No problem! Here's a sloppy copy/paste of the highlights from the Anthem policy:
For individuals undergoing gender reassignment surgery*, consisting of any combination of the following;
metoidioplasty, phalloplasty, vaginoplasty, penectomy, clitoroplasty, labiaplasty, vaginectomy, scrotoplasty, urethroplasty, or placement of testicular prostheses, are considered
medically necessary when
all of thefollowing criteria are met:
- The individual is at least 18 years of age; and
- The individual has capacity to make fully informed decisions and consent for treatment; and
- The individual has been diagnosed with gender dysphoria and exhibits all of the following:
- The desire to live and be accepted as a member of the opposite sex, usually accompanied by the wish to make his or her body as congruent as possible with the preferred sex through surgery and hormone treatment; and
- The transsexual identity has been present persistently for at least two years; and
- The disorder is not a symptom of another mental disorder; and
- The disorder causes clinically significant distress or impairment in social, occupational, or other important areas of functioning; and
- Individuals without a medical contraindication or otherwise unable or unwilling to take hormones, the individual has undergone a minimum of 12 months of continuous hormonal therapy when recommended by a mental health professional and provided under the supervision of a physician; and
- Documentation that the individual has completed a minimum of 12 months of successful continuous full time real-life experience in their new gender, across a wide range of life experiences and events that may occur throughout the year (for example, family events, holidays, vacations, season-specific work or school experiences). This includes coming out to partners, family, friends, and community members (for example, at school, work, and other settings).
Note:
- The medical documentation should include the start date of living full time in the new gender.
- Verification via communication with individuals who have related to the individual in an identity-congruent gender role, or requesting documentation of a legal name change, may be reasonable in some cases; and
- Regular participation in psychotherapy throughout the real-life experience when recommended by a treating medical or behavioral health practitioner; and
- If the individual has significant medical or mental health issues present, they must be reasonably well controlled. If the individual is diagnosed with severe psychiatric disorders and impaired reality testing (for example, psychotic episodes, bipolar disorder, dissociative identity disorder, borderline personality disorder), an effort must be made to improve these conditions with psychotropic medications and/or psychotherapy before surgery is contemplated; and
- Two referrals from qualified mental health professionals who have independently assessed the individual. If the first referral is from the individual's psychotherapist, the second referral should be from a person who has only had an evaluative role with the individual. Two separate letters, or one letter signed by both (for example, if practicing within the same clinic) are required.
* At least one of the professionals submitting a letter must have a doctoral degree (Ph.D., M.D., Ed.D., D.Sc., D.S.W., or Psy.D) and be capable of adequately evaluating co-morbid psychiatric conditions. One letter is sufficient if signed by two providers, one of whom has met the doctoral degree specifications, in addition to the specifications set forth above.
Not Medically Necessary:
Gender reassignment surgery is considered
not medically necessary when one or more of the criteria above have not been met.
) and pushing and pulling the piercing prevented it from healing up propperly. In a way, I doubt the needle did more than hurt like a bitch.
