Are You a Transgender Who Sued Medi-Cal for SRS or Transition Surgery and Won?
I am a transgender person (male-to-female) and I am on Medi-Cal. My understanding from the Transgender law Center’s information they provided is that Medi-Cal does not specify transgender-related surgery as "standard coverage," but do do not currently and never have had an exclusionary clause against covering it if a case can be made that the requested coverage is indeed medically necessary and a recomended treatment for Gender Identity Disorder.
The real problem is finding surgeons who will accept Medi-Cal, which pays out below market rate, for Sex Reassignment, Breast Augmentation, Tracheal Shave, Facial Feminization, etc. Finding a surgeon who will take the Medi-Cal benefits as payment is the first thing needed before suing Medi-Cal, since it is nearly unofficial routine for them to automatically deny ANY APPLICATIONS for coverage of ANY TYPE of surgical proceedure. Once you have a surgeon willing to take your Medi-Cal, you just take Medi-Cal to court over the denied claim, and it’s pretty comon that your lawsuit will be won and Medi-Cal ordered by the court to cover your operation through your surgeon.
I have read many e-zines of such cases being won in court for their Sex Reassignment Surgery to be covered by Medi-Cal, however, the problem is that (for protection of their identity) their names have been changed in the PRINTED articles, so there is no way to contact these individuals. However, the bigger probelm (according to the Transgender Law Center San Francisco) is finding a surgeon who accepts Medi-Cal. However, it clearly goes without saying that, if those transgender people won their court cases for coverage of SRS through Medi-Cal, then clearly, they all found surgeons who willingly took the Medi-Cal for the surgery. After all, what good does it do to have Medi-Cal be ordered to pay for a surgery that you haven’t found a doctor to perform?
I knew someone who was a friend-of-a-friend of mine who sued Medi-Cal and won. She had her surgery, I believe, in 2000 (give or take a couple of years).
She unfortunately passed away about 2 years ago. From what I understand about her plight, her situation matched exactly what you described. She found a surgeon in the San Francisco area (not sure where, or with whom). So there are definitely surgeons who will do this (they probably just try to keep this fact under wraps as much as possible).
Hope this helps.
Good luck in your future