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TonyaJanelle

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While I am very suspicious that the in-network cost was exactly 50% of my claim, I'm not sure I am going to pursue this further. Half a loaf is better than none.
Yeah, better than what it was. Could be scenarios where its 50%, like if you've met deductible and that procedure is covered at 50%. I got extra lucky when we switched to Aetna since Dr Gast and the UW Hospital are in network. My old insurance UHC, just Dr was.
 

Linde

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and even quoted a recent IRS court decision stating that BAs for treating gender dysphoria in transgender patients are not considered cosmetic procedures and are a deductible medical expense.

~Terri
I wonder if Medicare would accept this, too? Do they set a criteria at which point of development breast augmentation would be paid for, and which amount of breast growth would not be covered anymore?

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Linde
 

Kenna

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His office went one further, and even quoted a recent IRS court decision stating that BAs for treating gender dysphoria in transgender patients are not considered cosmetic procedures and are a deductible medical expense.
Hi Terri, Well done!
Could you provide details of this court decision, and how to access it, please? While we have a totally different system here in Australia, it could be a useful addition to the proposition I'm planning to put to my surgeon - and hopefully the authorities above him.
Thanks,
-Kenna
 

Maybebaby56

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Hi Terri, Well done!
Could you provide details of this court decision, and how to access it, please? While we have a totally different system here in Australia, it could be a useful addition to the proposition I'm planning to put to my surgeon - and hopefully the authorities above him.
Thanks,
-Kenna
Hi Kenna,

I have sent you a copy of the letter provided by my surgeon via PM. You will have to navigate the internets to find the US Tax Court Ruling. The citation to the appropriate docket is in the letter. Good luck!

With kindness,

Terri
 

Linde

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Terri
It would be nice if you could provide some of the details here in the forum, because other member might want to follow up on it, too.

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Linde
 

Maybebaby56

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Terri
It would be nice if you could provide some of the details here in the forum, because other member might want to follow up on it, too.

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Linde
Hi Linde,

The Tax Court ruling is O'Donnahbain v. Commissioner (2010), 134 T.C., No. 4, Docket 6402-06.

The Tax Court ruled that "GID is a well-recognized and serious mental disorder" and upheld that "GID is a disease and sex-reassignment related surgeries treated the disease within the meaning of IRS Section 213 and were therefore not cosmetic surgery".

Some forum members may be aghast at the pathologizing of transgenderism and the assertion that transgender individuals have a disease, but this is how the law, and therefore legal briefs and insurance claims work. Medical treatments are for pathologies. At the time this case was filed (2010) the DSM still considered called it "gender identity disorder" and a psychopathology. It was not until 2013 that the term was changed in DSM-5 to "gender identity dysphoria" and not a mental illness.

I'm sure we could start a whole new thread about the current rift between individuals who identify as "transgender" vs. "transsexual", and the subsequent devolvement into labeling people as "truscum" and "tucutes" and whether or not it is possible to be transgender without experiencing gender dysphoria. To me this identity politics in the LGBTQ community is utterly nonsensical and self-defeating, but if you are a regular on Reddit, you know this stuff exists.

With kindness,

Terri
 
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Linde

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Thanks Terri
I agree fully with you. To get the surgery stuff rolling for me, I had to be diagnosed to be transsexual. Intersex is not know to the system for this kind of purpose. But I really don't care, it is terminology only, and I am fine with anything, as long as it leads to the desired goal.
I dislike this infighting in the LGBTQI community as much as you do. It leads to nothing and just makes it harder for the individuals to get help.

I used to be a moderator on Reddit, and threw in the towel because we were even fighting among the moderator team.

And in some areas there are fights between intersex and trans people I learned on Facebook. I simply don't understand why this is so, we are all in the same darn boat, and try to life a normal life as possible.

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Linde
 

Kenna

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To me this identity politics in the LGBTQ community is utterly nonsensical and self-defeating, but if you are a regular on Reddit, you know this stuff exists.
This is one of the reasons I generally avoid Reddit.
Hugs,
-Kenna
 

Maybebaby56

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Thanks Terri
I agree fully with you. To get the surgery stuff rolling for me, I had to be diagnosed to be transsexual. Intersex is not know to the system for this kind of purpose. But I really don't care, it is terminology only, and I am fine with anything, as long as it leads to the desired goal.
I dislike this infighting in the LGBTQI community as much as you do. It leads to nothing and just makes it harder for the individuals to get help.

I used to be a moderator on Reddit, and threw in the towel because we were even fighting among the moderator team.

And in some areas there are fights between intersex and trans people I learned on Facebook. I simply don't understand why this is so, we are all in the same darn boat, and try to life a normal life as possible.

Hugs
Linde

Yup. If you don't have that ICD F64.0 in your medical files, you're screwed. For those of you not yet familiar with diagnosis codes and want medical treatment for gender dysphoria, I suggest you gain familiarity. You gotta learn the rules if you want to play the game.
  • F64.0 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes.

~Terri
 

Linde

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I searched around in Medicare if they changed their view of breast augmentation. They did not, in fact it is depending on each individual case if they pay for bottom surgery, and the decission can be different from state to state.
As late as 2020, breast augmentation was still considered to be a cosmetic procedure, and I doubt that anything changed under the Trump regime.
With a little luck, we might see some positive movement under Biden, but those are political decissions, and who knows what will develope. Medicare/Medicaid is controlled by politics, and one never can predict what will be decided.


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Linde
 

Rachel

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I had 555 ml mentor gummy bears. Dr. McGinn did the surgery. I opted for the 555 ml because at the time I wanted a full C cup. The question about over and under came up. Dr. McGinn recommedned I go with under the muscle. Her reason is that she thought my skin was too loose and feared the implants would break the stitches and slide.

I had 555 mentor implants and I was a 42A. I thought I was too small. I lost weight and have been doing some things to enhance my breasts and I am now a 38 DD and have a 38 DDD on order. The bra bridge between the boobs is raised up a good bit again. I am growing still.

We are self insured where I work and Aetna is the administrator. We have fantastic trans benefits. My BA was covered by insurance. I inquired about a larger BA and I would need a letter from my therapist to qualify. I discussed it with my therapist several times but decided to not have the surgery. BA surgery hurts, having very large boobs can be limiting and clothing choices are reduced. Also, Dr. McGinn performed and the BA it was intended to be under the muscle. I am partially under the muscle. Dr. McGinn had a very difficult time getting the implants partially under the muscle.

I lost weight and pump and use domperion. So when I lost weight I went to a 38D then 38DD and now need a DDD.

So weight matters, your body configuration matters (my peck muscles are high and I guess difficult to work with) and additional things can cause change too.

I am very glad I went with under the muscle (partial) becasue it looks very natural and feels natural. I see a lot of naked woman and it is natural to compare vaginas and breasts to others. I feel a lot more comfortable with my body since seeing a lot of woman naked. There are women I see with large, medium, small boobs and vaginas. I was obsessing on boob size but now an very comfortable with them.
 

Linde

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My daughter has very large natural breasts, and she is always complaining about them. They are in the way, they make her back hurt, they limit her in finding clothing she likes, etc.
I have natural 38 D breasts, and am very happy with this size. I can wear almost any kind of clothing right off of the rack. I hope m boobs don't grow anymore, because I would not want to have any more.

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Rachel

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So to me, under the muscle was better looking and feeling and look natural. Body configuration matters in placement. Having a doctor that has worked on trans matters.

Implant size will not vary but your body may so keep that in mind. I went from a 42 to a 38. My breasts look much larger now. I do pumping and take galacto globulins and my cup increased from D to DDD. If I stop pumping and taking the galacto globulins I do not know if my breasts will decrease in size. I do know my nipples and areola are larger too and hopefully the tissue will stay put.

If I were to get a BA again (due to an issue or manufacturers recommendation) I would go under the muscle. I most likely would go a little bigger, perhaps 650. The reason is think by then I will have loose skin. I have no loose breast skin now.
 

Linde

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. If I stop pumping and taking the galacto globulins I do not know if my breasts will decrease in size.
All I can find in the literature is that breast size created by pumping will go back once pumping is not done anymore. But some loose skin may remain and the breast could stat to look wrinkly.

Pumping was probably not the best idea to beginn with?

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Linde
 

Rachel

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Millions of woman pump. I have not yet achieved milk production. I have achieved several positive results. Such as areola increase, nipple increase and increase in areola resilience.

I believe my breast growth is from E1 and E2 administration and not in milk gland growth.

I agree, if I had milk tissue growth than stopping would reduce the tissue such as with billions of females that have their breasts results post breast feeding. However, I have not yet made milk tissue or milk. However, I could be wrong and maybe I am making milk tissue.

I am at parties with lots of woman and yes, older woman have saggy breasts. I have breasts of a 22 year old.

I need to schedule a breast exam soon. I can not wait to see the three year difference in breast size from an ex ray.

I do recommend under muscle breast implant.

Rachel
 

Linde

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I agree, if I had milk tissue growth than stopping would reduce the tissue such as with billions of females that have their breasts results post breast feeding. However, I have not yet made milk tissue or milk. However, I could be wrong and maybe I am making milk tissue.

Rachel
If you are taking progesterone you might have developed milk producing tissue already. You might want to get your prolactin level checked.


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Linde
 
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