Health Insurance for Hormone Replacement Therapy and GRS

Q.   My name is xxx and I am doing a little research for a friend that does not have access to the internet. He is looking for information for personal use and also for the job that he is currently employed in.

My main question to you in the cost that are involved and also the benefits that may be entitled from being a member of private health insurance. It is a very grey area, particularly when you contact the funds directly as it is not a talked about subject. Also classifications that are made as to weather it is 'medically necessary' operation or not.

Any additional information that you may have on the topic would be greatly appreciated, also any other people that you would know of that we could get in contact with to discuss the issue.

Lastly I would like to thank you for telling your story over the web page, hopefully the information that I can get from yourself and other sources will be greatly appreciated and helpful to my good friend.

I guess both of us being gay males around the age of 22, I was having a little trouble understanding exactly what he was going through and why he would want to change himself, but after many late night discussions and lots of reading, I now understand that it is not a choice or a decision, it is just ment to be.

I am looking forward to your reply, and once again thank you for the information that you have shared on the website.. Kind Regards

Response by Chrysalis

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A.  If I understand correctly, you are looking for information on Hormone Replacement Therapy (HRT) and Gender/Sex Reassignment Surgery (GRS/SRS) and if the costs are covered by private health insurance.

First, HRT will cost $100.00 US a month or more depending on your source of drugs and may be covered by health insurance if the physician justifies it as correcting a hormonal imbalance rather than treatment for transsexualism. I am not familiar with how the health insurance programs of countries other than the US might handle such a claim.

Next, GRS/SRS costs range from about $7000.00 US to more than $20.000 US depending which surgeon you chose and exactly which procedures you want performed. The cost of the surgery is generally required in full prior the surgical date. At present I do not know of any private insurance that covers these costs. Although there have been some changes initiated by a number larger municipalities to cover these costs as part or their employee health benefits, by and large this cost is still born by the individual.

Note, the costs listed for the GRS/SRS do NOT include travel, food or lodging which is not covered by any medical plan that I am aware of.

As far as "medical necessity" again that will depend upon how the attending physician writes the claim up, worded properly and with conviction there should be no difficulty in establishing the necessity of the procedures. Care must be take by the physician to leave absolutely no loopholes in the justification since experience has shown that private health insurers will try to find any excuse possible NOT to make payment.

Further information on costs may be obtained from several of the sources listed in the Linkbook here at Another Waye, several Surgeons and other Medical Doctor's have their sites listed in the Support and Professional Services section.

I am sorry that I do not have more information on the costs and all in Australia, hopefully what I have given you will be of some benefit to your friend on his/her journey.

Chrysalis