Getting surgery approved, one subtask at a time.

(Content warning and top notes: I go into detail about the insurance process as well as a breaking down a few of the steps for vaginoplasty—well more the medical coding rather than the surgery itself, but still.)

You would think that planning for major surgery—especially one that requires three months of downtime—would require a bit of preplanning for things like payment, recovery care.

You’d be right, it does. But the entire system set up to approve, cover, and pay for surgery is not at all conducive to it.

Because that would be smart. It would make sense. Something that is totally against everything the US’s profit-driven medical system is set up for. So if you stumble across this blog because you’re trying to figure out what navigating the whole process is like, this post is for you.

A couple weeks ago, I got a letter from my insurance company saying that surgery hadn’t been approved yet. I was pretty shocked since I thought Mount Sinai (where I’m getting surgery), had already submitted everything months ago to get pre-approval for hair removal and such.

Instead, approval is happening one subtask at a time. And I get a letter from my insurance company for each step: removal of the testes, skin graft (but no more than 20cm), muscle flap. Not yet approved: creating the vaginal canal, nor the hospital stay itself.

I’m not worried, Mt. Sinai knows what they’re doing, most of the approvals go through in the month leading up to surgery, so in many ways, this is to be expected. It’s just a little harrowing. It’s also kind of hard to plan for all the support you need when home care (at-home nurse visits) doesn’t get approved until the last couple weeks.

But at the end of the day, it’s a reminder that transitioning is a personal decision—one that is only between you and your doctors and your insurance company and state legislators.

Twenty days to go. I’ve got labs on Tuesday and have stopped all NSAIDS, alcohol, and supplements as well.


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