Insurance backed out of reassignment surgery

My name is Emily, and I am transgender. It has been a long journey to get this far, and I am delighted to be on the edge of my reassignment surgery to finally start living true to myself. These surgeries are complicated to arrange within the US due to a lengthy wait-list paired with the fluidity of insurance coverage. My surgery date was scheduled a year in advance, and my insurance wasn't queried until a couple months ago. 

To be brief, my insurance led me to believe everything for this surgery would be covered until I ultimately had to summon $23,150 in under 5 days, or I would lose my date and deposit. I am 24 years old, and that is more money than I have ever held. There was a wealth of confusion in all parties leading to an extended delay of resolving my insurance coverage, which dropped me on a hard and surprising cash deadline. I had to borrow money to cover the difference, and reset my bank accounts.

The tale of my insurance battle is long and complicated, but I will try my best to summarize the highlights. 

There were no surgeons in my state when I was seeking a practice for reassignment surgery. The insurance reps I spoke with on separate occasions told me a waiver would grant coverage to an out-of-network practice in another state pretty easily because of this. The entire cost of surgery was estimated at $2,250 to cover copays for the hospital stay, which was delightfully manageable.

I spent nearly $1,000 on phone consults and to secure a date with a surgeon I am comfortable with. He is a badass, and great at what he does. His practice confirmed my benefits as out-of-network, which should have been fine based on what my insurance told me earlier.

Months go by, and it comes time for the practice to attain authorization for the surgery . My insurance company granted authorization for the surgery, but not for the practice. The reason they cited was a local in-network option is available to me. Wait, what?

A local medical center called Denver Health started offering the surgery after I had secured my date with a deposit. They already had a wait-list over 100 long.  The confusing thing is, that center is NOT in network. No one representing my insurance company has been able to explain how this surgery was covered with Denver Health.

I brought the news to my employer, who got me in contact with our company insurance rep--she's a warrior. She did some research and found a way the company can file an exception to grant coverage for this particular surgery. That's when things got complicated.

Months of confusion, misinformation, and miscommunication between my insurance and the practice delayed this process to the point where the practice sprung a deadline on me. I had 5 days to either resolve my insurance coverage, or I must switch to self-pay priced at $23,150 to keep my date. This amount was due in full at the end of the week in the absence of concrete resolution with my insurance.

Losing the date is terrifying not only because I had put down money for it, but getting another one would apply a significant delay to a dream I have been working towards my whole life. The importance of this surgery to a person in my position is often misunderstood. It has been deemed medically necessary by my insurance to maintain and promote my mental wellness, which is ironic considering the complications in covering it. 

The days to follow were the most stressful I have ever experienced. This is the kind of stress I could feel in bones. Numerous phone calls bearing bad news and uncertainty lead me outside to break down in my car so I could pull myself together and return to work. I am already terrified about a big surgery, and overwhelmed by all the logistics I have to coordinate to make it possible, but now there was substantial doubt on if I could even afford it.

Given the glacial pace of progress with my insurance thus far, I elected to raise the funds to pay the $23,150 at the end of the week in case it failed to come together in time. This exceeded my bank accounts, and I had to borrow. I planned and saved about $8,000 for medical expenses, which was more than tripe the quote from my insurance reps. I never expected to need to do self-pay, and definitely not on 5-days notice.

I am so glad I prepared for the worst, because my insurance informed me less than 24 hours prior to my deadline they cannot legally cover this surgery using my in-network benefits. My insurance had pursued an option under false information, and it was never possible. Months were consumed leading me to believe they are on the cusp of an unattainable solution They apologized and said the information will be corrected, but there is nothing they can do. A courtesy bill will by sent my insurance following surgery, but out-of-network benefits are a joke, and I cannot expect to get anything back from it.

Here we are. The surgery has been paid for, but I will not be earning much for the next couple months due to the time off work. I was beginning to set my sights on the next phase of my life, but my financial status has been reset. I am relieved the surgery will be able to continue, and I will be overjoyed with gratitude to be on the other side. 

I am hoping for some help to get back on my feet as I roll out of the hospital bed. It has been a test of my strength to simultaneously fight many fronts in the pursuit of happiness, and I have surprised myself with new limits. I've never lost sight of my dream, but the world sure found plenty of ways to try.

I appreciate everyone who took the time to read my story, and I wish you the best in the pursuit of your own dreams.

Donations

 See top
  • Anonymous 
    • $50 
    • 17 mos
  • Elenn & eric Rose 
    • $200 
    • 17 mos
  • Kevin Van Auker 
    • $25 
    • 17 mos
  • Anonymous 
    • $25 
    • 17 mos
  • Anonymous 
    • $30 
    • 17 mos
See all

Organizer

Emily Deleff 
Organizer
Centennial, CO
  • #1 fundraising platform

    People have raised more money on GoFundMe than anywhere else. Learn more

  • GoFundMe Guarantee

    In the rare case that something isn’t right, we will refund your donation. Learn more

  • Expert advice, 24/7

    Contact us with your questions and we’ll answer, day or night. Learn more