Appeals Committee

Yesterday, I contacted a legal organization to bring teeth and claws into my case with Select Health.

I live in Taylorsville, Utah, a community on the outskirts of Salt Lake City. My healthcare plan is Select Health Plus PPO + HSA, and it is offered through my employer. On Monday, I met with the Appeals Committee for my third-level and final internal appeal.

The case I made was based on the following bullet points:

·         Why Select Health needs to drop the exclusions against Gender Reassignment and treat my policy as if they never existed:

1.     A transgender woman was sentenced to 30 years in prison for robbing banks to be able to afford gender reassignment surgery. After she was incarcerated, she attempted to remove her penis with a knife. Attempts like this are more costly in medical treatment than actually supporting gender reassignment surgery, and are very common.

2.     A friend of mine changed her insurance company from Select Health to Blue Cross Blue Shield in January of this year. Blue Cross Blue Shield has promised to pay $19,000 dollars of her gender reassignment surgery. Given her delight, she'll probably be their customer for life.

3.     Google in California now covers Gender Reassignment Surgery in their insurance policy.

4.     So does American Express.

5.     So do 10 of the Fortune 20.

6.     The exclusions themselves have references that are over 20 years old. What are the assumptions behind those exclusions? It's quite likely that whatever they were, they are no longer valid.

7.     There has been a lot of medical advancement with regards to understanding the eschatology of Gender Identity Disorder and its treatment in the intervening 20 years, most of it in the last 10 years.

8.     The assumption that gender identity disorder can be treated effectively using reparative therapy is now no longer honored among professionals who deal with transgender people, because of the underlying eschatology. In fact, the only treatment that does work, has been found to be transitional therapy, which necessitates in some cases, gender reassignment surgery.

9.     The World Professional Association for Transgender Health, the American Medical Association, and the American Psychological Association have stated that gender reassignment, including surgery in some cases, is medically necessary treatment; and that failure to provide or cover such treatment can be considered discriminatory.

10.   The US Tax Court agrees.

11.   Select Health prides itself on being a discriminatory-free insurance company; but these exclusions are discriminatory against people who suffer from GID.

12.   Select Health, however willingly or unwillingly, made my employer a participant in that discrimination by not providing an option whereby gender reassignment would be covered.

13.   My employer, with over a 1000 employees, is currently interviewing insurance providers, to make sure that the insurance provider meets employee needs within corporate resource boundaries. I have started working with the company's human resources to let them know that these exclusions are in direct contradiction to their employment policy.

The committee also had in front of them the presentation I prepared for my prior presentation. They also had hundreds of pages to reference, including AMA Resolution 122, Tax Court vs O'Dhonobain, the WPATH standards of care as well as my documentation showing that I had followed WPATH SOC.

Monday, when I met with the three members of the trustee board, a lawyer, medical director, note taker and organizer, as well as one other person were present. One of the trustees served as facilitator and after reading my case and complimenting the presentation booklet I had prepared for the last meeting, proceeded to inform me that “it all ends here,” and that they change policy. I stated a summary of my case, and emphasized why the exclusions in their policy with regards to gender reassignment need to be dropped. In the end, I challenged them to determine the thinking behind the exclusions, treat those reasons as assumptions and to strike them from the policy if the assumptions cannot be validated.

During the meeting, the facilitator grilled me over choice, why I went to Thailand instead of having the procedure done in Colorado, why they showed no records of me pre-vetting the insurance policy ahead of time (I just did it anonymously), and if I knew I was taking a risk that the procedure would not be covered.

The trustee sitting to his left seemed to be more concerned with penny-pinching and whether coverage of the surgery had “market penetration.” In fact, his first words, before I knew what he was talking about were, “I’m wondering about the penetration.” I felt rather shocked by that particular statement until he clarified his intent later.

The remaining trustee’s frame of reference was on the public perception of Select Health. He seemed amenable and didn’t have any questions for me.

So, in summary, I feel that they are at least slightly worried about their public image; and yet, there is a hesitancy to take a risk to pay for the surgery without knowing that their competitors have already profited from the risk.

So, even though I came in trying to argue that coverage is the right thing to do, I had to digress to argue about cost. I even asked the penny-pincher, “What is the value of a human life?” I  later referred to calculations by the AMA and myself that the total cost is negligible.

At this point, I give it a 50/50 chance of going either way.

Hugs and Blessings,

Sofia

Vagina Monologues Audition

But I assert that every woman, in the present state of society, is bound to maintain her own independence and her own integrity of character; to assert herself earnestly and firmly as the equal of man, who is only her peer. This is her first right, her first duty, and if she lives in a country where the law supposes that she is to be subjected to her husband, and she consents to this subjection, I do insist that she consents to degradation; that this is sin, and it is impossible to make it other than sin. True, in this State, and in nearly all the states, the idea of marriage is that of subjection, in all respects, of the wife to the husband--personal subjection, subjection in the rights over their children and over their property; but this is a false relation.

--  Antoinette Brown Blackwell, Debating Marriage and Divorce Laws at the Tenth National Woman's Rights Convention in New York, 1860

 Today, I auditioned for my third performance in Eve Ensler's Vagina Monologues. This morning, I accidentally slept in til 9:30 AM, awoke for a quick bath, printed off the audition pieces, and updated my entertainment resume. It took me awhile to find the head shot I wanted to use as well as format the resume to fit one page with the dance experience that I added. I finally got to the audition about two minutes before my slot at 11:10 AM, despite the rain, getting a little lost and parking halfway to the other end of the parking lot.


As I was filling out my resume, I overheard the director talking about someone who was a belly dancer and was pretty good, because she had seen me practicing. It had to have been me she was talking about, because it was my slot, she had seen me through the door, and she had indeed seen me practicing last year while we waited for the performance to start.

So when I walked in, I said, "Hi. Are you talking about me already?"


I couldn't make up my mind which monologue to read, so I was encouraged to read them all, and I did, all except for one that is. They looked at me and said, "That was awesome."  Wow, two compliments in one day. So now I'm waiting for the casting to be completed and announced. Practice is supposed to begin this week.

Meanwhile, I continue to practice my routines for Azalea and my solo at Divine Love. For some reason it took about an hour and 20 tries to get the former right today, but the second, which I've been having difficulty learning, just flowed out very naturally. I'm 2 seconds over 2/3 of the way through the piece. On Monday, I pick up the remaining pieces of the choreography and take them home to study.

On Monday, I am also appearing in front of Select Health's Appeal Committee to try to explain in 30 minutes why they need to drop the exclusions for Gender Reassignment Surgery and cover my claim.

That's about it for now.

Hugs and Blessings,
Sofia

Nature vs. Nurture

I am a female computer scientist and software engineer. I am also a poet and dancer, as well as tuned to empathy and support. I find meaning in artistic forms of expression and nurturing activities; yet I found that through persistence I was able to be good enough at math and science to excel in my studies and draw a really nice paycheck in computer programming.

Nature wired me with an inclination for nurturing and creativity, but I was nurtured in science and math, as a boy, because that's what I was assigned at birth. I struggled at first, but was able to eventually outperform anyone to whom I set my mind, especially in the field of logic. Meanwhile, I suppressed my natural proclivities.

I am a transsexual woman, who was born with a mild disorder of sexual development, invisible to the doctors and my parents.I played with all the toys I was given, but craved dance and nurturing toys. I learned spatial skills as well as military concepts because my father was in the Air Force. He had a vision that I would grow up to be a scientist or engineer, even though I preferred hanging around my mother.

Nurture won, but when I finally stopped suppressing my natural proclivities, I found I was able to develop them as well, in lightning speed over the last few years, and I know now I am the person I was meant to be.

In summary, while gender and a natural aptitude is programmed into us, shy of severe brain damage, the brain is plastic enough to mold skill in other areas. Men can learn to develop an artistic and empathetic sense, and women can develop a sense of reasoning.

What also comes into play is the theory of framesets. Many girls are told at an early age, when they achieve, that they are pretty and smart. Boys are told that they can achieve if they keep working at it. People internalize this. If they are told they are smart, they tend to believe that intelligence is something you are born with, and any failures they encounter may cause them them to doubt their own intelligence. On the other hand, people who are told they need to work harder to achieve, may come to believe that intelligence can be increased through dedication. This at least partly explains why so many female engineers are Asian.

In the end, Nature cannot be ignored, but Nurture can help to to round people out.


Hugs and Blessings,
Sopfia

Oz

We kept Oz on the old sewing machine in the bedroom. Oz had no plugged hole on the bottom, and the slot on the top was too narrow to work bills out, even if you used a knife, so once you'd put money into Oz, it stayed there. We tested it to make sure. We couldn't count the money, but because Oz was translucent, we could see our cash accumulating inside when we held him up to the light.

-- Jeanette Walls

 My Capital One debt is finally over. I sent the last payment two days ago. It took forever to pay it down, and it loomed over my head. I even inherited it as part of the divorce agreement. But finally it's gone. Meanwhile, my Discover and card is pretty close to full, so it's time to start paying it down; not as quickly as I'd like since I'm also making new car payments now--but the money I am saving on gas, since it's a hybrid will definitely help.

In addition to my daughter's flute payments, I am now also sending money for her private lessons. She's been first chair, and she has a dream. If her lessons will help her achieve that dream, I'll do what I can while I can.

My dream of dancing is about to hit the new year. I'm now taking three lessons a week. On Mondays, I'm about 20 seconds into a new choreography that I plan to solo as soon as I master it. I can only hope that I look half as awesome as my teacher as she does it. If I can get it done in time, I'm hoping to unveil it at the Divine Love show on February 11th. I'm also hoping to get Myst in the show as well.

Myst is a new troupe that grew out of a temporary troupe that was put to together for Night at the Casbah last year. It was done to spotlight the students of my intermediate dance class. New Beginnings got great reviews that night. Three of us went on to perform at the Halloween show. I did my solo and two of the others did a mini-troupe routine. Now three of us, who joined Azalea together, formed Myst so we can dance again at Dancing in the Snow on Saturday. We just had an awesome rehearsal on Saturday, and I picked up some hair pieces that go with my new costume so my hair doesn't get in my eyes. Deborah also volunteered to be our stage manager; I am excited about how this is coming together. You are going to have your socks knocked off when you see what we came up with.

Hugs and Blessings,
- Sofia Featherwind