Santa Rosa transgender man struggles to get surgeries covered
Lindsey Sachs’ birth certificate says he was born female, but his whole life, he’s considered himself a male.
He has become so uncomfortable with his female body parts, and disillusioned with his inability to get them removed, that his life has been put on hold. Debilitating social anxiety and intense physical discomfort have prevented him from finishing school, keeping a job or achieving his dream of starting a transgender support network in Sonoma County.
The transgender Santa Rosa man has been altering his body chemistry and physical attributes, hoping to reflect a male appearance, for nearly a decade. He injects testosterone into his thigh twice a month, and flattens his breasts with a chest binder.
When President Barack Obama’s health care law expanded Medi-Cal last year for low-income adults who don’t have children, Sachs qualified for new insurance coverage. Overnight, sex reassignment surgery became a possibility for the first time in his life.
“I have felt really depressed and isolated for so long, because my gender doesn’t reflect who I am on the inside,” said Sachs, 30. “So when I found out that I could finally get surgery, I was so excited.”
Sachs said he felt relief from depression and anxiety for the first time in his life. In order to complete his female-to-male transition, he had to find a team of specialists to perform a batch of surgeries, from common procedures including a mastectomy and a hysterectomy to more complicated and specialized surgeries, such as genital reconstruction. He chose to begin with his breasts, the primary source of his discomfort. But since January 2014, when Sachs qualified for free coverage under California’s low-income health program, requests for his surgery have been denied.
Although California requires Medi-Cal and private insurance companies to cover body-altering surgeries for transgender people, the health plan that covers the majority of Sonoma County’s Medi-Cal patients has prevented Sachs from accessing specialists to perform the surgeries he desires.
For low-income patients, navigating the path to surgery in the ever-changing health care landscape can be tricky. A shortage of competent specialists trained in transgender-specific health care, combined with the influx of people newly eligible for coverage, can force patients seeking surgery to wait a year or more. Ideally, patients should wait no more than two weeks for a first appointment with their surgeon, according to doctors and physicians groups.
Transgender patients also are routinely forced to file complicated appeals with insurers and state regulators to get procedures covered, and they frequently pay out of pocket, according to more than a dozen interviews with transgender advocates, health officials and doctors.
Complicating matters further, the reimbursement rates doctors are paid by Medi-Cal are famously low. Take, for instance, the price tag for a mastectomy and chest reconstruction at one East Bay clinic. Medi-Cal pays the plastic surgeon $220 for the three-hour surgery, while out of pocket, it would cost $5,000. Because of low payments like that, many specialists simply decline to accept Medi-Cal, exacerbating the shortage of doctors available to see transgender patients who want surgery.
“This is supposed to be covered, but the truth is, it’s not working,” said Dr. Dawn Harbatkin, a primary care physician with Lyon Martin Health Services, a community clinic in San Francisco whose patients primarily identify as lesbian, gay, bisexual or transgender. “For surgeons who can perform these surgeries, there is really no motivation for them to take the low Medi-Cal rates because the pay is so low, and they have more than enough business.”