I’m not rich, having a pink collar professional job. Pink, a traditionally female occupation and paid accordingly. I got exceptional insurance through my online college program at Johns Hopkins, a Consolidated Student Health plan using the Cigna network (but not exactly Cigna). That insurance is how I “won the lottery” and completed surgery. Although to many Medicaid patients, the cost is $0.
A quick hack: charge transition expenses you can afford already to a card that gives points for travel. My Chase Sapphire accrued enough points to give us $3k worth of travel, rental cars, an occasional fancy hotel pampering, and money left over to buy little luxuries off Amazon without spending a penny.
I had no lost wages. I bought a disability insurance plan from my work. It paid 60% of my salary while I was out for 3.5 months. I also have short term disability and got paid for 30 days at 100%. I used accrued sick leave which rolls over year to year of almost 30 days, so I got paid 100% for that. Warning: watch out for pre-existing condition look back periods. Don’t buy the plan just before going out for surgery or it won’t pay. I prob need to make a post just about this! There are work around and ways to plan.
Needless to say, it covered my family expenses and additional childcare– I have two young children– and kept us afloat. The disability plan didn’t pay out until much later though, but short term and sick leave bank was immediate.
I used FMLA to protect my job while out so much.
I also bought a hospital indemnity plan through my job. It gave me $350 a day each day I went into the ICU and $175 a day I was hospitalized. I think it gave a bonus of $200 for being admitted? This ended up paying me about $4k for all my ins and outs. This felt like robbing a bank! Best investment. There were no look backs or pre-existing conditions or exclusions. You go into a hospital? Send in the documents, and Aflac sent me cash.
My phalloplasty surgery was divided into three stages at Johns Hopkins under Dr. Devin O’Brien-Coon. When people ask how much each step cost, I have to say– the cost will vary significantly depending on the country. In the US, where I live, our health costs are out of control.
I’m from Texas originally, where most employers exclude transgender care from health insurance plans. When this is the case you feel so desperate. At a point I was willing to travel to Canada to see Maud Belanger and finance their $55k cash price like a mortgage. Come to find out, that’s the cash price neighborhood for stage one at Hopkins too.
I caught a lucky break. My college student insurance under Consolidated Student Health offered transgender coverage at 80%– meaning the plan would pay 80% of the bill and I would pay 20% of the bill. The plan has a maximum out of pocket of $4250, so once my 20% portiom has kicked in, they would pay 100% for the rest of the school year. It felt very fair, a generous plan for $150 a month premium. Are my European friends laughing at me? I know, we need a real national health system. But we take what we can get to survive.
Stage 0: hair removal. I had laser done on my arm a couple sessions. Not having UL but wanted to cut down on hair on my shaft. 3 @ $350ish. I could have done a lot more but didn’t want to spend more money or time on this. My insurance didn’t cover hair removal and I didn’t push them on it. Could have.
Cost: $1000 cash
Stage 1: creation of my penis and the nerve hookup linking the donor tissue (radial forearm free lap) to the hip and genital nerves. I was three days in the ICU and five days total in the hospital. They placed Integra. I got a variety of bills about six months later for anesthesiologists, physical therapists, surgeon teams, and hospital time, including $12k of medicines, and wound care supplies. I had Alloderm. I had to spend 6 weeks in Baltimore. A registered nurse came to my apartment to dress my wounds a few times a week. All my very expensive wound supplies were covered.
Cost to me: $4kish
Stage 1.5: a split thickness graft to my arm from my thigh. Day surgery. They placed a wound vac I had to carry around a week. Then it was removed in office.
Cost: $0 since I had already been billed the max.
Mental health: I did a lot of mental health therapy while I was out. Individual talk therapy about every other day, and intensive outpatient group therapy three times a week. I had a lifetime of gender trauma to sort through. I was ready to let it all go, especially with so much time off work required anyway and my plan max met.
Cost: $0, met max
Stage 2: (three months out) included hysterectomy, glansplasty, scrotoplasty, ball implants. The implants didn’t take and I had to have them removed in office on emergency surgery. I did tons of occupational and scar therapy and needed lots of physical therapy due to complications.
Cost to me: $0, met max
Stage 2.5 isn’t standard. This is where we revised scars which had become very raised and visible due to hypertrophy. I have a genetic condition that causes agressive healing, linked this scarring. It makes some of them unexpectedly painful, because of the way scarring can cause fluid retention and pressure on the nerve. So, I had linear scars revised on my leg and arm. Since I had a major infection and a significant portion of the scrotum had been removed at stage 2, we did fat grafting from my hips to my scrotum. We did fat grafting to my arm. Insurance considered these medical and not cosmetic due to specific arguments and conditions. Random, because I had met my max and everything was free, I started using expensive Testopel hormone pellets which I love. I won’t always have insurance this good so I’m living it up.
Cost: $0, met max
Stage 2.75: About 40 hours of micropigmentation tattooing on my penis. Did it hurt? Yeah. It was worth it.
Cost: $5000 cash, not covered by insurance
Stage 3: Implantation of Coloplast Titan and saline Torosa testicular implant.
Cost: $4000 my max out of pocket
Voice surgery: Having laryngoplasty done with Dr. Simon Best in a few weeks. It will relieve muscular stress and the pitch of my voice will be lower.
Bill: Dont know yet but we anticipate $50k
Cost: $0, because I will have met the max!
Medical grand total billed for the above: around $1 MM
My costs: $4k + $4k, two years of plan max; Johns Hopkins offers billpay assistance by income or even debt cancellation. Payment plan is offered to everyone, and they bill way after surgery. And I have eight months left of being at max so we see what else I can fit in there for free.
Tattoo: $5k total over four sessions
Laser: $1k the year prior to surgery, three sessions, but I had coupons which reduced it down to about $500.
Travel: $1500 in airbnb and bus/cab transportation in Bmore (a low number since I’m a serious bargain hunter) + $500 in flights (a low number because I had $2000 of airline miles points from having used my credit card which accrues airline points; got a few free nights of *extremely* fancy hotel pampering $2k and rental cars too $500).
And to look back: my top surgery cost $5750 cash with a free lipo revision. The insurance prince would be closer to $60k.
I think it’s fair to say my transition was a million dollars. BUT before that becomes a Conservative talking point, many of these expenses *only apply to me* because of scarring conditions, mental health, a nurse provided in my home, and complications.
You could get away with, surgical cash prices:
$6k top surgery double incision
$55k bottom surgery phallo cash
To me, it’s like how having a baby could cost a million dollars if it gets complicated. For most people the birth is $25k. They usually pay just a plan max of $6k-ish. You could also see a nurse midwife and pay more in the neighborhood of $4000 cash or $1600 under insurance.
The grand total medical-billed cost to me was two years of plan maximums, totaling $8k, which I am giving the hospital a little at a time. My various disability and hospital insurance plans will have covered lost wages and then some, greatly reducing the burden on my family.
(And we lived happily