[theoddz]

Originally Posted by Linus

So I've finally got a consult scheduled. Apparently this surgeon (Dr. Jewell -- Theo, I know you recommended Dr. V but he doesn't work with insurance and I wanted to see if I could get some if not all of this covered) has done top surgery before for FTMs. I'll ask her if she has before/after photos but I was curious if others have used this surgeon before.

She is interested in helping me work with my insurance provider (they listed her so I'm hopeful that they will cover majority of it.

I'm thinking of asking her the following:

1. What do I need to do to prepare for the surgery (e.g., weight loss, hormones, etc.). I expect weight loss to be on there since I'm 5'1" and 220 (it's already a goal for me anyways and once my back is better I'll be able to really pursue this more)

2. What procedure would she use and what the risks involved?

3. Expected time for recovery

4. Time in hospital; length of time for the surgery itself

5. If revisions needed (e.g., dog ear effect) will she do this?

6. post-op care for reducing scars and such

7. estimated costs (granted this will depend on insurance and such)

What else should I ask? What generally happens during the first consult?

Linus, it's all in what you're comfortable with. Remember, this is something that you're going to have to live with and be comfortable with. When I was ready for surgery, it was my goal to have a physician who had lots of experience working with FTMs and doing the reconstruction surgery. You want something that's going to look reasonably decent and the results are, largely, dependent not only on your body build and health, but on the surgeon's skill. The more experienced the surgeon, the better job you're going to get. If you're not satisfied with the results, how important is it going to be that your insurance paid for it??

Another thing to consider is this. Is the surgeon you choose willing to provide you with the necessary letters and/or documentation that will allow you to legally change your gender markers?? Some surgeons who might be less experienced with doing top surgery as legal GRS (Gender Reassignment Surgery) might be hesitant to sign affidavits attesting that their work now determines that you are, in fact, legally male. In other words, it's good to get a surgeon who is familiar with the legal aspects of gender reassignment surgery and is willing to provide you with appropriate documents, post op.

The only reason I can think of that Dr. V would not be willing to go the insurance route is that he is a board certified cosmetic/plastic/reconstruction surgeon. Most of the procedures he specializes in, like tummy tucks, face lifts, botox and other procedures done for strictly cosmetic reasons, have traditionally been considered to be purely elective and not "medically necessary" under traditional legal definition and therefore, not covered by most insurance policies. When you deal with insurers, you need staff in your office who are familiar and proficient with medical coding, because this is how doctors bill for their services.....ICD-9 Codes. If you don't know what you're doing with these codes, or the intricacies of medical coding, you can get yourself into some really deep trouble with mail and/or insurance fraud......and it doesn't have to be intentional. So yeah, I can understand why Dr. V doesn't want to be involved with trying to bill an insurer. One thing he did do for me, however, was to send the tissue samples from my procedure to a pathology lab that my private insurance DOES work with. This saved me nearly $500 out of pocket for pathology fees.

Anyway, do what you feel comfortable doing. I think that, ultimately, that's what we all do!! Good luck to you on this leg of The Journey!!! I hope your experience is as great as mine was. Having my top surgery completed was one of the best things I've ever done for myself and I am soooooo much more comfortable, physically, mentally and emotionally.

~Theo~