were there.
I got to meet people I have been talking to online for years! I also got to catch up with some friends and acquantances.
The workshops I attended were awesome. I am proud of the turn out for the workshops I did.
I officially am planning to do a lower surgery show and tell next year and plan to start drumming up guys willing to participate from NOW. I plan to be able to have something to "SHOW" by then. ( I will talk about that in another blog).
I realized how much I impact peoples lives. I met several guys for the first time who I have helped via the net. One guy got emotional which made me get emotional but I held back my need to get teary eyed due to there being over 1000 random people walking around (and probably because T makes it almost impossible for me to cry anyway!)
I am excited that the "To Be stealth or not to be stealth" workshop had a HUGE turn out. By huge I mean over 94 people were in ONE ROOM! It was crazy and beautiful at the same time.
The "Finding affordable ways to transition" workshop also had a good turnout despite being put at 8:30AM.
I left feeling like it was the best PTHC I have ever been too. This weekend did give me a sense of "community" and I think that had to do with the people that were there.
Tuesday, June 1, 2010
Lower surgery Update- June 1st,2010 and some other stuff.
Well today was a BIG day! I got my surgery date! *Does happy dance!* Only thing is that it was bitter sweet because the surgeon's assistant was willing to give me a surgery date that was closer which is what I really wanted. It would have worked out to be a date either within 2 days of my B-day or a week after my B-day. Unfortunately since I am still waiting for the insurance payment stuff to be figured out I decided to be safe and schedule for early 2011 (No, I am not telling the date yet!)
I did look into possibly getting a medical loan but that is not a feasable option for me right now but who knows I may explore it if other things don't work out.
Since the surgeon's already explicitly told me that they would adjust how much I have to pay based on what my insurance agrees to pay as the rate. I am even more committed to getting this rate in writing and to my surgeon's office.
My insurance isnt BIG NAME INSURANCE BUT when I am outside of my area It rolls over to BIG NAME INSURANCE in a way so I use BIG NAME INSURANCE providers (which this surgeon is) AND my insurance pays the BIG NAME INSURANCE rate. Since my insurance isnt directly BIG NAME INSURANCE that is what makes getting the rate trickier because usually when someone uses an BIG NAME INSURANCE provider they just pay the BIG NAME INSURANCE rate after the fact and if they don't know the rate they ask at that time.
Lucky for me I made nice with the Associate Director of Claims when I was waiting for my prior Authorization a few weeks back and I called her to ask how I go about resolving this matter. I explained that I need the rates or I have to pay upfront. She was upset not with me but at the fact that the rate was holding things up. She sent an email to whoever manages the linkage agreement between my primary insurance and BIG NAME INSURANCE.
I was told that they will make sure to get those rates to either me or my surgeon. If that happens then I will be good to go!
Since surgery is really in the works and almost set I decided to have a conversation with my Mother about this. My Mother in the beginning of my transition process was very Anti- medical transition. Since top surgery she has made a lot of progress but I wasn't sure if this would be too much for her. I called her and told her that I am planning surgery for my "basement" (My Grandmother's term for genital region). My Mother was very calm and mellow. She asked a few questions. She was timid at first then said that since we were at a good place in our relationship she didn't want to ask me anything to make me feel uncomfortable. She is in the medical feild so I explained it to her in medical terms and that made it easier for her. I told her ask anything that she wants and if it is "too much" I will let her know. She asked a few more questions about "function" and she was actually surprised that I wasn't getting a Phalloplasty (Once I explained to her the difference between a phallo and a meta). I did leave the door open to let her know that I am getting a meta for now BUT if for some reason I do not feel complete AND/or technology changes I can still get the Phallo in the future. She basically said, "It's good to leave your options open and you are young too!"
I went into the conversation feeling nervous not knowing what she would say or if she would try and talk me out of it. That was not the case. She wanted to get info on the surgery that I was getting, the surgeon I chose (probably so she could check credentials. That is something my Mother would do), She even asked if I would need anything. I dont want to ask her for the money because I want to be an adult about this BUT if things are getting close I am open to seeing if she will co-sign a loan if needed.
I did invite her to come. I thought she would be nervous or not want to but she was excited and honored that I would want her to be part of such a huge thing. She is already "planning" to take Family Medical Leave and help out where needed.
I am excited too. Today was a GREAT day!
I did look into possibly getting a medical loan but that is not a feasable option for me right now but who knows I may explore it if other things don't work out.
Since the surgeon's already explicitly told me that they would adjust how much I have to pay based on what my insurance agrees to pay as the rate. I am even more committed to getting this rate in writing and to my surgeon's office.
My insurance isnt BIG NAME INSURANCE BUT when I am outside of my area It rolls over to BIG NAME INSURANCE in a way so I use BIG NAME INSURANCE providers (which this surgeon is) AND my insurance pays the BIG NAME INSURANCE rate. Since my insurance isnt directly BIG NAME INSURANCE that is what makes getting the rate trickier because usually when someone uses an BIG NAME INSURANCE provider they just pay the BIG NAME INSURANCE rate after the fact and if they don't know the rate they ask at that time.
Lucky for me I made nice with the Associate Director of Claims when I was waiting for my prior Authorization a few weeks back and I called her to ask how I go about resolving this matter. I explained that I need the rates or I have to pay upfront. She was upset not with me but at the fact that the rate was holding things up. She sent an email to whoever manages the linkage agreement between my primary insurance and BIG NAME INSURANCE.
I was told that they will make sure to get those rates to either me or my surgeon. If that happens then I will be good to go!
Since surgery is really in the works and almost set I decided to have a conversation with my Mother about this. My Mother in the beginning of my transition process was very Anti- medical transition. Since top surgery she has made a lot of progress but I wasn't sure if this would be too much for her. I called her and told her that I am planning surgery for my "basement" (My Grandmother's term for genital region). My Mother was very calm and mellow. She asked a few questions. She was timid at first then said that since we were at a good place in our relationship she didn't want to ask me anything to make me feel uncomfortable. She is in the medical feild so I explained it to her in medical terms and that made it easier for her. I told her ask anything that she wants and if it is "too much" I will let her know. She asked a few more questions about "function" and she was actually surprised that I wasn't getting a Phalloplasty (Once I explained to her the difference between a phallo and a meta). I did leave the door open to let her know that I am getting a meta for now BUT if for some reason I do not feel complete AND/or technology changes I can still get the Phallo in the future. She basically said, "It's good to leave your options open and you are young too!"
I went into the conversation feeling nervous not knowing what she would say or if she would try and talk me out of it. That was not the case. She wanted to get info on the surgery that I was getting, the surgeon I chose (probably so she could check credentials. That is something my Mother would do), She even asked if I would need anything. I dont want to ask her for the money because I want to be an adult about this BUT if things are getting close I am open to seeing if she will co-sign a loan if needed.
I did invite her to come. I thought she would be nervous or not want to but she was excited and honored that I would want her to be part of such a huge thing. She is already "planning" to take Family Medical Leave and help out where needed.
I am excited too. Today was a GREAT day!
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