Trans Healthcare, An Anecdote

Let me begin by saying I am privileged. I am. There’s no denying it and it makes me tremendously sad that it is any sort of privilege rather than the universal norm: I have a PCP who is incomparable, and who specialises in LGBT+ healthcare; I live in Massachusetts where transgender discrimination is outlawed for the most part; and I have so~so insurance that I can actually afford to use after I’ve got done paying to have it; and if I’m ever back to broke, the state healthcare plan covers transition, free.

Too many people do not have anything of the sort. Too, it is not even a question of choice; in the US it’s wholly possible, for an example, to have only one ENT “in the area” for a referral to when the clinic in question refers people from Greenfield up near Vermont to Springfield down by Connecticut. Healthcare deserts, like food deserts, exist; so I’m also privileged to have a working car, any spare gas money, and anything like a time off policy … it doesn’t stop there being a multimonth wait for a non-emergency appointment for an assessment for potential pathologies which might be responsible for a voice control issue I developed after having a breathing tube during a surgery several years ago.

I did tweet about this, but it is terribly hard to express oneself in such circumstances.

(Let’s all take a moment to marvel at the fact I did that correctly, on the first try, without having to google how)

Now, in my personal case it is an inconvenience. I can either try to book with the dermatologist I’ve spoke with and either hope they figure out how to do the direct billing or I have to wade into how to file claims with my insurance for reimbursements OR I can go to an electrologist in West bloody Springfield (look, I abhor cities, I’d visit Hell before any given urban centre given a choice) who actually knows how to do the billing for all of this properly.

I repeat: I’m privileged. I have these options and the capacity to actually view them as options, as I’ve the means to go to the West Springfield place if I decide to.

So the anecdote for those unwilling to dive into Twitter:

Too, this is probably going to be the extended cut.

For anyone who’s missed the memo, I’m a transgender woman. Like some small, but not insignificant percentage which I’m in no mood to go dig up of such women I desire GCS (Gender Confirmation Surgery being the version I’m most familiar with, though some have a different word for the C I can’t ever recall). For reasons I’ve no intention to elaborate upon, it is necessary to have certain laser/electrolysis done prior to this. I am a redhead, laser is a non-option for me.

Now, I had, until now, had the pleasure of either working with THE LGBT+ primary care doc in this ⅓ of the state or with ones who are LGBT+ experienced, if only by themselves being LGBT.

Luckily I am not facing discrimination, just … in a word … inexperience. Imagine, though, how much worse this next bit would be were this an uglier circumstance and if I hadn’t any options!

See, for folks in a civilised country that just covers this kind of thing because Logic, a lot of insurers consider any and all hair removal cosmetic & strictly Not Covered. This means many hair removal providers don’t take insurance, and out-of-network is, in my case, Not Covered, and in others’ cases Very Expensive. So after a few YEARS of confusion I finally found that Yes, my insurance converts electrolysis exclusively for bottom-surgery prep … which means a few hoops to jump through for authorisation.

So I finally get a list of in-network providers; there’s more than one! And they’re NOT practically (or literally) in Boston!

Now, this will seem rather anticlimactic after all of this, but that’s my dumb luck, put yourself in the shoes of someone for whom there’s no alternatives.

I spend an unholy amount of time on the phone waiting to talk to their billing person who has no idea what I’m talking about and doesn’t understand that, yes, I am covered for this but they suggested I speak to them for particulars of the cost because they’ve quicker access to the details! They suggested I speak to scheduling. Who was grouchy to be having the conversation before hanging up on me.

Now, this could have been bad, but I have other places to contact and a brilliant primary care team who added a name to the list and can help with the proper authorisation if I want to claim reimbursements instead.

But my luck is an outlier. My privilege is just that, privilege. For the first years of my transition I couldn’t afford to do much in terms of finding out how accepting & experienced my healthcare choices were because I couldn’t afford insurance, never mind afford to use it … yes, even with the ACA. Georgia, what can I say?

This is, for me, nothing more than a nuisance. But imagine all the tiny and even very large ways it could be infinitely worse. This is the battle, if on small scale & for lower stakes, that we’re fighting for an acceptance or very existence that isn’t criminal. And if you think you have to be in countries like Saudi Arabia for that one to be a problem, you haven’t really been paying attention to the UK, or to a large number of US states, just to name a couple.

So no, don’t fret for me. I’m good. Use your imagination to understand how this is for people with less good fortune, then maybe stand up, take a deep breath and start shouting down the bigots and demanding accountability & good conscience from politicians. Fight back.

The point, really isn’t even about the story, really. It’s about that privilege I harped on. Because, really, that is all privilege is: rights that only some possess. Be it access to quality medicine, fresh food, justice, respect, common decency, education, safe homes … it’s things that ought to be the right of every single person, but for no rational reason are not. Sometimes it’s little things, like the slightly less a family pays to insure the car of their teen daughter vs her twin brother’s. Sometimes it’s big, like being able to get pulled over speeding and not risk it ending in brutality or death.

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