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Insurance for vaginoplasty

How many times a week do we get calls from friendly patients who wish to have Dr. Reed do their vaginoplasty.  In so many words they say, I have insurance and   my company pays for vaginoplasty.  Yes, this is true, but the amount they pay surgeons might be 10 cents on the dollar, or an amount so low, most transgender surgeons will not accept a “micro” payment from them (after numerous forms and delays in processing occur).  I have been on the phone in conference call with a prospective patient on the line and try to find out how much they allow, sometimes waiting 20 or more minutes, being passed from one clerk to another only to find out, no one is authorized to tell or knows the answer.

We tell patients to please check with other experienced surgeons.  Some times they are put on a 2 year holding list, because the doctor does not want to say “no” and in the event that surgeon is doing nothing else, he/she would consider working 5 hours for $1,050, to include a week of daily followup care, and calls 24/7 with legitimate concerns.

Our policy is not to accept assignment from any insurance company.  “Accepting assignment” means Dr. Reed allows the insurance company to determine what Dr. Reed will charge and accept for transsexual surgery and pay the doctor all or a part, based on that amount.  On December 18, 2015 for the first time we have learned Medicare is refusing to reimburse a patient any amount because a. we do not maintain electronic records or b. do not do  electronic billing or c. accept assignment.  This area has yet to be clarified.  So for the time being, what had worked in the past is not working now.

The Hospital and anesthesia provider, if you are done at the Hospital as far as we know, are paid some amount by Medicare or your participating insurance company.  If you have any questions or concerns please call Medicare or your insurance provider or the Hospital.

On February 6, 2015 our office has received a confirmation letter from First Coast a CMS (Centers for Medicare and Medicaid Services), saying that our PTAN (provider transaction access number) has been deactivated upon our request.  This is to say our office no longer accepts assignment or works with Medicare directly.  For any questions, please confer with Medicare or your insurance provider directly for the most authoritative answer.

You are always welcome to call Anne at our office for a compassionate discount.   Anticipate a fee reduction of several thousand dollars.  Yes, we want to do your vaginoplasty

Harold M. Reed, M.D.
The Reed Centre for Transgender Surgery – Miami
1-305-865-2000

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