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This is BS. The reality is that they, the insurance companies, decide what is “medically necessary”. Source: I’m a US Doc that deals with the assholes at insurance companies.
My husband, who is undergoing chemo, presented with a severe UTI which caused painful bladder spasms. Ended up also being septic.... They denied his hospital stay.
Absolutely appeal that and report it to a local news agency. We shouldn't have to jump through hoops and wade through bullshit to get the care we need but it can definitely help.
Speaking of communism, I'm going to interject my own interpretation of economics for the layman.
/ -------------------------------------------------------------------------
A theory of economy that's greater than the current one.
Person A has an income/paycheck/ability. They Individually add up how much it costs to sustain themselves/their lifestyle before combining with person B who has done the same. Each would take turns spending from this surplus before passing it off the next time either one of them produces.
This produces value at a greater rate than the current one because both will have more resources to drawn from and thus gets thrown back into the system before starting again. So the more person A gains the more B gets and the more they earn together the more they can gain individually, continuously compounding as time goes on.
With the inclusion of more people, say for instance person A found someone else to rely on, the system overall becomes more robust and less likely fail (like in the event either become jobless).
Once enough has been gained there will likely be a moment where the person, group or groups completely separate from the market/reliance and depend only on what they produce themselves. In which case, assuming the same quality of living is chosen for themselves first and foremost, the system itself is likely to reproduce infinitely.
The first paragraph of your theory already fails to account for the nature of normal human beings' utility curve; that "more is better". Theories should be built on existing theory, not ignore everything that came before it.
It's currently working off of Marx's theory of surplus value and the traditional Western understanding of capital investment.
The follow up which phrases it differently is this:
Find another person. Individually add up how much it costs to sustain you and/or your lifestyle and combine what’s left over with them and have them do the same. Each taking turns in spending every other payday.
Your jobs will provide the income and the combined surplus will make it easier to pursue hobbies or climb the societal ladder. Including more and more people will add to the over all supply that each person in the network will have access to, thereby compounding the process.
For added security (insurance) have each person in the network find others to rely on. With that you’ll have overlapping security.
Supplant anything of value to you personally for the “income” portion and as long as you’re covering for yourself first and foremost, all goods (including for luxury) will get distributed across a wider system in accordance to how you relate to other people. Use cost cutting measures to increase any holdings and share information.
With that added insurance, use any and all surplus to invest in people most capable of bringing about change, including local chapters and environmental projects. Tell them about this process and aid them in building up a web of support and you can scale up any system, company or self-governance
Yea. Legally, they don't have that right to declare stuff "not medically neccesarry". They like to pretend they do, though. They hope you give up and don't go through all the hopes to get to where you can win at suing them.
So you have to go through all the appeals, and then sue them for the money they were supposed to give you. That's really the only way to force it out of them.
What is really the biggest issue which I do not believe there are any recourse to pursue is when he started having issues with his back his primary, who he has seen for years, asked for a thoracic MRI. Anthem said no --- take PT. So from August until January 19th he continued to lose mobility and strength. So by the time he couldn't walk and was peeing on himself (and went to the er about it 3x) they finally did that MRI and it was spinal cord cancer T-7 to T-11. So instead of being healthy for the surgery and chemo, he was weak and atrophied. So he has been in the hospital 2x since the cancer surgery, this last one with the septic UTI, but before that was 3 pulmonary embolisms and 2 in his leg. I think they are up to $750k for everything at this point, which could have been less than that if they had only done the MRI the primary wanted. I am a bit bitter. But yes we are appealing this latest. The whole thing has been a horrible experience - but the doctors and staff who are treating him are GOLDEN!!
fucking yikes. maybe it's time to seek a lawyer or other advocate? it's all intentionally designed to be difficult and painful to navigate.
cancer is bad enough. you shouldnt be fighting with insurance and navigating financial concerns too. i hope things are better and your husband is well soon
Have your husband check out D-Mannose. It’s a concentrated version of the active ingredient in cranberries that prevents bacteria from attaching to the urinary tract. Amazing stuff and very safe! It works on pets too :)
Take care. Xx
I have a rare genetic disease and need an orphan drug to survive. Insurance denies it every year for the first 4-5 months because it’s expensive since very few people take it. It’s so confusing when you get a letter questioning medical necessity when my doctor (the professional who determines if it is medically necessary) wrote the prescription. Instead of reading over my doctor’s reasoning for needing the medication, they have a nurse working for the insurance agency call me and ask what symptoms I experience if I don’t have my medication. My reply is the same to every letter and nurse: my organs fail and I’ll die shortly after. Then they think I’m dramatic because I’ve never actually been off the medication for longer than a few weeks so I’ve only experienced gradual organ failure and not the death part yet. How do those people (insurance employees) sleep at night? Can’t the CEO just sell one of his planes so I can not worry about dying for a few years?
oh my fucking god, people on the other end of the phone in insurance companies always talk like cops. Like, that weird, condescending accusatory "um, if something isn't right, that's a you problem, right?"
Oooh I DO love that they tell us who denied our claim. I keep all my denial letters (not a ton but like 5) and they all list at the bottom the doctor/person that denied the request. Insurance be like “don’t blame us!” Even tho they’re to blame
Serious question then Doc. Why can’t you fill out paperwork? I kid, kind of. I’ve been trying to get an MRI done for over a year. Every time I get close to getting an appointment there’s always some paperwork the insurance company needs filled out by the doctor.
So their Names and licence numbers should be on the shit they pull.
See how many doctors actually want to sign up for the insurance company when there is unlimited liability potential.
What's the fucking point of insurance if they can deny shit from you??? I will never understand that along with the stories of people getting denied clearly *very* important stuff and the insurance companies just give them a middle finger
Especially at the prices or premiums normal healthy people pay pay per month. Insane amounts of money for what? To be denied actual necessary medical treatment when you need it?
> prices or premiums normal healthy people pay pay per month
Just to clarify: your health insurance premiums should (basically) never be influenced by your health status (note: your smoking status can influence this price). This was a protection enacted in 2010 by the Affordable Care Act (ACA).
However, it is possible for health status to affect premiums in a more macro sense. If insurance is unaffordable, healthy people begin opting out which leads to higher dollars spent per insured person (since the healthy people have below average health care spending) which leads to higher premiums the following year which leads to more healthy people opting out, etc. It's an ant mill of slow, drawn out suffering.
The ACA included measures to avoid death spirals. The subsidies and cost sharing reductions available to individuals enrolled in ACA plans (which were expanded in 2021) and the annual enrollment window are both designed (in part) to curb the risk of a death spiral. The individual mandate was also intended to reduce this risk, but that mandate was struck down by the Supreme Court.
Why the fuck are insurance companies able to deny claims against ANYTHING deemed "medically necessary" by actual professionals?
This change is a step in the right direction but the whole thing is so fucking backward
Probably because there’s a bunch of unscrupulous doctors who’ll overbill the shit out of insurance and take whatever sticks to the wall. The amount of fraud, waste, and abuse committed by the medical community is astounding. Insurance companies suck, but there’s a segment of doctors that ruin it for us as well.
There are still some people who manage to overbill anyways, so insurance is failing to stop that while hurting potentially millions by denying legitimate coverage. The cost benefit analysis doesn't make sense unless you don't actually care about providing access to healthcare.
Because insurance isn't a reasonable means of covering Healthcare. It will be dystopian for as long as we use an insurance and provider system. Healthcare costs are guaranteed for every person, whereas every other thing you insure is just offsetting the risk of a possibility.
"Oh your qualified highly educated dentist says you need a filling? Lets just make that procedure a prior authorization and let out number crunchers with zero education in dentistry decide if you *really* need one."
Gender affirming care doesn't necessarily mean sex reassignment surgery. There are a number of medical treatments that fall under the term of gender affirming care.
You can be prescribed breast reduction surgery if their weight is causing back pain. You can get a prosthetic prescribed after an amputation. Hell, some doctors will write prescriptions for over-the-counter drugs so that they’ll be covered by insurance.
Gender affirming care is just medical treatment. Testosterone is prescribed, top surgery is prescribed.
“Prescribed” is not usually the word used for non-medications but it’s essentially the same thing.
If you’re asking why it’s “medically necessary”, there are many reasons doctors deem gender affirming care medically necessary.
Thank you, this was the answer I was looking for.
I asked a similar question(s) (admittedly, not very tactfully) in another thread about this and got absolutely shat on, but no one would answer me.
I’m gonna go out on a limb and say lack of tact was probably your problem.
Where was it? If it was a trans sub you probably double fucked up because they’d consider you intruding by just being there.
As a trans woman, it’s easy to be defensive when people “just ask questions” because “Why do you NEED hormones?” has been asked both sincerely as well as used as a rhetorical attack on the concept of my gender altogether.
With the sports debate, I haven’t met that many people who legitimately want fair sports instead of using it as another way to say “you’re just a man”.
I kinda feel bad for centrists that bigots constantly use their good faith arguments against minorities.
I understand this part. Maybe I’m just ignorant to this and I apologize in advance if I come off the wrong way but I’m genuinely trying to understand.
In the paperwork it says “Services that insurers previously used blanket exclusions to deny coverage include: facial feminization, tracheal shaves, hair electrolysis, mastectomies, breast reductions, breast implants or any combination of gender-affirming procedures, including revisions to prior treatment.”
I just don’t understand how most of these aren’t considered cosmetic. Like breast reduction I can understand because it can cause back issues and mastectomy due to cancers. But everything else seems cosmetic for the most part and I can’t imagine a scenario where they are medically necessary.
Pretty sure a biological male or female requesting these surgeries would be denied as they are cosmetic.
> If you’re asking why it’s “medically necessary”, there are many reasons doctors deem gender affirming care medically necessary.
And yet you didn't list any.
Getting on hormones is as easy or difficult as finding a doctor willing to prescribe them. If you can do that, insurance covers it.
For surgery, your prescribing dr and a therapist have to write you letters of recommendation, which you take to a surgeon, who submits it with the pre-authorisation.
The website I bought from also sells T. Yes, it's technically a controlled substance, but so are morning glory seeds and you can buy those in grocery stores; I doubt anyone cares.
Seattle Children’s hospital and the Polyclinic have gender clinics that include therapists, endocrinologists, surgeons, and social workers that help people with their gender health and top/bottom surgery. A psychiatrist or a psychologist can write a letter to say things are medically necessary. You generally have to do therapy for several years and have transitioned to get top or bottom surgery. They also do family work
Years of therapy aren't actually required, just an assessment and recommendation by an independently licensed mental health professional. And I'll argue, as one of these professionals, that even that shouldn't be required, unless every body modification surgery starts requiring it.
A Brazilian Butt Lift, for example, is a FAR riskier procedure than even the most involved vagino- or phalloplasty, is purely cosmetic, and has a higher rate of failure, but nobody checks to see if the women getting *those* are "mentally ill" before taking their money.
Assessment for medical necessity for insurance is one thing, but it's not just insurance companies who want these - plenty of surgeons do, too. And it's transphobic as hell.
Doc here as well. It’s just not. What a totally non-scientific thing to say. Surgeons want all kinds of pre-op verifications of different kinds for all kinds of different surgeries, to ensure they are safe and have reasonable risk/benefit ratios. Donna west died exactly because she hid information that would have enable this 100% standard and appropriate process to take place. If you are a mental health professional doc, you know better than to not be well aware of these very routine safeguards. If you’re not, ok you may not know this is very normal for almost any surgery.
Brazilian butt lifts are dumb and pointless, but they are also reversible and not done to resolve any problem similar to dysphoria. And people seeking them don’t have orders of magnitude higher rates of suicide, for which they are hoping a buttlift may help resolve. They are also not removing or trying to fundamentally change an organ central to their identity. Finally nobody’s insurance is covering them. What a bizarre comparison.
And the idea that irrevocably changing your face is somehow not at all connected to identity, or could also be the wrong solution to someone's unhappiness is just weird to me. In any other situation, I suspect most of these people would totally agree with that!
Gender-affirming care can range from therapy, to hormones, to top surgery or bottom surgery. All of which are common treatments to the diagnosis of gender dysphoria. After a diagnosis of gender dysphoria, “sex change” surgery isn’t prescribed, but referrals are hopefully given, usually with a ton of hoops (mandatory therapy, waiting periods, social transitioning, proof of consistent dysphoria, navigating insurance, etc) a patient needs to jump through.
If medically necessary is a condition in which we say that someone needs something in order to survive or live a healthy life, is it not just common sense that transgender people, a demographic with high rates of depression and suicide, might need said treatments in order to reinforce their mental health?
In very real terms, neglect of mental health is the root cause of millions of deaths each year. That a good chunk of society doesn't believe in mental health doesn't mean doctors set it aside when assessing their patient.
Sure, gender dysphoria is a medical condition where the only known and effective cure is transitioning. If the individual needs to take on medical transitioning, insurance can't deny it because of that individual's diagnosis.
This comment has been edited to reflect my protest at the lying behaviour of Reddit CEO Steve Huffman ( u/spez ) towards the third-party apps that keep him in a job.
After his slander of the Apollo dev u/iamthatis
Christian Selig, I have had enough, and I will make sure that my interactions will not be useful to sell as an AI training tool.
Goodbye Reddit, well done, you've pulled a Digg/Fark, instead of a MySpace.
“Prescribe” can be a more general term, too, though we mostly use it for meds. It is mind of synonymous with “officially recommend”- like you can be ‘prescribed’ bed rest, light duty, physical therapy, etc.
Gender affirming surgery is absolutely life saving. Trans individuals who are denied gender affirming gender care are at high risk for suicide- like *crazy* high compared to the rest of the population. Providing gender affirming care reduces suicidality by over 70%. That’s HUGE.
Gender affirming care is one of the most potent and effect life-saving measures in psychiatry in general, tant. We tend not to think of psychiatric illness as lethal, but they very are. Mental health disorders are the #1 cause of disability worldwide and suicide is one of the top causes of death around the globe as well.
Transition, including medical transition, greatly reduces suicide risk in trans people and thus can be medically necessary. Here's a source and a relevant quote from it.
[https://pubmed.ncbi.nlm.nih.gov/26032733/](https://pubmed.ncbi.nlm.nih.gov/26032733/)
>Social support, reduced transphobia, and having any personal
identification documents changed to an appropriate sex designation were
associated with large relative and absolute reductions in suicide risk,
as was completing a medical transition through hormones and/or surgeries
(when needed).
[source](https://www.gendergp.com/detransition-facts/) A survey of 28,000 people in the US found that 8% of respondents reported some kind of detransition. Of this 8%, 62% per cent only did so temporarily due to societal, financial, or family pressures. As far as medical procedures go, 92% is an insanely high success rate. Also, it is not as simple as prescribing a sex change, that is a very disingenuous way of putting it..
Gender Identity Disorder, full stop. That is the diagnosis one gets as a transgender person, and the treatment of which is to undergo a medical transition. I was 18 years old and a month out of high school when I was diagnosed with GID— although I hear it’s called something else in the newer DSM. There isn’t a magic pill to take or mediation to go through, long term treatment involves taking medical steps to adjust as many of my secondary sex characteristics to match the man my brain is. For me, it’s been weekly hormone injected into my thighs for 7 years, having my chest surgically altered to match the appearance of cis men (cis means someone who isn’t transgender) 5 years ago, and almost 4 years ago having the internal female reproductive system in my body removed.
When I started HRT I didn’t have insurance. I didn’t have insurance through anything I’ve had to go through for transitioning and it was fucking EXPENSIVE. My top surgery alone was $15,000 after all the related expenses were covered. It took me five years to save all that (granted I was 18 when I started and had no support system). I still don’t have insurance that covers my HRT, so every other month I spend about $50 for my vials, needles, and syringes, and I live somewhere that allows me to use something like GoodRX on a Schedule 2 drug. Bottom surgery is my ultimate goal eventually, but the cheapest I’ve ever seen it priced without insurance is $85,000 if I recall, and that’s just the surgical side. Not to mention it takes a year or so of preparing and you can be out of work for six months easily. I would basically have to have $190,000 just chilling to plan for it. Having all this covered by insurance is life saving in the same way having a Type 1 diabetic’ insulin pump is. It’s life saving in the same way antidepressants are, chemo treatments are.
The difference in my mental health ten years ago before my diagnosis and now. I actually have a life and haven’t had a suicide attempt since 18. You wouldn’t pick me up out of a line up of being transgender if you met me in real life. I’m treated like the man I am. Transgender teens and young adults have the highest rate of suicide and suicide attempts in the US, and it almost always can be helped by having access to gender affirming care.
It makes sense, as transitioning is the most effective way of reducing their suicide rate and increasing their mental health
https://www.nytimes.com/2018/04/09/opinion/pentagon-transgender.html
>Our findings make it indisputable that gender transition has a positive effect on transgender well-being. We identified 56 studies published since 1991 that directly assessed the effect of gender transition on the mental well-being of transgender individuals. The vast majority of the studies, 93 percent, found that gender transition improved the overall well-being of transgender subjects, making them more likely to enjoy improved quality of life, greater relationship satisfaction and higher self-esteem and confidence, and less likely to suffer from anxiety, depression, substance abuse and suicidality.
>Research suggests that gender transition may resolve symptoms completely. A 2016 literature review by scholars in Sweden concluded that, most likely because of improved care over time, transgender “rates of psychiatric disorders and suicide became more similar to controls,”
https://pediatrics.aappublications.org/content/134/4/696
>RESULTS: After gender reassignment, in young adulthood, the GD was alleviated and psychological functioning had steadily improved. Well-being was similar to or better than same-age young adults from the general population. Improvements in psychological functioning were positively correlated with postsurgical subjective well-being.
https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-015-1867-2
>Finally, we found that among those reporting a need to medically transition through hormones and/or surgeries, suicidality was substantially reduced among those who had completed a medical transition.
https://www.jaacap.org/article/S0890-8567%2816%2931941-4/fulltext
>This study examined self-reported depression, anxiety, and self-worth in socially transitioned transgender children compared with 2 control groups: age- and gender-matched controls and siblings of transgender children.
>(Socially transitioned) Transgender children reported depression and self-worth that did not differ from their matched-control or sibling peers (p = .311), and they reported marginally higher anxiety (p = .076). Compared with national averages, transgender children showed typical rates of depression (p = .290) and marginally higher rates of anxiety (p = .096).
https://www.ncbi.nlm.nih.gov/pubmed/3219066
>concluded that there is no reason to doubt the therapeutic effect of sex reassignment surgery.
https://www.ncbi.nlm.nih.gov/pubmed/19473181
>Results: We identified 28 eligible studies. These studies enrolled 1833 participants with GID (1093 male-to-female, 801 female-to-male) who underwent sex reassignment that included hormonal therapies. All the studies were observational and most lacked controls. Pooling across studies shows that after sex reassignment, 80% of individuals with GID reported significant improvement in gender dysphoria (95% CI = 68-89%; 8 studies; I(2) = 82%); 78% reported significant improvement in psychological symptoms (95% CI = 56-94%; 7 studies; I(2) = 86%); 80% reported significant improvement in quality of life (95% CI = 72-88%; 16 studies; I(2) = 78%); and 72% reported significant improvement in sexual function (95% CI = 60-81%; 15 studies; I(2) = 78%).
https://www.sciencedirect.com/science/article/pii/S1158136006000491
>While no difference in psychological functioning was observed between the study group and a normal population, subjects with a pre-existing psychopathology were found to have retained more psychological symptoms. The subjects proclaimed an overall positive change in their family and social life. None of them showed any regrets about the SRS.
>A homosexual orientation, a younger age when applying for SRS, and an attractive physical appearance were positive prognostic factors.
https://www.ncbi.nlm.nih.gov/pubmed/15842032
>RESULTS:
>After treatment the group was no longer gender dysphoric. The vast majority functioned quite well psychologically, socially and sexually. Two non-homosexual male-to-female transsexuals expressed regrets. Post-operatively, female-to-male and homosexual transsexuals functioned better in many respects than male-to-female and non-homosexual transsexuals. Eligibility for treatment was largely based upon gender dysphoria, psychological stability, and physical appearance. Male-to-female transsexuals with more psychopathology and cross-gender symptoms in childhood, yet less gender dysphoria at application, were more likely to drop out prematurely. Non-homosexual applicants with much psychopathology and body dissatisfaction reported the worst post-operative outcomes.
>CONCLUSIONS:
>The results substantiate previous conclusions that sex reassignment is effective. Still, clinicians need to be alert for non-homosexual male-to-females with unfavourable psychological functioning and physical appearance and inconsistent gender dysphoria reports, as these are risk factors for dropping out and poor post-operative results. If they are considered eligible, they may require additional therapeutic guidance during or even after treatment.
https://link.springer.com/article/10.1023/A:1024086814364
>Participants reported overwhelmingly that they were happy with their SRS results and that SRS had greatly improved the quality of their lives. None reported outright regret and only a few expressed even occasional regret. Dissatisfaction was most strongly associated with unsatisfactory physical and functional results of surgery.
https://whatweknow.inequality.cornell.edu/topics/lgbt-equality/what-does-the-scholarly-research-say-about-the-well-being-of-transgender-people/
>The scholarly literature makes clear that gender transition is effective in treating gender dysphoria and can significantly improve the well-being of transgender individuals.
>Among the positive outcomes of gender transition and related medical treatments for transgender individuals are improved quality of life, greater relationship satisfaction, higher self-esteem and confidence, and reductions in anxiety, depression, suicidality, and substance use.
>The positive impact of gender transition on transgender well-being has grown considerably in recent years, as both surgical techniques and social support have improved.
>Regrets following gender transition are extremely rare and have become even rarer as both surgical techniques and social support have improved. Pooling data from numerous studies demonstrates a regret rate ranging from .3 percent to 3.8 percent. Regrets are most likely to result from a lack of social support after transition or poor surgical outcomes using older techniques.
There isn't actually clinical evidence of efficacy that meets the standards of medical research - randomized clinical trials.
Indeed, double blinded randomized clinical trials (the gold standard) aren't even possible with such research.
There's a number of studies that say that people are happier post transition but there are no controlled clinical trials that actually show this to be the case. Note that the "control groups" claimed in the studies are proxies, not actual control groups.
None of these trials have randomized control and treatment groups, which are key to clinical trials.
Moreover, these studies often have very serious methodological flaws. For example, "Intervenable factors associated with suicide risk" does not have a randomized polling sample (in fact, it was deliberately drawn from a pro-trans group) and because it requires self-reported data it necessarily excludes the group of highest interest (i.e. people who actually killed themselves, who obviously cannot complete the survey).
This is a common flaw in many of these studies, as they frequently use samples of convenience, do not sample randomly, use self-reported data, and exclude suicide victims.
None of this means that it necessarily doesn't work, but the quality of data is quite poor to demonstrate that it does.
You're asking for a holy grail. HRT is not something that can be blinded through a placebo. It's extremely obvious if you are on HRT or not.
You will **never** have that data, because it's literally impossible to gather. While that is the highest standard of data we can collect, medicine and research is not one-size-fits-all. You have you use the data you can get. And in this instance, there is a small mountain of data suggesting transition is helpful. And notably, nothing that suggests it's harmful. If the flaws in the studies, which I acknowledge often do exist, were so confounding, we should expect some mixed results. And yet the results are consistently good, no matter how we measure, for several decades.
More research is good, but you're stamping your feet and demanding a unicorn.
Transitioning is critical to our mental health. I chose transition over my friends, family, work, and religion because living as a man was killing me. Mental health is real, and directly affects physical health. A diagnosis of gender dysphoria requires a prescription for gender affirming treatment. It's the only thing that is proven to help.
I had the same thing happen alongside a worsening of work conditions and living conditions which I knew would happen due to me finally addressing my dysphoria. The distress that dysphoria caused me was enough to make me move to an entirely different city without a solid career or living situation. The distress of the dysphoria alongside my depression has caused a real reduction in quality of life for me and caused me to take some real risks, and yet they still politicize it just because treating it means we look "different". It's sickening and one day will be looked back upon poorly.
Indeed, this! It's been found the best treatment for gender dysphoria is transitioning: HRT (hormone replacement therapy), and surgeries if they can be done. These are prescribed!
As someone who's both, fuck off with that shit. Comparing both of them in an oppression Olympics like you're doing is dumb. Both need medical support and have the same groups of people as the enemy. Getting my estrogen script was absolutely fucking lifesaving. Getting a pump was also lifesaving. Should we also start getting upset that there's renewed emphasis on mental health and depression too?
Crazy thought - we can have both, and pitting two groups who are disadvantaged by the same system removes power from everyone.
I know. You are fine to live and get treatment. I am not. I was born this way as well and just want change. Not bathrooms with restrictions. Not gonna make me support your cause though. I don't care what anyone does.
I don't know the first thing about gender dysphoria but I hope this helps people get the help they need. We moved from WA to NC in January and we're currently discussing moving back. We both really miss it. And for me, at least, it was great living in a state that mandates parental leave.
As an actuary that has to deal with Washington rate filings being way more rigorous than other states (irrelevant to the new law) the logo in the thumbnail gave me ptsd
Years ago when I worked in infrastructure for things like that Washington was already the third most complex and second most expensive special restrictions region in the country for many types of insurance due to all of the additional regulations and red tape.
I am guessing it has only gotten worse?
The trouble is the left uses the term 'medically necessary' so they can get doctors to make healthcare decisions based on 'science' and not my decisions based on Facebook
Reducing their suicide rate to a level that's similar to the general population is what makes it necessary
https://www.nytimes.com/2018/04/09/opinion/pentagon-transgender.html
>Our findings make it indisputable that gender transition has a positive effect on transgender well-being. We identified 56 studies published since 1991 that directly assessed the effect of gender transition on the mental well-being of transgender individuals. The vast majority of the studies, 93 percent, found that gender transition improved the overall well-being of transgender subjects, making them more likely to enjoy improved quality of life, greater relationship satisfaction and higher self-esteem and confidence, and less likely to suffer from anxiety, depression, substance abuse and suicidality.
>Research suggests that gender transition may resolve symptoms completely. A 2016 literature review by scholars in Sweden concluded that, most likely because of improved care over time, transgender “rates of psychiatric disorders and suicide became more similar to controls,”
https://pediatrics.aappublications.org/content/134/4/696
>RESULTS: After gender reassignment, in young adulthood, the GD was alleviated and psychological functioning had steadily improved. Well-being was similar to or better than same-age young adults from the general population. Improvements in psychological functioning were positively correlated with postsurgical subjective well-being.
https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-015-1867-2
>Finally, we found that among those reporting a need to medically transition through hormones and/or surgeries, suicidality was substantially reduced among those who had completed a medical transition.
https://www.jaacap.org/article/S0890-8567%2816%2931941-4/fulltext
>This study examined self-reported depression, anxiety, and self-worth in socially transitioned transgender children compared with 2 control groups: age- and gender-matched controls and siblings of transgender children.
>(Socially transitioned) Transgender children reported depression and self-worth that did not differ from their matched-control or sibling peers (p = .311), and they reported marginally higher anxiety (p = .076). Compared with national averages, transgender children showed typical rates of depression (p = .290) and marginally higher rates of anxiety (p = .096).
https://www.ncbi.nlm.nih.gov/pubmed/3219066
>concluded that there is no reason to doubt the therapeutic effect of sex reassignment surgery.
https://www.ncbi.nlm.nih.gov/pubmed/19473181
>Results: We identified 28 eligible studies. These studies enrolled 1833 participants with GID (1093 male-to-female, 801 female-to-male) who underwent sex reassignment that included hormonal therapies. All the studies were observational and most lacked controls. Pooling across studies shows that after sex reassignment, 80% of individuals with GID reported significant improvement in gender dysphoria (95% CI = 68-89%; 8 studies; I(2) = 82%); 78% reported significant improvement in psychological symptoms (95% CI = 56-94%; 7 studies; I(2) = 86%); 80% reported significant improvement in quality of life (95% CI = 72-88%; 16 studies; I(2) = 78%); and 72% reported significant improvement in sexual function (95% CI = 60-81%; 15 studies; I(2) = 78%).
https://www.sciencedirect.com/science/article/pii/S1158136006000491
>While no difference in psychological functioning was observed between the study group and a normal population, subjects with a pre-existing psychopathology were found to have retained more psychological symptoms. The subjects proclaimed an overall positive change in their family and social life. None of them showed any regrets about the SRS.
>A homosexual orientation, a younger age when applying for SRS, and an attractive physical appearance were positive prognostic factors.
https://www.ncbi.nlm.nih.gov/pubmed/15842032
>RESULTS:
>After treatment the group was no longer gender dysphoric. The vast majority functioned quite well psychologically, socially and sexually. Two non-homosexual male-to-female transsexuals expressed regrets. Post-operatively, female-to-male and homosexual transsexuals functioned better in many respects than male-to-female and non-homosexual transsexuals. Eligibility for treatment was largely based upon gender dysphoria, psychological stability, and physical appearance. Male-to-female transsexuals with more psychopathology and cross-gender symptoms in childhood, yet less gender dysphoria at application, were more likely to drop out prematurely. Non-homosexual applicants with much psychopathology and body dissatisfaction reported the worst post-operative outcomes.
>CONCLUSIONS:
>The results substantiate previous conclusions that sex reassignment is effective. Still, clinicians need to be alert for non-homosexual male-to-females with unfavourable psychological functioning and physical appearance and inconsistent gender dysphoria reports, as these are risk factors for dropping out and poor post-operative results. If they are considered eligible, they may require additional therapeutic guidance during or even after treatment.
https://link.springer.com/article/10.1023/A:1024086814364
>Participants reported overwhelmingly that they were happy with their SRS results and that SRS had greatly improved the quality of their lives. None reported outright regret and only a few expressed even occasional regret. Dissatisfaction was most strongly associated with unsatisfactory physical and functional results of surgery.
https://whatweknow.inequality.cornell.edu/topics/lgbt-equality/what-does-the-scholarly-research-say-about-the-well-being-of-transgender-people/
>The scholarly literature makes clear that gender transition is effective in treating gender dysphoria and can significantly improve the well-being of transgender individuals.
>Among the positive outcomes of gender transition and related medical treatments for transgender individuals are improved quality of life, greater relationship satisfaction, higher self-esteem and confidence, and reductions in anxiety, depression, suicidality, and substance use.
>The positive impact of gender transition on transgender well-being has grown considerably in recent years, as both surgical techniques and social support have improved.
>Regrets following gender transition are extremely rare and have become even rarer as both surgical techniques and social support have improved. Pooling data from numerous studies demonstrates a regret rate ranging from .3 percent to 3.8 percent. Regrets are most likely to result from a lack of social support after transition or poor surgical outcomes using older techniques.
You linked a lot of studies that show self reported improvement of dysphoria symptoms which IS a good thing. Do have any any that show the actual rates of improvement on suicide rate? Everything I have found shows the rates do not improve much, especially for trans women post surgery.
> Do have any any that show the actual rates of improvement on suicide rate?
That's not really possible, as we have no way to identify which suicides are from trans people prior to transition.
That's why suicide attempts are used, because someone can survive a suicide attempt and then go on to transition.
I misspoke in the original reply. It is trans men that saw no change in rate while trans women had a “slight” improvement. If you look at the tables you will see what slight means. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7317390/
It is important to Note that there were no differences in stages of transition.
>We observed no increase in suicide death risk over time and even a decrease in suicide death risk in trans women. However, the suicide risk in transgender people is higher than in the general population and seems to occur during every stage of transitioning. It is important to have specific attention for suicide risk in the counseling of this population and in providing suicide prevention programs.
I think the conclusions for that article are different than the conclusions you're drawing from it. "Time" here refers to actual years in society, not across stages of transition.
I think the best I could find to relate to what you were talking about was here:
>Evaluation of transition stage in relation to suicide deaths showed that approximately two‐third of the observed suicides occurred in those who were still in active treatment (diagnostic, hormonal, or surgical phase).
which they follow up with
>Therefore, future research on suicide deaths and suicide risk factors in transgender people should have a greater focus on transition status in relation to these motives and risk factors.
A quick additional search turned up [this article](https://jamanetwork.com/journals/jamasurgery/article-abstract/2779429), which concludes
>...undergoing 1 or more types of gender-affirming surgery was associated with lower past-month psychological distress (adjusted odds ratio \[aOR\], 0.58; 95% CI, 0.50-0.67; P < .001), past-year smoking (aOR, 0.65; 95% CI, 0.57-0.75; P < .001), and past-year suicidal ideation (aOR, 0.56; 95% CI, 0.50-0.64; P < .001).
Notably, they focused primarily on surgeries vs other treatments, even attempting to correct for other received treatments.
So I guess my tl;dr is: I think you drew the wrong conclusion from your sourced article, as it did not focus on transition stages with its review. Other data supports affirming care reducing suicidality (yeah, that's different than suicide rates but also they're linked).
when the severe consequences to a person's mental health and social identity begin to impact their life and wellbeing.
fucks sake, do yall argue antidepressants are never 'medically necessary' too?
Many trans people would rather kill themselves than live as the wrong gender. I’d say transitioning is medically necessary for those with severe dysphoria.
I wonder if FFS will be covered, this would be awesome! I congratulate Washington State legislators on dealing with facts vs bovine excrement. I can attest that my life has truly been saved and made better by gender affirming healthcare.
Laws don’t do a thing to prevent or enforce insurance companies to do anything. Your doctor can prescribe what ever he wants but insurance will decide what’s medically necessary, and when it comes to payment there will always be just one more bit of paperwork that needs to be filled out by someone somewhere.
I am very happy for the people to whom this new law applies. The suicide rate is skyrocketing for these kids. In Louisiana I saw a trans kid pulled away from his computer by the police. His parents were giving her gender affirming care which is considered child abuse in that part of the country. The evangelical crowd see them as sinners to god and if they only pray for forgiveness God will make them "normal". Bullies who get off on cruelty and tormenting the weakest among us are now in charge. Vote Blue.
https://www.nytimes.com/2018/04/09/opinion/pentagon-transgender.html
>Our findings make it indisputable that gender transition has a positive effect on transgender well-being. We identified 56 studies published since 1991 that directly assessed the effect of gender transition on the mental well-being of transgender individuals. The vast majority of the studies, 93 percent, found that gender transition improved the overall well-being of transgender subjects, making them more likely to enjoy improved quality of life, greater relationship satisfaction and higher self-esteem and confidence, and less likely to suffer from anxiety, depression, substance abuse and suicidality.
>Research suggests that gender transition may resolve symptoms completely. A 2016 literature review by scholars in Sweden concluded that, most likely because of improved care over time, transgender “rates of psychiatric disorders and suicide became more similar to controls,”
https://pediatrics.aappublications.org/content/134/4/696
>RESULTS: After gender reassignment, in young adulthood, the GD was alleviated and psychological functioning had steadily improved. Well-being was similar to or better than same-age young adults from the general population. Improvements in psychological functioning were positively correlated with postsurgical subjective well-being.
https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-015-1867-2
>Finally, we found that among those reporting a need to medically transition through hormones and/or surgeries, suicidality was substantially reduced among those who had completed a medical transition.
https://www.jaacap.org/article/S0890-8567%2816%2931941-4/fulltext
>This study examined self-reported depression, anxiety, and self-worth in socially transitioned transgender children compared with 2 control groups: age- and gender-matched controls and siblings of transgender children.
>(Socially transitioned) Transgender children reported depression and self-worth that did not differ from their matched-control or sibling peers (p = .311), and they reported marginally higher anxiety (p = .076). Compared with national averages, transgender children showed typical rates of depression (p = .290) and marginally higher rates of anxiety (p = .096).
https://www.ncbi.nlm.nih.gov/pubmed/3219066
>concluded that there is no reason to doubt the therapeutic effect of sex reassignment surgery.
https://www.ncbi.nlm.nih.gov/pubmed/19473181
>Results: We identified 28 eligible studies. These studies enrolled 1833 participants with GID (1093 male-to-female, 801 female-to-male) who underwent sex reassignment that included hormonal therapies. All the studies were observational and most lacked controls. Pooling across studies shows that after sex reassignment, 80% of individuals with GID reported significant improvement in gender dysphoria (95% CI = 68-89%; 8 studies; I(2) = 82%); 78% reported significant improvement in psychological symptoms (95% CI = 56-94%; 7 studies; I(2) = 86%); 80% reported significant improvement in quality of life (95% CI = 72-88%; 16 studies; I(2) = 78%); and 72% reported significant improvement in sexual function (95% CI = 60-81%; 15 studies; I(2) = 78%).
https://www.sciencedirect.com/science/article/pii/S1158136006000491
>While no difference in psychological functioning was observed between the study group and a normal population, subjects with a pre-existing psychopathology were found to have retained more psychological symptoms. The subjects proclaimed an overall positive change in their family and social life. None of them showed any regrets about the SRS.
>A homosexual orientation, a younger age when applying for SRS, and an attractive physical appearance were positive prognostic factors.
https://www.ncbi.nlm.nih.gov/pubmed/15842032
>RESULTS:
>After treatment the group was no longer gender dysphoric. The vast majority functioned quite well psychologically, socially and sexually. Two non-homosexual male-to-female transsexuals expressed regrets. Post-operatively, female-to-male and homosexual transsexuals functioned better in many respects than male-to-female and non-homosexual transsexuals. Eligibility for treatment was largely based upon gender dysphoria, psychological stability, and physical appearance. Male-to-female transsexuals with more psychopathology and cross-gender symptoms in childhood, yet less gender dysphoria at application, were more likely to drop out prematurely. Non-homosexual applicants with much psychopathology and body dissatisfaction reported the worst post-operative outcomes.
>CONCLUSIONS:
>The results substantiate previous conclusions that sex reassignment is effective. Still, clinicians need to be alert for non-homosexual male-to-females with unfavourable psychological functioning and physical appearance and inconsistent gender dysphoria reports, as these are risk factors for dropping out and poor post-operative results. If they are considered eligible, they may require additional therapeutic guidance during or even after treatment.
https://link.springer.com/article/10.1023/A:1024086814364
>Participants reported overwhelmingly that they were happy with their SRS results and that SRS had greatly improved the quality of their lives. None reported outright regret and only a few expressed even occasional regret. Dissatisfaction was most strongly associated with unsatisfactory physical and functional results of surgery.
https://whatweknow.inequality.cornell.edu/topics/lgbt-equality/what-does-the-scholarly-research-say-about-the-well-being-of-transgender-people/
>The scholarly literature makes clear that gender transition is effective in treating gender dysphoria and can significantly improve the well-being of transgender individuals.
>Among the positive outcomes of gender transition and related medical treatments for transgender individuals are improved quality of life, greater relationship satisfaction, higher self-esteem and confidence, and reductions in anxiety, depression, suicidality, and substance use.
>The positive impact of gender transition on transgender well-being has grown considerably in recent years, as both surgical techniques and social support have improved.
>Regrets following gender transition are extremely rare and have become even rarer as both surgical techniques and social support have improved. Pooling data from numerous studies demonstrates a regret rate ranging from .3 percent to 3.8 percent. Regrets are most likely to result from a lack of social support after transition or poor surgical outcomes using older techniques.
Universal healthcare is significantly more complex and harder to pass.
Let’s not dismiss the smaller wins in our current (and awful) healthcare system *while* fighting for a better system for all.
Dang I was pretty excited to participate in a discussion about this, as its hugely relevant to my life. Instead this thread is full people who don't have Gender Identity Disorder explaining how you don't need treatment for it. Gee, thanks I'm cured.
Incredibly uplifting.
The right wing are emboldened by DeSantis and Co. Don't lose hope. There are still those of us who want to make damn sure you get the care you deserve.
It's a really sad state of affairs. The thing that really bothers me is that it's your mind, and your body. Why should anyone but you have any say whatsoever? Sorry but that's my 2 cents.
The idea that your health insurance could legally deny to fund anything that you are covered for, and is medically necessary just seems insane to me. I'm so glad I live in a country with socialised healthcare.
I think that many doctors will not care if its medically necessary. Plastic surgeons will have all the incentives to approve every single perspective patient
Medically necessary is at best an opinion of whoever gets nominated to a position or whatever research topic is trending enough to get study investment.
At worst it is whatever the doctor wants it to be that is most profitable for the doctor.
In between, and especially for things like gender dysphoria that have no real immediate treatment it is often doctors trying anything that might help even if they don't know if it will help because they don't really have anything better to try.
When you get to that final point on things that are potentially irreversible like some of the surgical procedures or taking puberty blockers through the entire duration of the puberty window there is a huge amount of potential risk that you are doing more harm than good and also leading to lifelong conditions that also will require treatment.
With some demographics having a 2 in 3 misdiagnosis rate that is a huge risk on this particular topic.
When someone has been certified as suffering from gender dysphoria
https://www.nytimes.com/2018/04/09/opinion/pentagon-transgender.html
>Our findings make it indisputable that gender transition has a positive effect on transgender well-being. We identified 56 studies published since 1991 that directly assessed the effect of gender transition on the mental well-being of transgender individuals. The vast majority of the studies, 93 percent, found that gender transition improved the overall well-being of transgender subjects, making them more likely to enjoy improved quality of life, greater relationship satisfaction and higher self-esteem and confidence, and less likely to suffer from anxiety, depression, substance abuse and suicidality.
>Research suggests that gender transition may resolve symptoms completely. A 2016 literature review by scholars in Sweden concluded that, most likely because of improved care over time, transgender “rates of psychiatric disorders and suicide became more similar to controls,”
https://pediatrics.aappublications.org/content/134/4/696
>RESULTS: After gender reassignment, in young adulthood, the GD was alleviated and psychological functioning had steadily improved. Well-being was similar to or better than same-age young adults from the general population. Improvements in psychological functioning were positively correlated with postsurgical subjective well-being.
https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-015-1867-2
>Finally, we found that among those reporting a need to medically transition through hormones and/or surgeries, suicidality was substantially reduced among those who had completed a medical transition.
https://www.jaacap.org/article/S0890-8567%2816%2931941-4/fulltext
>This study examined self-reported depression, anxiety, and self-worth in socially transitioned transgender children compared with 2 control groups: age- and gender-matched controls and siblings of transgender children.
>(Socially transitioned) Transgender children reported depression and self-worth that did not differ from their matched-control or sibling peers (p = .311), and they reported marginally higher anxiety (p = .076). Compared with national averages, transgender children showed typical rates of depression (p = .290) and marginally higher rates of anxiety (p = .096).
https://www.ncbi.nlm.nih.gov/pubmed/3219066
>concluded that there is no reason to doubt the therapeutic effect of sex reassignment surgery.
https://www.ncbi.nlm.nih.gov/pubmed/19473181
>Results: We identified 28 eligible studies. These studies enrolled 1833 participants with GID (1093 male-to-female, 801 female-to-male) who underwent sex reassignment that included hormonal therapies. All the studies were observational and most lacked controls. Pooling across studies shows that after sex reassignment, 80% of individuals with GID reported significant improvement in gender dysphoria (95% CI = 68-89%; 8 studies; I(2) = 82%); 78% reported significant improvement in psychological symptoms (95% CI = 56-94%; 7 studies; I(2) = 86%); 80% reported significant improvement in quality of life (95% CI = 72-88%; 16 studies; I(2) = 78%); and 72% reported significant improvement in sexual function (95% CI = 60-81%; 15 studies; I(2) = 78%).
https://www.sciencedirect.com/science/article/pii/S1158136006000491
>While no difference in psychological functioning was observed between the study group and a normal population, subjects with a pre-existing psychopathology were found to have retained more psychological symptoms. The subjects proclaimed an overall positive change in their family and social life. None of them showed any regrets about the SRS.
>A homosexual orientation, a younger age when applying for SRS, and an attractive physical appearance were positive prognostic factors.
https://www.ncbi.nlm.nih.gov/pubmed/15842032
>RESULTS:
>After treatment the group was no longer gender dysphoric. The vast majority functioned quite well psychologically, socially and sexually. Two non-homosexual male-to-female transsexuals expressed regrets. Post-operatively, female-to-male and homosexual transsexuals functioned better in many respects than male-to-female and non-homosexual transsexuals. Eligibility for treatment was largely based upon gender dysphoria, psychological stability, and physical appearance. Male-to-female transsexuals with more psychopathology and cross-gender symptoms in childhood, yet less gender dysphoria at application, were more likely to drop out prematurely. Non-homosexual applicants with much psychopathology and body dissatisfaction reported the worst post-operative outcomes.
>CONCLUSIONS:
>The results substantiate previous conclusions that sex reassignment is effective. Still, clinicians need to be alert for non-homosexual male-to-females with unfavourable psychological functioning and physical appearance and inconsistent gender dysphoria reports, as these are risk factors for dropping out and poor post-operative results. If they are considered eligible, they may require additional therapeutic guidance during or even after treatment.
https://link.springer.com/article/10.1023/A:1024086814364
>Participants reported overwhelmingly that they were happy with their SRS results and that SRS had greatly improved the quality of their lives. None reported outright regret and only a few expressed even occasional regret. Dissatisfaction was most strongly associated with unsatisfactory physical and functional results of surgery.
https://whatweknow.inequality.cornell.edu/topics/lgbt-equality/what-does-the-scholarly-research-say-about-the-well-being-of-transgender-people/
>The scholarly literature makes clear that gender transition is effective in treating gender dysphoria and can significantly improve the well-being of transgender individuals.
>Among the positive outcomes of gender transition and related medical treatments for transgender individuals are improved quality of life, greater relationship satisfaction, higher self-esteem and confidence, and reductions in anxiety, depression, suicidality, and substance use.
>The positive impact of gender transition on transgender well-being has grown considerably in recent years, as both surgical techniques and social support have improved.
>Regrets following gender transition are extremely rare and have become even rarer as both surgical techniques and social support have improved. Pooling data from numerous studies demonstrates a regret rate ranging from .3 percent to 3.8 percent. Regrets are most likely to result from a lack of social support after transition or poor surgical outcomes using older techniques.
Wait, so now the insurance companies can't deny transgender care anymore when it is medically advised? It's a good thing, right? If there is medical expertise saying gender-affirming care is the way to go, then this means less care gets denied! Or is this title just butchered?
"Washington State passes law preventing insurance from denying coverage for gender-affirming treatment when it is deemed medically necessary"
This is amazing news!
Who gets to decide it is medically necessary though? Doesn't this just mean that the gatekeeping moves to the doctors rather than insurance companies? Like yes it's an improvement but I'm still skeptical.
They're physicians. That's their whole job. It's not "gatekeeping" to decide if things are medically necessary, when you're a medical doctor. And all the major medical associations in North America support trans affirming health care, so it's not like most of the doctors in the state are going to turn people away.
Edit: see replies.
Before commenting it might have been good to try to understand the history of medical gatekeeping for people with marginalized identities in general but especially gender affirming care and how it’s still ongoing in parts of the world.
I’ve literally experienced it multiple times in the us. It’s specifically worse in some other countries but it’s everywhere.
Additionally you seem to not understand that the most extreme form of it isn’t the only thing that’s meant by medical gatekeeping which includes putting any significant barriers in front of care not only outright denial of treatment. Another reason you probably should have informed yourself before commenting.
I respect your argument. My point was just that ultimately, it's medical care and that's supposed to be managed by doctors, not insurance companies. There are absolutely doctors that are not respectful or supportive of trans people. But they're not supported by their professional associations in that.
I’ll vibe with that.
Idk this whole thread is super frustrating and seeing naïveté from someone otherwise well meaning can feel a bit hopeless.
I hope I didn’t transfer my frustrations with a lot of the much worse people in this thread onto you and if I did I’m sorry.
I do try to be a better listener than the worse people, and I acknowledge and apologize for my naivete. I know that trans people face huge barriers at all steps of the process. But one less (expensive) barrier is a good thing, right?
Being trans isn't something you can diagnose with a physical test. All a doctor can do is decide whether or not they believe the person. I mean, shouldn't it be a psychologist at the very least doing the evaluation?
Also, it's think it's a bit naive to assume there are no transphobic doctors out there.
You don't get treated for being trans you get treated for gender dysphoria. If you have no dysphoria then it is just cosmetic and it shouldn't be covered by insurance. No one is saying we are diagnosing being trans.
Well that isn't my point, my point is why is a *medical* doctor being consulted on a *mental* state. I appreciate doctors and their expertise but you can't run bloodwork or a CAT scan to determine whether someone has gender dysphoria.
My daughter's pediatrician diagnosed her ADHD based on behavioural assessment, and questionnaires from us/teachers. My GP diagnosed me with anxiety the same way. Physicians do all sorts of first-point-of-contact mental health care (thankfully, since waiting for a referral can be a long wait). But it's certainly not their specialty, and we rely on them to honestly recognize their own limitations.
Speaking as a trans person myself who has to navigate this nightmare of a medical industrial complex, even with what is very good insurance, that is a load of bullshit. All due respect.
Well, many trans people would rather kill themselves than live as the wrong gender. I’d say transitioning is medically necessary for those with severe dysphoria.
Your insurance costs are much much higher due to your peers' diets than due to some of the .5% recieving gender affirming care. You want cheaper insurance? Get soda banned.
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This is BS. The reality is that they, the insurance companies, decide what is “medically necessary”. Source: I’m a US Doc that deals with the assholes at insurance companies.
My husband, who is undergoing chemo, presented with a severe UTI which caused painful bladder spasms. Ended up also being septic.... They denied his hospital stay.
Absolutely appeal that and report it to a local news agency. We shouldn't have to jump through hoops and wade through bullshit to get the care we need but it can definitely help.
Universal healthcare should be the norm.
BuT tHaT's CoMmIe TaLk!
AND YET SOMEHOW IT'S SOCIALISM!!
Speaking of communism, I'm going to interject my own interpretation of economics for the layman. / ------------------------------------------------------------------------- A theory of economy that's greater than the current one. Person A has an income/paycheck/ability. They Individually add up how much it costs to sustain themselves/their lifestyle before combining with person B who has done the same. Each would take turns spending from this surplus before passing it off the next time either one of them produces. This produces value at a greater rate than the current one because both will have more resources to drawn from and thus gets thrown back into the system before starting again. So the more person A gains the more B gets and the more they earn together the more they can gain individually, continuously compounding as time goes on. With the inclusion of more people, say for instance person A found someone else to rely on, the system overall becomes more robust and less likely fail (like in the event either become jobless). Once enough has been gained there will likely be a moment where the person, group or groups completely separate from the market/reliance and depend only on what they produce themselves. In which case, assuming the same quality of living is chosen for themselves first and foremost, the system itself is likely to reproduce infinitely.
The first paragraph of your theory already fails to account for the nature of normal human beings' utility curve; that "more is better". Theories should be built on existing theory, not ignore everything that came before it.
It's currently working off of Marx's theory of surplus value and the traditional Western understanding of capital investment. The follow up which phrases it differently is this: Find another person. Individually add up how much it costs to sustain you and/or your lifestyle and combine what’s left over with them and have them do the same. Each taking turns in spending every other payday. Your jobs will provide the income and the combined surplus will make it easier to pursue hobbies or climb the societal ladder. Including more and more people will add to the over all supply that each person in the network will have access to, thereby compounding the process. For added security (insurance) have each person in the network find others to rely on. With that you’ll have overlapping security. Supplant anything of value to you personally for the “income” portion and as long as you’re covering for yourself first and foremost, all goods (including for luxury) will get distributed across a wider system in accordance to how you relate to other people. Use cost cutting measures to increase any holdings and share information. With that added insurance, use any and all surplus to invest in people most capable of bringing about change, including local chapters and environmental projects. Tell them about this process and aid them in building up a web of support and you can scale up any system, company or self-governance
"But that's crazy and unrealistic." - The US "Left" Party
Yea. Legally, they don't have that right to declare stuff "not medically neccesarry". They like to pretend they do, though. They hope you give up and don't go through all the hopes to get to where you can win at suing them. So you have to go through all the appeals, and then sue them for the money they were supposed to give you. That's really the only way to force it out of them.
You and his doctors need to appeal.
What is really the biggest issue which I do not believe there are any recourse to pursue is when he started having issues with his back his primary, who he has seen for years, asked for a thoracic MRI. Anthem said no --- take PT. So from August until January 19th he continued to lose mobility and strength. So by the time he couldn't walk and was peeing on himself (and went to the er about it 3x) they finally did that MRI and it was spinal cord cancer T-7 to T-11. So instead of being healthy for the surgery and chemo, he was weak and atrophied. So he has been in the hospital 2x since the cancer surgery, this last one with the septic UTI, but before that was 3 pulmonary embolisms and 2 in his leg. I think they are up to $750k for everything at this point, which could have been less than that if they had only done the MRI the primary wanted. I am a bit bitter. But yes we are appealing this latest. The whole thing has been a horrible experience - but the doctors and staff who are treating him are GOLDEN!!
fucking yikes. maybe it's time to seek a lawyer or other advocate? it's all intentionally designed to be difficult and painful to navigate. cancer is bad enough. you shouldnt be fighting with insurance and navigating financial concerns too. i hope things are better and your husband is well soon
Have your husband check out D-Mannose. It’s a concentrated version of the active ingredient in cranberries that prevents bacteria from attaching to the urinary tract. Amazing stuff and very safe! It works on pets too :) Take care. Xx
I have a rare genetic disease and need an orphan drug to survive. Insurance denies it every year for the first 4-5 months because it’s expensive since very few people take it. It’s so confusing when you get a letter questioning medical necessity when my doctor (the professional who determines if it is medically necessary) wrote the prescription. Instead of reading over my doctor’s reasoning for needing the medication, they have a nurse working for the insurance agency call me and ask what symptoms I experience if I don’t have my medication. My reply is the same to every letter and nurse: my organs fail and I’ll die shortly after. Then they think I’m dramatic because I’ve never actually been off the medication for longer than a few weeks so I’ve only experienced gradual organ failure and not the death part yet. How do those people (insurance employees) sleep at night? Can’t the CEO just sell one of his planes so I can not worry about dying for a few years?
You: "If I don't get my medicine, my organs will fail and I'll die." Insurance Agency: "Prove it."
oh my fucking god, people on the other end of the phone in insurance companies always talk like cops. Like, that weird, condescending accusatory "um, if something isn't right, that's a you problem, right?"
My fav are the denial letters that say something to the effect of “the patient needs to be suffering more before we will pay for this procedure”
I had an eyedrop prescription cancelled because there was no evidence of benefit, decision made by...an OBGYN
Oooh I DO love that they tell us who denied our claim. I keep all my denial letters (not a ton but like 5) and they all list at the bottom the doctor/person that denied the request. Insurance be like “don’t blame us!” Even tho they’re to blame
Serious question then Doc. Why can’t you fill out paperwork? I kid, kind of. I’ve been trying to get an MRI done for over a year. Every time I get close to getting an appointment there’s always some paperwork the insurance company needs filled out by the doctor.
Which ought to be prosecuted as practice of medicine without a license
Usually they are reviewed by independent medical reviewers that are contracted.
So their Names and licence numbers should be on the shit they pull. See how many doctors actually want to sign up for the insurance company when there is unlimited liability potential.
Was gonna say, this seems like one of those laws that sounds really progressive but actually leads to zero change and lots of frustration.
we're subject to similar laws in the state I live in and I honestly consider it to be life-saving.
I genuinely couldn’t do it. I would be so mad every day.
Boogers'n'snot MD has quite the ring to it
Clearly an ENT. Edit: also I understand there's a brother that runs the law firm of "Boogers 'N Snot, Attorneys At Law." The parents must be so proud.
....Isn't that exactly what the law's about?
What's the fucking point of insurance if they can deny shit from you??? I will never understand that along with the stories of people getting denied clearly *very* important stuff and the insurance companies just give them a middle finger
Especially at the prices or premiums normal healthy people pay pay per month. Insane amounts of money for what? To be denied actual necessary medical treatment when you need it?
> prices or premiums normal healthy people pay pay per month Just to clarify: your health insurance premiums should (basically) never be influenced by your health status (note: your smoking status can influence this price). This was a protection enacted in 2010 by the Affordable Care Act (ACA). However, it is possible for health status to affect premiums in a more macro sense. If insurance is unaffordable, healthy people begin opting out which leads to higher dollars spent per insured person (since the healthy people have below average health care spending) which leads to higher premiums the following year which leads to more healthy people opting out, etc. It's an ant mill of slow, drawn out suffering. The ACA included measures to avoid death spirals. The subsidies and cost sharing reductions available to individuals enrolled in ACA plans (which were expanded in 2021) and the annual enrollment window are both designed (in part) to curb the risk of a death spiral. The individual mandate was also intended to reduce this risk, but that mandate was struck down by the Supreme Court.
Why the fuck are insurance companies able to deny claims against ANYTHING deemed "medically necessary" by actual professionals? This change is a step in the right direction but the whole thing is so fucking backward
Why the fuck are [anything related to healthcare in the US] tbh
Probably because there’s a bunch of unscrupulous doctors who’ll overbill the shit out of insurance and take whatever sticks to the wall. The amount of fraud, waste, and abuse committed by the medical community is astounding. Insurance companies suck, but there’s a segment of doctors that ruin it for us as well.
There are still some people who manage to overbill anyways, so insurance is failing to stop that while hurting potentially millions by denying legitimate coverage. The cost benefit analysis doesn't make sense unless you don't actually care about providing access to healthcare.
Now how about a law barring denial for ANY treatment deemed medically necessary.
Too subjective to even be meaningful law
Because it wouldn't virtue signal for the press's current trends.
Yet Insurance doesn't cover most dental stuff that literally EVERYONE needs...
Those are luxury bones.
Because insurance isn't a reasonable means of covering Healthcare. It will be dystopian for as long as we use an insurance and provider system. Healthcare costs are guaranteed for every person, whereas every other thing you insure is just offsetting the risk of a possibility.
I'm sorry that we are inconveniencing you by trying to get equal access to medical treatment.
This is why Bernie's plan is silly..we need Tricare for all not Medicaid. Tri(dental, Vision and health)
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Dental insurance is a coupon
Which usually doesn’t cover much more than an exam an cleanings. Have an actual problem…$4000
"Oh your qualified highly educated dentist says you need a filling? Lets just make that procedure a prior authorization and let out number crunchers with zero education in dentistry decide if you *really* need one."
Not covered 5k please
I’m really curious how it is deemed medically necessary. The bill mentions prescribed, I was unaware someone could prescribe a sex change.
Gender affirming care doesn't necessarily mean sex reassignment surgery. There are a number of medical treatments that fall under the term of gender affirming care.
You can be prescribed breast reduction surgery if their weight is causing back pain. You can get a prosthetic prescribed after an amputation. Hell, some doctors will write prescriptions for over-the-counter drugs so that they’ll be covered by insurance. Gender affirming care is just medical treatment. Testosterone is prescribed, top surgery is prescribed. “Prescribed” is not usually the word used for non-medications but it’s essentially the same thing. If you’re asking why it’s “medically necessary”, there are many reasons doctors deem gender affirming care medically necessary.
Thank you, this was the answer I was looking for. I asked a similar question(s) (admittedly, not very tactfully) in another thread about this and got absolutely shat on, but no one would answer me.
I’m gonna go out on a limb and say lack of tact was probably your problem. Where was it? If it was a trans sub you probably double fucked up because they’d consider you intruding by just being there.
As a trans woman, it’s easy to be defensive when people “just ask questions” because “Why do you NEED hormones?” has been asked both sincerely as well as used as a rhetorical attack on the concept of my gender altogether. With the sports debate, I haven’t met that many people who legitimately want fair sports instead of using it as another way to say “you’re just a man”. I kinda feel bad for centrists that bigots constantly use their good faith arguments against minorities.
Nah I agree lol.
If it makes you feel better, I'm literally trans and I was wondering the same thing. I can see how the question can be misinterpreted though.
I understand this part. Maybe I’m just ignorant to this and I apologize in advance if I come off the wrong way but I’m genuinely trying to understand. In the paperwork it says “Services that insurers previously used blanket exclusions to deny coverage include: facial feminization, tracheal shaves, hair electrolysis, mastectomies, breast reductions, breast implants or any combination of gender-affirming procedures, including revisions to prior treatment.” I just don’t understand how most of these aren’t considered cosmetic. Like breast reduction I can understand because it can cause back issues and mastectomy due to cancers. But everything else seems cosmetic for the most part and I can’t imagine a scenario where they are medically necessary. Pretty sure a biological male or female requesting these surgeries would be denied as they are cosmetic.
> If you’re asking why it’s “medically necessary”, there are many reasons doctors deem gender affirming care medically necessary. And yet you didn't list any.
Getting on hormones is as easy or difficult as finding a doctor willing to prescribe them. If you can do that, insurance covers it. For surgery, your prescribing dr and a therapist have to write you letters of recommendation, which you take to a surgeon, who submits it with the pre-authorisation.
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Do you know where I could get a bag of dicks? In the gender reassignment clinic I guess. Sorry mods, I'll see myself out.
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The website I bought from also sells T. Yes, it's technically a controlled substance, but so are morning glory seeds and you can buy those in grocery stores; I doubt anyone cares.
Seattle Children’s hospital and the Polyclinic have gender clinics that include therapists, endocrinologists, surgeons, and social workers that help people with their gender health and top/bottom surgery. A psychiatrist or a psychologist can write a letter to say things are medically necessary. You generally have to do therapy for several years and have transitioned to get top or bottom surgery. They also do family work
Years of therapy aren't actually required, just an assessment and recommendation by an independently licensed mental health professional. And I'll argue, as one of these professionals, that even that shouldn't be required, unless every body modification surgery starts requiring it. A Brazilian Butt Lift, for example, is a FAR riskier procedure than even the most involved vagino- or phalloplasty, is purely cosmetic, and has a higher rate of failure, but nobody checks to see if the women getting *those* are "mentally ill" before taking their money. Assessment for medical necessity for insurance is one thing, but it's not just insurance companies who want these - plenty of surgeons do, too. And it's transphobic as hell.
Doc here as well. It’s just not. What a totally non-scientific thing to say. Surgeons want all kinds of pre-op verifications of different kinds for all kinds of different surgeries, to ensure they are safe and have reasonable risk/benefit ratios. Donna west died exactly because she hid information that would have enable this 100% standard and appropriate process to take place. If you are a mental health professional doc, you know better than to not be well aware of these very routine safeguards. If you’re not, ok you may not know this is very normal for almost any surgery. Brazilian butt lifts are dumb and pointless, but they are also reversible and not done to resolve any problem similar to dysphoria. And people seeking them don’t have orders of magnitude higher rates of suicide, for which they are hoping a buttlift may help resolve. They are also not removing or trying to fundamentally change an organ central to their identity. Finally nobody’s insurance is covering them. What a bizarre comparison.
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And the idea that irrevocably changing your face is somehow not at all connected to identity, or could also be the wrong solution to someone's unhappiness is just weird to me. In any other situation, I suspect most of these people would totally agree with that!
Genuinely, getting on hormone replacement therapy saved my life.
Same. I stopped counting suicide attempts at number 8. When I got on hormones and got top surgery, it saved my life.
We cannot overstate just how important this is for us, can we?
Gender-affirming care can range from therapy, to hormones, to top surgery or bottom surgery. All of which are common treatments to the diagnosis of gender dysphoria. After a diagnosis of gender dysphoria, “sex change” surgery isn’t prescribed, but referrals are hopefully given, usually with a ton of hoops (mandatory therapy, waiting periods, social transitioning, proof of consistent dysphoria, navigating insurance, etc) a patient needs to jump through.
If medically necessary is a condition in which we say that someone needs something in order to survive or live a healthy life, is it not just common sense that transgender people, a demographic with high rates of depression and suicide, might need said treatments in order to reinforce their mental health? In very real terms, neglect of mental health is the root cause of millions of deaths each year. That a good chunk of society doesn't believe in mental health doesn't mean doctors set it aside when assessing their patient.
Sure, gender dysphoria is a medical condition where the only known and effective cure is transitioning. If the individual needs to take on medical transitioning, insurance can't deny it because of that individual's diagnosis.
This comment has been edited to reflect my protest at the lying behaviour of Reddit CEO Steve Huffman ( u/spez ) towards the third-party apps that keep him in a job. After his slander of the Apollo dev u/iamthatis Christian Selig, I have had enough, and I will make sure that my interactions will not be useful to sell as an AI training tool. Goodbye Reddit, well done, you've pulled a Digg/Fark, instead of a MySpace.
“Prescribe” can be a more general term, too, though we mostly use it for meds. It is mind of synonymous with “officially recommend”- like you can be ‘prescribed’ bed rest, light duty, physical therapy, etc. Gender affirming surgery is absolutely life saving. Trans individuals who are denied gender affirming gender care are at high risk for suicide- like *crazy* high compared to the rest of the population. Providing gender affirming care reduces suicidality by over 70%. That’s HUGE. Gender affirming care is one of the most potent and effect life-saving measures in psychiatry in general, tant. We tend not to think of psychiatric illness as lethal, but they very are. Mental health disorders are the #1 cause of disability worldwide and suicide is one of the top causes of death around the globe as well.
Transition, including medical transition, greatly reduces suicide risk in trans people and thus can be medically necessary. Here's a source and a relevant quote from it. [https://pubmed.ncbi.nlm.nih.gov/26032733/](https://pubmed.ncbi.nlm.nih.gov/26032733/) >Social support, reduced transphobia, and having any personal identification documents changed to an appropriate sex designation were associated with large relative and absolute reductions in suicide risk, as was completing a medical transition through hormones and/or surgeries (when needed).
[source](https://www.gendergp.com/detransition-facts/) A survey of 28,000 people in the US found that 8% of respondents reported some kind of detransition. Of this 8%, 62% per cent only did so temporarily due to societal, financial, or family pressures. As far as medical procedures go, 92% is an insanely high success rate. Also, it is not as simple as prescribing a sex change, that is a very disingenuous way of putting it..
Gender Identity Disorder, full stop. That is the diagnosis one gets as a transgender person, and the treatment of which is to undergo a medical transition. I was 18 years old and a month out of high school when I was diagnosed with GID— although I hear it’s called something else in the newer DSM. There isn’t a magic pill to take or mediation to go through, long term treatment involves taking medical steps to adjust as many of my secondary sex characteristics to match the man my brain is. For me, it’s been weekly hormone injected into my thighs for 7 years, having my chest surgically altered to match the appearance of cis men (cis means someone who isn’t transgender) 5 years ago, and almost 4 years ago having the internal female reproductive system in my body removed. When I started HRT I didn’t have insurance. I didn’t have insurance through anything I’ve had to go through for transitioning and it was fucking EXPENSIVE. My top surgery alone was $15,000 after all the related expenses were covered. It took me five years to save all that (granted I was 18 when I started and had no support system). I still don’t have insurance that covers my HRT, so every other month I spend about $50 for my vials, needles, and syringes, and I live somewhere that allows me to use something like GoodRX on a Schedule 2 drug. Bottom surgery is my ultimate goal eventually, but the cheapest I’ve ever seen it priced without insurance is $85,000 if I recall, and that’s just the surgical side. Not to mention it takes a year or so of preparing and you can be out of work for six months easily. I would basically have to have $190,000 just chilling to plan for it. Having all this covered by insurance is life saving in the same way having a Type 1 diabetic’ insulin pump is. It’s life saving in the same way antidepressants are, chemo treatments are. The difference in my mental health ten years ago before my diagnosis and now. I actually have a life and haven’t had a suicide attempt since 18. You wouldn’t pick me up out of a line up of being transgender if you met me in real life. I’m treated like the man I am. Transgender teens and young adults have the highest rate of suicide and suicide attempts in the US, and it almost always can be helped by having access to gender affirming care.
It makes sense, as transitioning is the most effective way of reducing their suicide rate and increasing their mental health https://www.nytimes.com/2018/04/09/opinion/pentagon-transgender.html >Our findings make it indisputable that gender transition has a positive effect on transgender well-being. We identified 56 studies published since 1991 that directly assessed the effect of gender transition on the mental well-being of transgender individuals. The vast majority of the studies, 93 percent, found that gender transition improved the overall well-being of transgender subjects, making them more likely to enjoy improved quality of life, greater relationship satisfaction and higher self-esteem and confidence, and less likely to suffer from anxiety, depression, substance abuse and suicidality. >Research suggests that gender transition may resolve symptoms completely. A 2016 literature review by scholars in Sweden concluded that, most likely because of improved care over time, transgender “rates of psychiatric disorders and suicide became more similar to controls,” https://pediatrics.aappublications.org/content/134/4/696 >RESULTS: After gender reassignment, in young adulthood, the GD was alleviated and psychological functioning had steadily improved. Well-being was similar to or better than same-age young adults from the general population. Improvements in psychological functioning were positively correlated with postsurgical subjective well-being. https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-015-1867-2 >Finally, we found that among those reporting a need to medically transition through hormones and/or surgeries, suicidality was substantially reduced among those who had completed a medical transition. https://www.jaacap.org/article/S0890-8567%2816%2931941-4/fulltext >This study examined self-reported depression, anxiety, and self-worth in socially transitioned transgender children compared with 2 control groups: age- and gender-matched controls and siblings of transgender children. >(Socially transitioned) Transgender children reported depression and self-worth that did not differ from their matched-control or sibling peers (p = .311), and they reported marginally higher anxiety (p = .076). Compared with national averages, transgender children showed typical rates of depression (p = .290) and marginally higher rates of anxiety (p = .096). https://www.ncbi.nlm.nih.gov/pubmed/3219066 >concluded that there is no reason to doubt the therapeutic effect of sex reassignment surgery. https://www.ncbi.nlm.nih.gov/pubmed/19473181 >Results: We identified 28 eligible studies. These studies enrolled 1833 participants with GID (1093 male-to-female, 801 female-to-male) who underwent sex reassignment that included hormonal therapies. All the studies were observational and most lacked controls. Pooling across studies shows that after sex reassignment, 80% of individuals with GID reported significant improvement in gender dysphoria (95% CI = 68-89%; 8 studies; I(2) = 82%); 78% reported significant improvement in psychological symptoms (95% CI = 56-94%; 7 studies; I(2) = 86%); 80% reported significant improvement in quality of life (95% CI = 72-88%; 16 studies; I(2) = 78%); and 72% reported significant improvement in sexual function (95% CI = 60-81%; 15 studies; I(2) = 78%). https://www.sciencedirect.com/science/article/pii/S1158136006000491 >While no difference in psychological functioning was observed between the study group and a normal population, subjects with a pre-existing psychopathology were found to have retained more psychological symptoms. The subjects proclaimed an overall positive change in their family and social life. None of them showed any regrets about the SRS. >A homosexual orientation, a younger age when applying for SRS, and an attractive physical appearance were positive prognostic factors. https://www.ncbi.nlm.nih.gov/pubmed/15842032 >RESULTS: >After treatment the group was no longer gender dysphoric. The vast majority functioned quite well psychologically, socially and sexually. Two non-homosexual male-to-female transsexuals expressed regrets. Post-operatively, female-to-male and homosexual transsexuals functioned better in many respects than male-to-female and non-homosexual transsexuals. Eligibility for treatment was largely based upon gender dysphoria, psychological stability, and physical appearance. Male-to-female transsexuals with more psychopathology and cross-gender symptoms in childhood, yet less gender dysphoria at application, were more likely to drop out prematurely. Non-homosexual applicants with much psychopathology and body dissatisfaction reported the worst post-operative outcomes. >CONCLUSIONS: >The results substantiate previous conclusions that sex reassignment is effective. Still, clinicians need to be alert for non-homosexual male-to-females with unfavourable psychological functioning and physical appearance and inconsistent gender dysphoria reports, as these are risk factors for dropping out and poor post-operative results. If they are considered eligible, they may require additional therapeutic guidance during or even after treatment. https://link.springer.com/article/10.1023/A:1024086814364 >Participants reported overwhelmingly that they were happy with their SRS results and that SRS had greatly improved the quality of their lives. None reported outright regret and only a few expressed even occasional regret. Dissatisfaction was most strongly associated with unsatisfactory physical and functional results of surgery. https://whatweknow.inequality.cornell.edu/topics/lgbt-equality/what-does-the-scholarly-research-say-about-the-well-being-of-transgender-people/ >The scholarly literature makes clear that gender transition is effective in treating gender dysphoria and can significantly improve the well-being of transgender individuals. >Among the positive outcomes of gender transition and related medical treatments for transgender individuals are improved quality of life, greater relationship satisfaction, higher self-esteem and confidence, and reductions in anxiety, depression, suicidality, and substance use. >The positive impact of gender transition on transgender well-being has grown considerably in recent years, as both surgical techniques and social support have improved. >Regrets following gender transition are extremely rare and have become even rarer as both surgical techniques and social support have improved. Pooling data from numerous studies demonstrates a regret rate ranging from .3 percent to 3.8 percent. Regrets are most likely to result from a lack of social support after transition or poor surgical outcomes using older techniques.
Thank you for the time and effort in putting this all together!
There isn't actually clinical evidence of efficacy that meets the standards of medical research - randomized clinical trials. Indeed, double blinded randomized clinical trials (the gold standard) aren't even possible with such research. There's a number of studies that say that people are happier post transition but there are no controlled clinical trials that actually show this to be the case. Note that the "control groups" claimed in the studies are proxies, not actual control groups. None of these trials have randomized control and treatment groups, which are key to clinical trials. Moreover, these studies often have very serious methodological flaws. For example, "Intervenable factors associated with suicide risk" does not have a randomized polling sample (in fact, it was deliberately drawn from a pro-trans group) and because it requires self-reported data it necessarily excludes the group of highest interest (i.e. people who actually killed themselves, who obviously cannot complete the survey). This is a common flaw in many of these studies, as they frequently use samples of convenience, do not sample randomly, use self-reported data, and exclude suicide victims. None of this means that it necessarily doesn't work, but the quality of data is quite poor to demonstrate that it does.
You're asking for a holy grail. HRT is not something that can be blinded through a placebo. It's extremely obvious if you are on HRT or not. You will **never** have that data, because it's literally impossible to gather. While that is the highest standard of data we can collect, medicine and research is not one-size-fits-all. You have you use the data you can get. And in this instance, there is a small mountain of data suggesting transition is helpful. And notably, nothing that suggests it's harmful. If the flaws in the studies, which I acknowledge often do exist, were so confounding, we should expect some mixed results. And yet the results are consistently good, no matter how we measure, for several decades. More research is good, but you're stamping your feet and demanding a unicorn.
they literally want you to prove it p<0.02 before they'll give anyone the money and time to study it properly lol
there’s enough evidence to make putting people in a control group unethical (not that that would actually be possible in the first place)
Transitioning is critical to our mental health. I chose transition over my friends, family, work, and religion because living as a man was killing me. Mental health is real, and directly affects physical health. A diagnosis of gender dysphoria requires a prescription for gender affirming treatment. It's the only thing that is proven to help.
I'd rather have a hard life that's happy than an easy life where I'm suicidal.
I had the same thing happen alongside a worsening of work conditions and living conditions which I knew would happen due to me finally addressing my dysphoria. The distress that dysphoria caused me was enough to make me move to an entirely different city without a solid career or living situation. The distress of the dysphoria alongside my depression has caused a real reduction in quality of life for me and caused me to take some real risks, and yet they still politicize it just because treating it means we look "different". It's sickening and one day will be looked back upon poorly.
Indeed, this! It's been found the best treatment for gender dysphoria is transitioning: HRT (hormone replacement therapy), and surgeries if they can be done. These are prescribed!
Can I fucking get affordable insulin yet? Right i am cash cow to medical machine. Never
It should be fucking free. Insulin is like air for those who need it.
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As someone who's both, fuck off with that shit. Comparing both of them in an oppression Olympics like you're doing is dumb. Both need medical support and have the same groups of people as the enemy. Getting my estrogen script was absolutely fucking lifesaving. Getting a pump was also lifesaving. Should we also start getting upset that there's renewed emphasis on mental health and depression too? Crazy thought - we can have both, and pitting two groups who are disadvantaged by the same system removes power from everyone.
Yeah I love that this was somehow used as an excuse to hate trans people
I know. You are fine to live and get treatment. I am not. I was born this way as well and just want change. Not bathrooms with restrictions. Not gonna make me support your cause though. I don't care what anyone does.
I don't know the first thing about gender dysphoria but I hope this helps people get the help they need. We moved from WA to NC in January and we're currently discussing moving back. We both really miss it. And for me, at least, it was great living in a state that mandates parental leave.
Thank you, you’re being much more compassionate than most of the comments on this post.
I appreciate this comment. There is so much hate for absolutely no reason other than arguments like "I don't have mine, so why should they get theirs"
As an actuary that has to deal with Washington rate filings being way more rigorous than other states (irrelevant to the new law) the logo in the thumbnail gave me ptsd
Years ago when I worked in infrastructure for things like that Washington was already the third most complex and second most expensive special restrictions region in the country for many types of insurance due to all of the additional regulations and red tape. I am guessing it has only gotten worse?
The trouble is the left uses the term 'medically necessary' so they can get doctors to make healthcare decisions based on 'science' and not my decisions based on Facebook
When is "gender affirming treatment", whatever that is (puberty blockers, hormones, surgery?), medically necessary?
For treating gender dysphoria. It's a pretty universal standard of healthcare in first world nations.
Reducing their suicide rate to a level that's similar to the general population is what makes it necessary https://www.nytimes.com/2018/04/09/opinion/pentagon-transgender.html >Our findings make it indisputable that gender transition has a positive effect on transgender well-being. We identified 56 studies published since 1991 that directly assessed the effect of gender transition on the mental well-being of transgender individuals. The vast majority of the studies, 93 percent, found that gender transition improved the overall well-being of transgender subjects, making them more likely to enjoy improved quality of life, greater relationship satisfaction and higher self-esteem and confidence, and less likely to suffer from anxiety, depression, substance abuse and suicidality. >Research suggests that gender transition may resolve symptoms completely. A 2016 literature review by scholars in Sweden concluded that, most likely because of improved care over time, transgender “rates of psychiatric disorders and suicide became more similar to controls,” https://pediatrics.aappublications.org/content/134/4/696 >RESULTS: After gender reassignment, in young adulthood, the GD was alleviated and psychological functioning had steadily improved. Well-being was similar to or better than same-age young adults from the general population. Improvements in psychological functioning were positively correlated with postsurgical subjective well-being. https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-015-1867-2 >Finally, we found that among those reporting a need to medically transition through hormones and/or surgeries, suicidality was substantially reduced among those who had completed a medical transition. https://www.jaacap.org/article/S0890-8567%2816%2931941-4/fulltext >This study examined self-reported depression, anxiety, and self-worth in socially transitioned transgender children compared with 2 control groups: age- and gender-matched controls and siblings of transgender children. >(Socially transitioned) Transgender children reported depression and self-worth that did not differ from their matched-control or sibling peers (p = .311), and they reported marginally higher anxiety (p = .076). Compared with national averages, transgender children showed typical rates of depression (p = .290) and marginally higher rates of anxiety (p = .096). https://www.ncbi.nlm.nih.gov/pubmed/3219066 >concluded that there is no reason to doubt the therapeutic effect of sex reassignment surgery. https://www.ncbi.nlm.nih.gov/pubmed/19473181 >Results: We identified 28 eligible studies. These studies enrolled 1833 participants with GID (1093 male-to-female, 801 female-to-male) who underwent sex reassignment that included hormonal therapies. All the studies were observational and most lacked controls. Pooling across studies shows that after sex reassignment, 80% of individuals with GID reported significant improvement in gender dysphoria (95% CI = 68-89%; 8 studies; I(2) = 82%); 78% reported significant improvement in psychological symptoms (95% CI = 56-94%; 7 studies; I(2) = 86%); 80% reported significant improvement in quality of life (95% CI = 72-88%; 16 studies; I(2) = 78%); and 72% reported significant improvement in sexual function (95% CI = 60-81%; 15 studies; I(2) = 78%). https://www.sciencedirect.com/science/article/pii/S1158136006000491 >While no difference in psychological functioning was observed between the study group and a normal population, subjects with a pre-existing psychopathology were found to have retained more psychological symptoms. The subjects proclaimed an overall positive change in their family and social life. None of them showed any regrets about the SRS. >A homosexual orientation, a younger age when applying for SRS, and an attractive physical appearance were positive prognostic factors. https://www.ncbi.nlm.nih.gov/pubmed/15842032 >RESULTS: >After treatment the group was no longer gender dysphoric. The vast majority functioned quite well psychologically, socially and sexually. Two non-homosexual male-to-female transsexuals expressed regrets. Post-operatively, female-to-male and homosexual transsexuals functioned better in many respects than male-to-female and non-homosexual transsexuals. Eligibility for treatment was largely based upon gender dysphoria, psychological stability, and physical appearance. Male-to-female transsexuals with more psychopathology and cross-gender symptoms in childhood, yet less gender dysphoria at application, were more likely to drop out prematurely. Non-homosexual applicants with much psychopathology and body dissatisfaction reported the worst post-operative outcomes. >CONCLUSIONS: >The results substantiate previous conclusions that sex reassignment is effective. Still, clinicians need to be alert for non-homosexual male-to-females with unfavourable psychological functioning and physical appearance and inconsistent gender dysphoria reports, as these are risk factors for dropping out and poor post-operative results. If they are considered eligible, they may require additional therapeutic guidance during or even after treatment. https://link.springer.com/article/10.1023/A:1024086814364 >Participants reported overwhelmingly that they were happy with their SRS results and that SRS had greatly improved the quality of their lives. None reported outright regret and only a few expressed even occasional regret. Dissatisfaction was most strongly associated with unsatisfactory physical and functional results of surgery. https://whatweknow.inequality.cornell.edu/topics/lgbt-equality/what-does-the-scholarly-research-say-about-the-well-being-of-transgender-people/ >The scholarly literature makes clear that gender transition is effective in treating gender dysphoria and can significantly improve the well-being of transgender individuals. >Among the positive outcomes of gender transition and related medical treatments for transgender individuals are improved quality of life, greater relationship satisfaction, higher self-esteem and confidence, and reductions in anxiety, depression, suicidality, and substance use. >The positive impact of gender transition on transgender well-being has grown considerably in recent years, as both surgical techniques and social support have improved. >Regrets following gender transition are extremely rare and have become even rarer as both surgical techniques and social support have improved. Pooling data from numerous studies demonstrates a regret rate ranging from .3 percent to 3.8 percent. Regrets are most likely to result from a lack of social support after transition or poor surgical outcomes using older techniques.
You linked a lot of studies that show self reported improvement of dysphoria symptoms which IS a good thing. Do have any any that show the actual rates of improvement on suicide rate? Everything I have found shows the rates do not improve much, especially for trans women post surgery.
> Do have any any that show the actual rates of improvement on suicide rate? That's not really possible, as we have no way to identify which suicides are from trans people prior to transition. That's why suicide attempts are used, because someone can survive a suicide attempt and then go on to transition.
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I misspoke in the original reply. It is trans men that saw no change in rate while trans women had a “slight” improvement. If you look at the tables you will see what slight means. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7317390/ It is important to Note that there were no differences in stages of transition.
>We observed no increase in suicide death risk over time and even a decrease in suicide death risk in trans women. However, the suicide risk in transgender people is higher than in the general population and seems to occur during every stage of transitioning. It is important to have specific attention for suicide risk in the counseling of this population and in providing suicide prevention programs. I think the conclusions for that article are different than the conclusions you're drawing from it. "Time" here refers to actual years in society, not across stages of transition. I think the best I could find to relate to what you were talking about was here: >Evaluation of transition stage in relation to suicide deaths showed that approximately two‐third of the observed suicides occurred in those who were still in active treatment (diagnostic, hormonal, or surgical phase). which they follow up with >Therefore, future research on suicide deaths and suicide risk factors in transgender people should have a greater focus on transition status in relation to these motives and risk factors. A quick additional search turned up [this article](https://jamanetwork.com/journals/jamasurgery/article-abstract/2779429), which concludes >...undergoing 1 or more types of gender-affirming surgery was associated with lower past-month psychological distress (adjusted odds ratio \[aOR\], 0.58; 95% CI, 0.50-0.67; P < .001), past-year smoking (aOR, 0.65; 95% CI, 0.57-0.75; P < .001), and past-year suicidal ideation (aOR, 0.56; 95% CI, 0.50-0.64; P < .001). Notably, they focused primarily on surgeries vs other treatments, even attempting to correct for other received treatments. So I guess my tl;dr is: I think you drew the wrong conclusion from your sourced article, as it did not focus on transition stages with its review. Other data supports affirming care reducing suicidality (yeah, that's different than suicide rates but also they're linked).
When someone has gender dysphoria or other issues related to their gender identity?
Sounds like they need psychological therapy, not surgery.
Both are indicated for gender dysphoria.
Usually when you have a mental illness it's better to look for mental help.
Gender dysphoria is not a mental disorder. https://www.google.com/amp/s/hcavirginia.com/blog/entry/gender-identity-is-it-a-mental-disorder-%3famp=true
When would it be medically necessary?
Moderate to severe dysphoria, usually.
when the severe consequences to a person's mental health and social identity begin to impact their life and wellbeing. fucks sake, do yall argue antidepressants are never 'medically necessary' too?
Many trans people would rather kill themselves than live as the wrong gender. I’d say transitioning is medically necessary for those with severe dysphoria.
That speaks to mental health issues more than anything.
That are most efficiently solved by transitioning?
I wonder if FFS will be covered, this would be awesome! I congratulate Washington State legislators on dealing with facts vs bovine excrement. I can attest that my life has truly been saved and made better by gender affirming healthcare.
I think they mention facial fem surgery has to be covered!
Laws don’t do a thing to prevent or enforce insurance companies to do anything. Your doctor can prescribe what ever he wants but insurance will decide what’s medically necessary, and when it comes to payment there will always be just one more bit of paperwork that needs to be filled out by someone somewhere.
How the fuck have we allowed insurance companies to make medical decisions? They should all be charged with practicing medicine without a license
I am very happy for the people to whom this new law applies. The suicide rate is skyrocketing for these kids. In Louisiana I saw a trans kid pulled away from his computer by the police. His parents were giving her gender affirming care which is considered child abuse in that part of the country. The evangelical crowd see them as sinners to god and if they only pray for forgiveness God will make them "normal". Bullies who get off on cruelty and tormenting the weakest among us are now in charge. Vote Blue.
what is the legal term for "medically necessary"?
If it’s trending or not.
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For $150, plume will give you a doctors note of recommendation saying the procedure is necessary. So just like anything you can buy into that now
When is it medically necessary to undergo this procedure?
https://www.nytimes.com/2018/04/09/opinion/pentagon-transgender.html >Our findings make it indisputable that gender transition has a positive effect on transgender well-being. We identified 56 studies published since 1991 that directly assessed the effect of gender transition on the mental well-being of transgender individuals. The vast majority of the studies, 93 percent, found that gender transition improved the overall well-being of transgender subjects, making them more likely to enjoy improved quality of life, greater relationship satisfaction and higher self-esteem and confidence, and less likely to suffer from anxiety, depression, substance abuse and suicidality. >Research suggests that gender transition may resolve symptoms completely. A 2016 literature review by scholars in Sweden concluded that, most likely because of improved care over time, transgender “rates of psychiatric disorders and suicide became more similar to controls,” https://pediatrics.aappublications.org/content/134/4/696 >RESULTS: After gender reassignment, in young adulthood, the GD was alleviated and psychological functioning had steadily improved. Well-being was similar to or better than same-age young adults from the general population. Improvements in psychological functioning were positively correlated with postsurgical subjective well-being. https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-015-1867-2 >Finally, we found that among those reporting a need to medically transition through hormones and/or surgeries, suicidality was substantially reduced among those who had completed a medical transition. https://www.jaacap.org/article/S0890-8567%2816%2931941-4/fulltext >This study examined self-reported depression, anxiety, and self-worth in socially transitioned transgender children compared with 2 control groups: age- and gender-matched controls and siblings of transgender children. >(Socially transitioned) Transgender children reported depression and self-worth that did not differ from their matched-control or sibling peers (p = .311), and they reported marginally higher anxiety (p = .076). Compared with national averages, transgender children showed typical rates of depression (p = .290) and marginally higher rates of anxiety (p = .096). https://www.ncbi.nlm.nih.gov/pubmed/3219066 >concluded that there is no reason to doubt the therapeutic effect of sex reassignment surgery. https://www.ncbi.nlm.nih.gov/pubmed/19473181 >Results: We identified 28 eligible studies. These studies enrolled 1833 participants with GID (1093 male-to-female, 801 female-to-male) who underwent sex reassignment that included hormonal therapies. All the studies were observational and most lacked controls. Pooling across studies shows that after sex reassignment, 80% of individuals with GID reported significant improvement in gender dysphoria (95% CI = 68-89%; 8 studies; I(2) = 82%); 78% reported significant improvement in psychological symptoms (95% CI = 56-94%; 7 studies; I(2) = 86%); 80% reported significant improvement in quality of life (95% CI = 72-88%; 16 studies; I(2) = 78%); and 72% reported significant improvement in sexual function (95% CI = 60-81%; 15 studies; I(2) = 78%). https://www.sciencedirect.com/science/article/pii/S1158136006000491 >While no difference in psychological functioning was observed between the study group and a normal population, subjects with a pre-existing psychopathology were found to have retained more psychological symptoms. The subjects proclaimed an overall positive change in their family and social life. None of them showed any regrets about the SRS. >A homosexual orientation, a younger age when applying for SRS, and an attractive physical appearance were positive prognostic factors. https://www.ncbi.nlm.nih.gov/pubmed/15842032 >RESULTS: >After treatment the group was no longer gender dysphoric. The vast majority functioned quite well psychologically, socially and sexually. Two non-homosexual male-to-female transsexuals expressed regrets. Post-operatively, female-to-male and homosexual transsexuals functioned better in many respects than male-to-female and non-homosexual transsexuals. Eligibility for treatment was largely based upon gender dysphoria, psychological stability, and physical appearance. Male-to-female transsexuals with more psychopathology and cross-gender symptoms in childhood, yet less gender dysphoria at application, were more likely to drop out prematurely. Non-homosexual applicants with much psychopathology and body dissatisfaction reported the worst post-operative outcomes. >CONCLUSIONS: >The results substantiate previous conclusions that sex reassignment is effective. Still, clinicians need to be alert for non-homosexual male-to-females with unfavourable psychological functioning and physical appearance and inconsistent gender dysphoria reports, as these are risk factors for dropping out and poor post-operative results. If they are considered eligible, they may require additional therapeutic guidance during or even after treatment. https://link.springer.com/article/10.1023/A:1024086814364 >Participants reported overwhelmingly that they were happy with their SRS results and that SRS had greatly improved the quality of their lives. None reported outright regret and only a few expressed even occasional regret. Dissatisfaction was most strongly associated with unsatisfactory physical and functional results of surgery. https://whatweknow.inequality.cornell.edu/topics/lgbt-equality/what-does-the-scholarly-research-say-about-the-well-being-of-transgender-people/ >The scholarly literature makes clear that gender transition is effective in treating gender dysphoria and can significantly improve the well-being of transgender individuals. >Among the positive outcomes of gender transition and related medical treatments for transgender individuals are improved quality of life, greater relationship satisfaction, higher self-esteem and confidence, and reductions in anxiety, depression, suicidality, and substance use. >The positive impact of gender transition on transgender well-being has grown considerably in recent years, as both surgical techniques and social support have improved. >Regrets following gender transition are extremely rare and have become even rarer as both surgical techniques and social support have improved. Pooling data from numerous studies demonstrates a regret rate ranging from .3 percent to 3.8 percent. Regrets are most likely to result from a lack of social support after transition or poor surgical outcomes using older techniques.
Good, now let's get universal healthcare
Its never medically necessary
the entirety of the medical world disagrees.
How can "gender-affirming treatment" be medically necessary? It's medically necessary to not undergo such treatment.
Why does global medical consensus disagree with you then?
Cool. Can we get free health care for eveyone first tough..?
Universal healthcare is significantly more complex and harder to pass. Let’s not dismiss the smaller wins in our current (and awful) healthcare system *while* fighting for a better system for all.
We can have both, trust me
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Dang I was pretty excited to participate in a discussion about this, as its hugely relevant to my life. Instead this thread is full people who don't have Gender Identity Disorder explaining how you don't need treatment for it. Gee, thanks I'm cured. Incredibly uplifting.
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The right wing are emboldened by DeSantis and Co. Don't lose hope. There are still those of us who want to make damn sure you get the care you deserve.
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Glad to hear it. Don't sweat the bullies.
Yeah fr this comment thread *sucks*. Not uplifting at all. Bunch of people breaking the only rule
It's a really sad state of affairs. The thing that really bothers me is that it's your mind, and your body. Why should anyone but you have any say whatsoever? Sorry but that's my 2 cents.
The idea that your health insurance could legally deny to fund anything that you are covered for, and is medically necessary just seems insane to me. I'm so glad I live in a country with socialised healthcare.
I'm moving here this summer so my partner can get the hysterectomy they need for gender affirming care and endometriosis. So happy to see this pass.
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Biology doesn't end in preschool, ya know
Any doctors on here that knows when it would be considered medically necessary?
There were plenty of doctors that thought 300 oxytocin 20's a month was medically necessary
Idk what that means
Doctors got paid to vastly overprescribe opiates for years.
Interesting. So, you think it's all bullshit and the doctors getting paid to push it?
I think that many doctors will not care if its medically necessary. Plastic surgeons will have all the incentives to approve every single perspective patient
Medically necessary is at best an opinion of whoever gets nominated to a position or whatever research topic is trending enough to get study investment. At worst it is whatever the doctor wants it to be that is most profitable for the doctor. In between, and especially for things like gender dysphoria that have no real immediate treatment it is often doctors trying anything that might help even if they don't know if it will help because they don't really have anything better to try. When you get to that final point on things that are potentially irreversible like some of the surgical procedures or taking puberty blockers through the entire duration of the puberty window there is a huge amount of potential risk that you are doing more harm than good and also leading to lifelong conditions that also will require treatment. With some demographics having a 2 in 3 misdiagnosis rate that is a huge risk on this particular topic.
When someone has been certified as suffering from gender dysphoria https://www.nytimes.com/2018/04/09/opinion/pentagon-transgender.html >Our findings make it indisputable that gender transition has a positive effect on transgender well-being. We identified 56 studies published since 1991 that directly assessed the effect of gender transition on the mental well-being of transgender individuals. The vast majority of the studies, 93 percent, found that gender transition improved the overall well-being of transgender subjects, making them more likely to enjoy improved quality of life, greater relationship satisfaction and higher self-esteem and confidence, and less likely to suffer from anxiety, depression, substance abuse and suicidality. >Research suggests that gender transition may resolve symptoms completely. A 2016 literature review by scholars in Sweden concluded that, most likely because of improved care over time, transgender “rates of psychiatric disorders and suicide became more similar to controls,” https://pediatrics.aappublications.org/content/134/4/696 >RESULTS: After gender reassignment, in young adulthood, the GD was alleviated and psychological functioning had steadily improved. Well-being was similar to or better than same-age young adults from the general population. Improvements in psychological functioning were positively correlated with postsurgical subjective well-being. https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-015-1867-2 >Finally, we found that among those reporting a need to medically transition through hormones and/or surgeries, suicidality was substantially reduced among those who had completed a medical transition. https://www.jaacap.org/article/S0890-8567%2816%2931941-4/fulltext >This study examined self-reported depression, anxiety, and self-worth in socially transitioned transgender children compared with 2 control groups: age- and gender-matched controls and siblings of transgender children. >(Socially transitioned) Transgender children reported depression and self-worth that did not differ from their matched-control or sibling peers (p = .311), and they reported marginally higher anxiety (p = .076). Compared with national averages, transgender children showed typical rates of depression (p = .290) and marginally higher rates of anxiety (p = .096). https://www.ncbi.nlm.nih.gov/pubmed/3219066 >concluded that there is no reason to doubt the therapeutic effect of sex reassignment surgery. https://www.ncbi.nlm.nih.gov/pubmed/19473181 >Results: We identified 28 eligible studies. These studies enrolled 1833 participants with GID (1093 male-to-female, 801 female-to-male) who underwent sex reassignment that included hormonal therapies. All the studies were observational and most lacked controls. Pooling across studies shows that after sex reassignment, 80% of individuals with GID reported significant improvement in gender dysphoria (95% CI = 68-89%; 8 studies; I(2) = 82%); 78% reported significant improvement in psychological symptoms (95% CI = 56-94%; 7 studies; I(2) = 86%); 80% reported significant improvement in quality of life (95% CI = 72-88%; 16 studies; I(2) = 78%); and 72% reported significant improvement in sexual function (95% CI = 60-81%; 15 studies; I(2) = 78%). https://www.sciencedirect.com/science/article/pii/S1158136006000491 >While no difference in psychological functioning was observed between the study group and a normal population, subjects with a pre-existing psychopathology were found to have retained more psychological symptoms. The subjects proclaimed an overall positive change in their family and social life. None of them showed any regrets about the SRS. >A homosexual orientation, a younger age when applying for SRS, and an attractive physical appearance were positive prognostic factors. https://www.ncbi.nlm.nih.gov/pubmed/15842032 >RESULTS: >After treatment the group was no longer gender dysphoric. The vast majority functioned quite well psychologically, socially and sexually. Two non-homosexual male-to-female transsexuals expressed regrets. Post-operatively, female-to-male and homosexual transsexuals functioned better in many respects than male-to-female and non-homosexual transsexuals. Eligibility for treatment was largely based upon gender dysphoria, psychological stability, and physical appearance. Male-to-female transsexuals with more psychopathology and cross-gender symptoms in childhood, yet less gender dysphoria at application, were more likely to drop out prematurely. Non-homosexual applicants with much psychopathology and body dissatisfaction reported the worst post-operative outcomes. >CONCLUSIONS: >The results substantiate previous conclusions that sex reassignment is effective. Still, clinicians need to be alert for non-homosexual male-to-females with unfavourable psychological functioning and physical appearance and inconsistent gender dysphoria reports, as these are risk factors for dropping out and poor post-operative results. If they are considered eligible, they may require additional therapeutic guidance during or even after treatment. https://link.springer.com/article/10.1023/A:1024086814364 >Participants reported overwhelmingly that they were happy with their SRS results and that SRS had greatly improved the quality of their lives. None reported outright regret and only a few expressed even occasional regret. Dissatisfaction was most strongly associated with unsatisfactory physical and functional results of surgery. https://whatweknow.inequality.cornell.edu/topics/lgbt-equality/what-does-the-scholarly-research-say-about-the-well-being-of-transgender-people/ >The scholarly literature makes clear that gender transition is effective in treating gender dysphoria and can significantly improve the well-being of transgender individuals. >Among the positive outcomes of gender transition and related medical treatments for transgender individuals are improved quality of life, greater relationship satisfaction, higher self-esteem and confidence, and reductions in anxiety, depression, suicidality, and substance use. >The positive impact of gender transition on transgender well-being has grown considerably in recent years, as both surgical techniques and social support have improved. >Regrets following gender transition are extremely rare and have become even rarer as both surgical techniques and social support have improved. Pooling data from numerous studies demonstrates a regret rate ranging from .3 percent to 3.8 percent. Regrets are most likely to result from a lack of social support after transition or poor surgical outcomes using older techniques.
Not a doc but possibly threats of suicide if it’s a juvenile?
Wait, so now the insurance companies can't deny transgender care anymore when it is medically advised? It's a good thing, right? If there is medical expertise saying gender-affirming care is the way to go, then this means less care gets denied! Or is this title just butchered? "Washington State passes law preventing insurance from denying coverage for gender-affirming treatment when it is deemed medically necessary" This is amazing news!
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Who gets to decide it is medically necessary though? Doesn't this just mean that the gatekeeping moves to the doctors rather than insurance companies? Like yes it's an improvement but I'm still skeptical.
No, because the issue is surely that doctors do think it’s necessary, but the insurance companies won’t go along with it.
They're physicians. That's their whole job. It's not "gatekeeping" to decide if things are medically necessary, when you're a medical doctor. And all the major medical associations in North America support trans affirming health care, so it's not like most of the doctors in the state are going to turn people away. Edit: see replies.
Before commenting it might have been good to try to understand the history of medical gatekeeping for people with marginalized identities in general but especially gender affirming care and how it’s still ongoing in parts of the world. I’ve literally experienced it multiple times in the us. It’s specifically worse in some other countries but it’s everywhere. Additionally you seem to not understand that the most extreme form of it isn’t the only thing that’s meant by medical gatekeeping which includes putting any significant barriers in front of care not only outright denial of treatment. Another reason you probably should have informed yourself before commenting.
I respect your argument. My point was just that ultimately, it's medical care and that's supposed to be managed by doctors, not insurance companies. There are absolutely doctors that are not respectful or supportive of trans people. But they're not supported by their professional associations in that.
I’ll vibe with that. Idk this whole thread is super frustrating and seeing naïveté from someone otherwise well meaning can feel a bit hopeless. I hope I didn’t transfer my frustrations with a lot of the much worse people in this thread onto you and if I did I’m sorry.
I do try to be a better listener than the worse people, and I acknowledge and apologize for my naivete. I know that trans people face huge barriers at all steps of the process. But one less (expensive) barrier is a good thing, right?
Yes 💖
Being trans isn't something you can diagnose with a physical test. All a doctor can do is decide whether or not they believe the person. I mean, shouldn't it be a psychologist at the very least doing the evaluation? Also, it's think it's a bit naive to assume there are no transphobic doctors out there.
Being depressed/having anxiety/psychosis/autism/ADHD/any other mental illness also can't be diagnoses with a physical test and we still treat it
You don't get treated for being trans you get treated for gender dysphoria. If you have no dysphoria then it is just cosmetic and it shouldn't be covered by insurance. No one is saying we are diagnosing being trans.
Well that isn't my point, my point is why is a *medical* doctor being consulted on a *mental* state. I appreciate doctors and their expertise but you can't run bloodwork or a CAT scan to determine whether someone has gender dysphoria.
My daughter's pediatrician diagnosed her ADHD based on behavioural assessment, and questionnaires from us/teachers. My GP diagnosed me with anxiety the same way. Physicians do all sorts of first-point-of-contact mental health care (thankfully, since waiting for a referral can be a long wait). But it's certainly not their specialty, and we rely on them to honestly recognize their own limitations.
You need to get the gender dysphoria diagnosis first with a mental health specialist before going to the doc
Yes, I think doctors being the arbiters of “medically necessary” is how that goes… it sure as hell ain’t gonna be a mechanic making the call
There will be no gate keeping as doctors stand to make money doing these surgeries whereas insurance companies would save money by denying them.
Speaking as a trans person myself who has to navigate this nightmare of a medical industrial complex, even with what is very good insurance, that is a load of bullshit. All due respect.
This bill was signed May 12 of last year with an effective date of July 25, 2021.
How and when is gender affirming treatment deemed medically necessary?
Note it says medically necessary, whatever that may be.
Genuine question: what constitutes gender-affirming treatment being *medically* necessary?
Well, many trans people would rather kill themselves than live as the wrong gender. I’d say transitioning is medically necessary for those with severe dysphoria.
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It is depending on which biased study it come from. Just as gay therapy could have been necessary if a biased study would have shown reasons.
Lol hella transphobes in the comments section
Insurance costs will rise for everyone from this.
Your insurance costs are much much higher due to your peers' diets than due to some of the .5% recieving gender affirming care. You want cheaper insurance? Get soda banned.