10 ways to pay for SRS | part 1 | Tara's Transgender Resources

10 Ways to Pay for SRS
Sometimes without your own money!

Sex reassignment surgery: the ultimate goal of a trans person. Most surgery is expensive and SRS is no exception. Even the cheapest in Thailand is going to cost thousands of dollars after airfare, hotel and miscellaneous expenses. Unfortunately, many of us don't have well-paying jobs, graduate degrees, savings or the ability to borrow that kind of money; some are disabled and unable to work.

How can we get something we want more than the world?

1. Insurance. Most US insurance companies have exclusions for gender identity related procedures, claiming SRS is "cosmetic," "elective" or "experimental." However, some insurance companies pay for SRS. Check your insurance manual, or HR, to see if gender identity procedures and medications are excluded.

In the case, Victoria L. Davidson vs. Aetna Life & Casualty Insurance Co. (1979), the New York supreme court declared that sex reassignment surgery was not cosmetic, but was medically necessary, forcing Aetna Insurance to cover a trans person's SRS. The crux of the plaintiff's evidence was a statement from her doctor stating that SRS was medically necessary. You may be able to use this ruling as supporting evidence if your insurance has refused to pay and you want to appeal, or go to court. Try to find a sympathetic lawyer who will take your case pro bono especially if he, or she, is transgender. I believe some insurance in New York (public/private) will cover SRS.

There are ways to get around insurance exclusions. Sometimes hormones will be covered if your doctor uses hormone imbalance, or some other non-gender identity related, diagnosis. Gender identity counseling can be often covered if your therapist uses an anxiety or adjustment disorder diagnosis code.

This is from Blue Cross/Blue Shield: "Our Medical Affairs Department indicated that it is generally accepted among professionals that an adult with gender identity disorder who experiences anxiety and stress as a result of the disorder should be treated. Mental health services billed with an anxiety or adjustment disorder diagnosis code would be covered under the mental health benefits available on the plan."

Free hormones. You can sometimes get free hormones from a doctor by asking for samples. Doctors often get free samples from drug manufacturers. I once was given a grab bag of different types of estrogen from a doctor that lasted for months!

Some provinces in Canada (I believe Alberta does) pay for SRS, but from what I understand it's becoming more difficult. It also may be difficult to become a Canadian citizen if you don't live there. If you want to try. There are websites that have information and how to apply. Check for the provinces that still pay for SRS.

So far, I haven't heard of anyone having SRS (other than mastectomy for the FTM) covered by Medicare. They claim SRS is "experimental":

"35-61 TRANSSEXUAL SURGERY Transsexual surgery, also known as sex reassignment surgery or intersex surgery, is the culmination of a series of procedures designed to change the anatomy of transsexuals to conform to their gender identity. Transsexuals are persons with an overwhelming desire to change anatomic sex because of their fixed conviction that they are members of the opposite sex. For the male-to-female, transsexual surgery entails castration, penectomy and vulva-vaginal construction. Surgery for the female-to- Rev. 131 35-62 COVERAGE ISSUES - MEDICAL PROCEDURES 11-00 male transsexual consists of bilateral mammectomy, hysterectomy and salpingo-oophorectomy, which may be followed by phalloplasty and the insertion of testicular prostheses. Transsexual surgery for sex reassignment of transsexuals is controversial. Because of the lack of well controlled, long term studies of the safety and effectiveness of the surgical procedures and attendant therapies for transsexualism, the treatment is considered experimental. Moreover, there is a high rate of serious complications for these surgical procedures. For these reasons transsexual surgery is not covered."

As with any insurance denial, I recommend appealing the decision and, if all your administrative options are exhausted, file a suit in court!

Medicaid is increasingly covering SRS!

If you checked out the link above, then you read the story of a FTM who forced Medicaid to cough up over $80k for his gender surgeries! I recommend following his path and trying to have Medicaid cover your surgery, just as any medically-necessary procedure. If denied, use all your appeal processes then go to court, if necessary. Don't just stop at the first denial. Again, the court system was set up for the purpose of challenging unethical business practices!

Update! - Harold Reed no longer offers SRS funding program

I received the following from Dr. Reed on July 15, 2009:

This is to advise you that we have not been able to offer grants, which had been solely based upon testicular donation, for over 2 years. That project was concluded by the research lab.

We do offer individual consideration for needy people only. However, without any contingency funds to cover the unexpected, we cannot operate. A financial statement may be requested.

Thank you for referring the many nice patients who have made inquires, some of whom we have been able to assist.

As is, our fees run about 6000 below what other charge in North America if that is of any help. Unless you have an impulsive need for genital ablation, please select a doctor whose work is pleasing to you and who may respond to your request for assistance (circumstances change for us all, for example some doctor may have a cancellation and be willing to fill that time slot for less).

Harold M. Reed, M.D.

Medica insurance in Minnesota covers SRS, hormones and gender identity counseling. If you don't live in the Minneapolis / St. Paul area this requires moving there and either finding a job that has Medica or buying the insurance yourself. But if it gets your surgery, why not?

Medica Insurance: Adult Reassignment Surgery, Utilization Management Policy

I've heard from a source that Minnesota's state assistance covers SRS, but (according to the source) you have to be on HRT, or seeing a therapist before 7/1/98. Contact Minnesota's social services to find out what their current policies are.

As said in the introduction, Medi-Cal in the San Francisco area (and perhaps other areas) covers SRS. However, I've heard reports that people are having difficulty finding doctors who accept Medi-Cal. If anyone has more info about this I'd appreciate emailing me.

2. Work. If you're able to work and make good money this should be a no-brainer. Yet some people say they can't get a job or are just too lazy to work their butt off for awhile. When questioned, I usually find out they can't find employment either because of a bad job market in the area or there are few jobs that match their qualifications. If your passability is an issue you may have difficulty finding a job due to discrimination. In these cases the answer is to move somewhere there's a better job market and / or to a trans-friendly area with gender identity anti-discrimination laws. Then I'll hear, "I don't want to sell my house," "I don't want to move where it's cold," etc. Then you don't want your SRS enough.

"I can't afford to move..."

There are usually ways around this. Find someone with garage, basement, or a space where you can store everything but your essentials then drive, take a bus or train, to somewhere with a better job market. When I moved to Portland 20 years ago I had one suitcase with a few changes of clothes, some plates and silverware. I rented a studio apartment before I moved so I'd have a place to live when I got there. The next day I canvassed the city with resumes and got a job in three days. Check the area's job market you're considering and, if you can, find employment before moving.

US Jurisdictions with Laws Prohibiting Discrimination on the Basis of Gender Identity

Barter

Barter is the oldest form of money. You might not be able to pay for SRS through barter, but there are other things, like electrolysis, you may be able to. Does your electrologist have a computer? Can you work on computers or do website design? Does her office and / or house need regular cleaning? I designed a website for one electrologist and cleaned the apartment for another in trade for electrolysis.

the costs of medically-necessary gender identity procedures, i.e. SRS, facial feminization surgery, etc, can be used as tax deductions.

3. Student Financial Aid

If you have a low-paying job that just keeps you afloat most colleges have grants, student loans, assistance programs and scholarships. Contact your local colleges for info. There are other federal sources (see links below). You can take night classes, or day classes if you work at night, and within a year or two (depending on the curriculum) have the skills to find a well-paying job. Both the medical field and computer systems, such as network administrators, pay well. There are specialty schools, like Apollo College, where you can get your tuition paid for by a PELL grant, or student loan, and in a relatively short time be trained for a job. Some of them allow you to work from home, though I'm not sure of their efficacy. I have a friend who's going to nursing school, due to loans and financial aid not a dime out of her pocket has gone to tuition.

Sources for scholarships and student financial aid
FastWeb
Advisory Committee on Student Financial Assistance
GLBT Scholarship Resources
Looking for Student Aid - Federal State and Other Source

4. Start you own business. Do you have a talent or are very knowledgeable about something, or can do physical work? Being self-employed, in my opinion, is the best way to make money. But only if you're motivated. You won't have a boss telling you what to do or a regular paycheck coming in every week or two. Having your own business gives you the freedom to work when you want. It's also easy to avoid paying taxes since there's no paper trail filed by an employer.

Not paying taxes can be risky. The choice to get a business license and pay taxes or work under the government radar is up to you. If your business stays relatively small you can probably avoid paying taxes and not draw much attention. If you do choose to be above board and pay Uncle Sam having your own business means you can deduct business expenses, like supplies, mileage, office, training, most anything within reason. Check with the IRS, or a tax accountant, if you have questions about what's deductible.

There are no secrets to starting a small business

Find a service or product that's needed in your community and offer it. Notice I said need, not want. For example, people who drive cars are going to need gas and repairs. I'm not suggesting opening a gas station, but auto repair is a possibility. Avoid products people may not need (MLM, or network marketing, is notorious for this), like vitamins and herbal supplements.

Write a short ad for your business, post it in publications, have business cards and flyers printed, then wait for customers to call or email you. There are online offers for free color business cards, like Vistaprint - you only pay for shipping. A catchy business title and a well-worded ad are important. Look at ads in your area of expertise for ideas.

I started a housecleaning business, twice, that way. I also ran a business ferrying people, who came to Dr. Meltzer for surgery, back and forth from the airport to the hospital and around town and put people up in a spare bedroom in my home. I charged for boarding as well as $15 per trip (most gave me $20). I got a lot of free meals at nice restaurants when they wanted to get out of the hospital!

I'm now running an eBay business. I put up some flyers around my apartment complex telling people I will sell their unwanted items. I do the photography, listing, collect the money from the winning bidder and ship the items, then split the profits with the owner 50/50.

Don't be concerned if you get no responses to your ad for a few weeks. It takes an ad three weeks before people start seeing it. That's why you see the same advertisements month after month, even year after year. Target your ads to your prospective clientele. The larger the circulation of the publication the more people will see your ad, but they are more expensive. Once you start getting customers, especially if you're good, you'll probably get business through word-of-mouth, too.

The SBA provides loans for businesses. They have special programs for women.

In a few months, my housecleaning ads and word-of-mouth referrals got me more houses than I could handle. When that happens contract out your work by hiring workers. For example, charge the customer a certain rate, say $20 an hour, pay your workers $15 an hour and pocket the profit. Soon you'll have a crew of workers, while you sit back and manage your business. That's where the money is made (I had to quit the business as I'd developed a sensitivity to cleaning chemicals and have back problems).

If you can contract your workers you won't have to deduct taxes, social security, worker's compensation, etc. from their pay. Check with the IRS for current contracting terms. Usually, contractors use their own tools and work on their own schedule, but it's possible to work under the government radar and avoid the BS.

5. Max out credit cards. Establish some credit, get a bunch of cards and spread it across them. Of course, that means either paying back the money or declaring bankruptcy. Bankruptcy ruins your credit for 7 years, but may be worth it to get SRS if there are no other options. If you're considering bankruptcy check with a bankruptcy lawyer first, especially as bankruptcy laws have been tightened.

Some may question the morality of charging SRS on credit cards, then declaring bankruptcy. If you've exhausted all other avenues then this may be a last resort. The reality of the situation is SRS should be covered by insurance and since most doesn't cover it sometimes we have to use Plan B.

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