Box 3 of the CMS-1500 claim form

[Tallulah]

I use SimplePractice as my electronic medical record software. They have two boxes in the demographic form, one for sex and one for gender. The sex option has male, female, and prefer not to say. Given that I work with individuals of all sexes, I asked them to add intersex as an option. They said that the Sex field is a dropdown used to populate Box 3 of the CMS-1500 claim form, and that it cannot include intersex because insurance payers only accept Male or Female values in that box. I emailed the white house asking for them to add intersex as an option, and am working on sorting through the CMS and HHS websites to find people to contact to ask them as well. Anyone else interested in helping with my project? It seems to me like the right time to try. (Or, alternatively, if you think this doesn't matter and I should stop trying, I would also like that opinion.) Thanks for your responses.

 

[Linde]

I found a similar problem when I wanted the surgery. I had to be diagnosed to be transsexual, and had to have genital dysphoria. Intersex seems not to ve existing for any procedure.

Hugs
Linde

 

[Madrhode]

I am licensed in exactly this medical billing and coding. I would love to lend my recently obtained knowledge to this fight because intersex is one thing and also I want to include another designation if you have it allows you access to male and female procedures with out having to add extra submissIon paperwork.

 

[Tallulah]

I haven't done anything with it yet other than sending a letter to the white house. I feel like I could write a pretty clear and persuasive note to the people who would have the power to change this if I knew who they were/how to get in touch with them. Fiona took a look at the CMS's website but what she sent me didn't have a clear contact person.

 

[Madrhode]

I want to answer properly but I just spent two hours fighting a scanner to upload my surgery paperwork and passed my work night bed time so tomorrow I got you Chica

 

[Tallulah]

Thank you.

 

[Madrhode]

So to answer your question there is almost no way you could change it alone. The CMS is the coding guidelines that are decided on by the insurance company’s basically and the largest being Medicare/Medicaid/ tricare which while not a company is the largest insurer in the country which of course is our government. Since Medicare/Medicaid/tricare is the most wide spread and forces it guidelines to fill out the cms 1500 the entire US based insurers use CMS 1500 as the standard. So you would have to convince Medicare/medicaid/tricare to adopt it as their new standard which in turn would drive all other US insurers to follow suit. How do you change this? It’s going to take legislation. The most recent overhaul was the affordable care act and hi tech act and that requires congress and president. So Biden is a start but we need it widespread and tons of fronts to all our congress members to get this changed and though nearly impossible it could be done but we need to be United. Some states are locally adding it there medical laws but it still doesn’t affect CMS 1500 and certainly will not affect texas for a long time.

 

[Linde]

And as a Medicare member, I discovered that change is very slow. It for sure requires a political act. I think covering GRS was added during the Obama years, but the coverage still gets decided case by case upon an application.
Everything else, like BA, facial surgery, and even facial hair removal is considered to be of cosmetic nature. Nothing wrong with that woman with a full beard!

Hugs
Linde

 

[Tallulah]

Well, if it's going to take a political act we're more likely to get that now than in the past.

 

[Tallulah]

I received this comment on a response elsewhere: "Please bear in mind that intersex is not a legal sex. It is a status. The intersex community is debating between a preference to still put a binary sex on the birth certificate vs leaving it blank."

This is confusing to me. How is limiting individuals to male, female, or no answer a solution? Thanks for y'alls feedback. Happy to learn and appreciate responses

 

[Linde]

Well that is the problem intersex people in the US have. Intersex in many European countries is considered to be a third gender option like other or divers. An intersex person in Germany can determine by themselves which of the 3 gender ID they want to have.

Her in the US I had to be diagnosed to be transsexual to get my surgery, and my ID changed. We are not officially existing as a individual gender in this country. We just have some biological abnormalities like any other person with a birth defect.
Just as a side line, there is no real intersex community in the US, there are some intersex people who are self declared advocates, and act like the spokespersons for the rest of us, who are not as noisy. It is mostly younger persons who still have enough fighting spirit in them.

One of the problems is that most health insurance plans do not pay for the rather expensive testing of people like I, and many of us don't even know that they are intersex, or don't know which exact syndromes they. For example for my case, to know exactly what I have in detail, a genetic test would have to be made, and that would cost me about $7000, and no insurance will cover the cost. Up until now I paid abut $2000 out of pocket to know about myself as much as I currently do. Most intersex persons can't even afford to spend that much. The result is that we might get the wrong medical treatment, or no treatment at all.
Being born intersex is still something that is hushed about like for a cleft lip or other disfiguring birth defects.
I can tell you, it sucked a lot growing up as an intersex kid/youth, because I looked clearly different that the other male kids, of who was supposed to be one.
I for one, am a very happy woman these days, because I finally have my chromosomes and my body and mind all in tune with each other, and I can live the life I should have lived all the time.
But I can speak only for myself, because every other intersex persons may feel different about their syndromes, and several, specifically the younger ones, fell pretty happy not to decide for one of the two genders, and continue to live in the middle between the two genders, while I dream of a life as a simple cis gender woman.

Hugs
Linde

 

[Tallulah]

Well that is the problem intersex people in the US have. Intersex in many European countries is considered to be a third gender option like other or divers. An intersex person in Germany can determine by themselves which of the 3 gender ID they want to have.

Her in the US I had to be diagnosed to be transsexual to get my surgery, and my ID changed. We are not officially existing as a individual gender in this country. We just have some biological abnormalities like any other person with a birth defect.
Just as a side line, there is no real intersex community in the US, there are some intersex people who are self declared advocates, and act like the spokespersons for the rest of us, who are not as noisy. It is mostly younger persons who still have enough fighting spirit in them.

One of the problems is that most health insurance plans do not pay for the rather expensive testing of people like I, and many of us don't even know that they are intersex, or don't know which exact syndromes they. For example for my case, to know exactly what I have in detail, a genetic test would have to be made, and that would cost me about $7000, and no insurance will cover the cost. Up until now I paid abut $2000 out of pocket to know about myself as much as I currently do. Most intersex persons can't even afford to spend that much. The result is that we might get the wrong medical treatment, or no treatment at all.
Being born intersex is still something that is hushed about like for a cleft lip or other disfiguring birth defects.
I can tell you, it sucked a lot growing up as an intersex kid/youth, because I looked clearly different that the other male kids, of who was supposed to be one.
I for one, am a very happy woman these days, because I finally have my chromosomes and my body and mind all in tune with each other, and I can live the life I should have lived all the time.
But I can speak only for myself, because every other intersex persons may feel different about their syndromes, and several, specifically the younger ones, fell pretty happy not to decide for one of the two genders, and continue to live in the middle between the two genders, while I dream of a life as a simple cis gender woman.

Hugs
Linde

I'm so sorry Linde. US healthcare sucks. Reading your story reaffirms that the situation is not tenable. I would like to help.

 

[Linde]

I'm so sorry Linde. US healthcare sucks. Reading your story reaffirms that the situation is not tenable. I would like to help.

I know that you would, but nobody really knows where to start any changes. it is nothing else than a good old run around. As long ass politicians treat us as if we are non existent the best, or product of the devil, nothing will change. I have to say it is mostly the evangelical side, who considers us to be monstrosities that need to be eradicated, nothing will change.

Hugs
Linde