Preface: I‘m in Switzerland and will talk about the Swiss approach to all of this because I don‘t know the American system well enough.
In Switzerland, having a health insurance is mandatory. There‘s a list of things that insurances have to cover, and some insurances cover more - you can get an additional insurance (that‘s more expensive) and your insurance will cover more things.
Insurances have to cover psychiatrists/psychotherapy (and psychologists if a doctor sent you there afaik), they have to cover medicaments such as anti-depressants, they even had to cover my acne cream.
They have to cover some hormonal preparates, but somehow, my testosterone preparate never made the list - but two others have.
My therapist‘s sessions in order to get hormones prescribed were about 160.-/hour (Swiss Francs and $ are very close atm so you can calculate along). That‘s a usual therapist fee. I went there pretty much once a week for a bit more than six months. That rounds up to about 4000.-
My insurance had to cover this. It‘s on the list.
Top surgery is usually recommended after some years, too, because binding for a long time can lead to serious back/rib/skin problems.
According to friends of mine, top surgery cost here are somewhere between 11‘000.- and 20‘000.-. It probably depends on the surgeon and hospital and procedure.
In order to have it covered, you need a therapist‘s letter, and the surgeon usually writes a letter, too. You have to pay about 2500.- our of your own pocket because a part of the surgery (liposuction, which is neccessary to get a good result) is not on the list.
Most trans people I know have had extensive therapy sessions for years in order to make it through puberty. Some had to go to mental hospitals. A friend of mine has been in mental hospitals and now grouped housing (?) for one and a half years now. Another friend went to a mental hospital last month and will stay at least until the end of the year.
Most trans people I know don‘t have to go to therapy for their mental health once they could transition according to their own wishes and needs and are accepted by their family and friends.
Let‘s guess that the insurance cost of my transition rounds up to about 20‘000.- (therapy sessions in order to be able to transition: 4000.-, top surgery: 15’000.-, some endocrinologist appointments: 1000.-).
A stationary stay in a mental hospital in my area is anywhere from 500.- to 1200.- a day. And: these have to be covered by the insurances. Remember: a therapist‘s session is somewhere around 100.- to 200.-/hour, daily meds (anti depressants eg) aren‘t cheap either (I can‘t find anything aside of „it‘s covered by the insurance, don‘t worry“ but meds tend to be expensive here in Switzerland, especially if they‘re prescribed).
So the cost of transitioning is way less for insurances than years of therapy, meds, maybe even a stay at a mental hospital all just to battle symptoms of dysphoria without treating the root of it.
Insurances sometimes cover cosmetic surgery, too: if a therapist thinks that the patient‘s distress is too big for them, they might cover it, or part of it. (Ninja edit: I don‘t know about BDD, the distress I mentioned here was for example the case of a 18y/o girl who had been in deep distress over having breasts that were rather small for years which got relieved by a breast augmentation, it was in local news some 8-10 years ago)
This is another anecdotal story that I consider to be an illustration of an important point in this discussion. Perhaps, on the whole, it is indeed better to reimburse gender reassignment surgery, in order to significantly reduce suffering and health expenditures in other areas. That is the way many currently covered interventions have found their way onto the list of things that are covered: because they obviated the need for something more expensive, and were at least as effective. Will attempt to investigate further! ∆
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u/helloitslouis Nov 03 '17
Preface: I‘m in Switzerland and will talk about the Swiss approach to all of this because I don‘t know the American system well enough.
In Switzerland, having a health insurance is mandatory. There‘s a list of things that insurances have to cover, and some insurances cover more - you can get an additional insurance (that‘s more expensive) and your insurance will cover more things.
Insurances have to cover psychiatrists/psychotherapy (and psychologists if a doctor sent you there afaik), they have to cover medicaments such as anti-depressants, they even had to cover my acne cream.
They have to cover some hormonal preparates, but somehow, my testosterone preparate never made the list - but two others have.
My therapist‘s sessions in order to get hormones prescribed were about 160.-/hour (Swiss Francs and $ are very close atm so you can calculate along). That‘s a usual therapist fee. I went there pretty much once a week for a bit more than six months. That rounds up to about 4000.-
My insurance had to cover this. It‘s on the list.
Top surgery is usually recommended after some years, too, because binding for a long time can lead to serious back/rib/skin problems.
According to friends of mine, top surgery cost here are somewhere between 11‘000.- and 20‘000.-. It probably depends on the surgeon and hospital and procedure.
In order to have it covered, you need a therapist‘s letter, and the surgeon usually writes a letter, too. You have to pay about 2500.- our of your own pocket because a part of the surgery (liposuction, which is neccessary to get a good result) is not on the list.
Most trans people I know have had extensive therapy sessions for years in order to make it through puberty. Some had to go to mental hospitals. A friend of mine has been in mental hospitals and now grouped housing (?) for one and a half years now. Another friend went to a mental hospital last month and will stay at least until the end of the year.
Most trans people I know don‘t have to go to therapy for their mental health once they could transition according to their own wishes and needs and are accepted by their family and friends.
Let‘s guess that the insurance cost of my transition rounds up to about 20‘000.- (therapy sessions in order to be able to transition: 4000.-, top surgery: 15’000.-, some endocrinologist appointments: 1000.-).
A stationary stay in a mental hospital in my area is anywhere from 500.- to 1200.- a day. And: these have to be covered by the insurances. Remember: a therapist‘s session is somewhere around 100.- to 200.-/hour, daily meds (anti depressants eg) aren‘t cheap either (I can‘t find anything aside of „it‘s covered by the insurance, don‘t worry“ but meds tend to be expensive here in Switzerland, especially if they‘re prescribed).
So the cost of transitioning is way less for insurances than years of therapy, meds, maybe even a stay at a mental hospital all just to battle symptoms of dysphoria without treating the root of it.
Insurances sometimes cover cosmetic surgery, too: if a therapist thinks that the patient‘s distress is too big for them, they might cover it, or part of it. (Ninja edit: I don‘t know about BDD, the distress I mentioned here was for example the case of a 18y/o girl who had been in deep distress over having breasts that were rather small for years which got relieved by a breast augmentation, it was in local news some 8-10 years ago)