Medical Necessity of Electrolysis In Transgender Patients Kittysbelle

Medical Necessity of Electrolysis In Transgender Patients Kittysbelle, 4/29/18

Nerves are Very Real

Not only can most not fathom being born “wrong” but the repercussions of not being able to interact with others in the most social sense, if not the basest. Transsexualism now known as gender dysphoria, experienced to different degrees by those of biologic variance, not only forces the afflicted to overcome harsh social constructs equivalent to banishment from peers in our current society, for some of us it effects our ability to function, to ever develop physical relations. to “know” another human being on a relationship level. Yet what i want to get through to you in this is something as common and unforgiving as HAIR.

If you accept the fact that brains are mosaicly sexed organs to infinite degrees, including instances of crossex adaptability, then one must include the complete nervous system as lending itself to what that brain perceives. in the epidermal system, the largest number of nerve endings are in bundles, around the root of each and every hair. A primitive form of extrasensory perception to most, unrelenting waves of dirty stitches sending signals of alienable wrong to others. A sexed brain would have evolved to expect certain structures based upon the sex hormones typically introduced directing expected growth at certain periods of a bodies development. The mental map of what the body should be is constantly under attack, what is termed “dysphoria” is in reality an utter revulsion from a form that seems to be attacking itself. “This isn’t me, this is not self”

The central nervous unit is receiving signals from the genitalia and elsewhere, that somethings “wrong”, these should not be exposed and vulnerable but safely tucked inside. Now imagine those dirty stitches growing out of a woman’s face or out of her vagina that threw itself up thru virilization. The psychological/physiological torment of plucking-burningrazing only to have it return in ever thickening waves, the deformity betwix our legs that caused all of this , also requiring permanent removal of hair in preoperative steps before surgical correction of the area can happen.

Nerve Plexis Hair plexis

To the afflicted this is not merely some life affirming aesthetic body work, this is a cruel constant untreated aggravation. Something that happened beyond our control, something that at one time was preventable through puberty suppressants now practiced on the youth, something that has a cure, held out of reach by ignorance. Laser and electrolysis are both seen by medical science as being necessary and effective steps in combating crippling bodily dysphoria, which untreated causes sever depression, self surgical attempts, and suicide. We cry to the heavens for help, please rethink blanketed exclusions of our minorities healthcare.

Vellus and Androgenic Hair Vellus Androgenic Vellus hair is short, thin, slightcolored, “peach fuzz”, barely noticeable thin hair that develops on most of a person's body during childhood. Androgens are the main regulator of human hair follicles, changing small vellus follicles producing tiny, virtually invisible hairs into larger intermediate and terminal follicles making bigger, pigmented hairs. You are born with as many follicles as you will ever have. Vellus hair replaces lanugo hair on a human fetus at 36 to 40 weeks of gestation. including facial hair, pubic hair, chest hair, leg hair, armpit hair and others.

Hyper-Androgenism resulting in Hirsutism *this list in no way complete Hirsutism Is defined as a condition of unwanted, male-pattern hair growth in women, that can arise from excess male hormones called androgens. Poly. Cystic Ovarian Syndrome (PCOS) Genetic pre-disposition to growth of cysts on the Ovaries that trick the body into producing more androgens. Treated with the same hormonal regimes and electrolysis as TS/IS patients Congenital Adrenal Hyperplasia (CAH) is a group of inherited genetic variances that affect the adrenal glands. In general CAH patients lack cortisol used to regulate hormones, resulting in overproduction of androgen. Gender Dysphoria Is experienced by those whom the sex related structures of the brain are contrary to other physical sex characteristics, that results in a significant distress or impairment.

Normal Hair Growth Cycles Anagen, Catagen, Telogen

Rate of Growth Cycles for different parts of the body *Based on Canadian research

New hair Germinating Cells come from stem cells in and around the Sebaceous Glands • Each follicle can have none or multiple Glands. • Typically thru shedding, new hair germinating cells are released. • Gaining guidance from the dermal palpia, or recreating it if not completely destroyed.

3 Different Types of Electrolysis Galvanic electrolysis, works through a caustic chemical reaction. This procedure requires the passing of low flow direct current through the electrolysis needle to produce Lye within the hair follicle destroying the surrounding tissue. 15 secs-3 mins, 80 -90% first pass reduction *invented in 1875 Thermolysis functions by damaging the hair follicle thermally rather than chemically. high frequency alternating current is passed down the needle instead of direct current producing heat in the follicle by molecular vibration. 0. 02– 20 sec, 60 -70% Lowest first pass reduction *ideal for vellus hair Blend is a combination of both chemical and thermal destruction by delivering direct and alternating currents through the needle. Heating the Lye makes it more caustic, as well it is spread around the follicle by agitation. This is considered by most users to be the most effective form. 6 -12 sec, 70 -80% first pass reduction *ideal for areas that will be surgically inverted

think about how hard it is for a black trans person, if a white trans person cant get care. . Galvanic is true electrology and the technique you need, bonus it has highest first pass reduction. The curvature of the pore could be seen as a distorted follicle, dependent on the technicians proficiency. Galvanic works by filling the pore with lye which eats away hair germination cells and is unaffected by any curvature. A lot of black people might think laser is not an option, but it is. People of color should look for a certain laser called the Nd: YAG. It works using a photogenic gell that’s first applied an absorbed by the pore. The laser then targets the gell. A place in Texas called “electrology 3000” specializes in darker pigmented skin , doing 8 hr sessions.

High Cost of Treatment Base rate in Ohio is a dollar a min, or 65 hr including tax Its estimated that you need between 100 -400 hrs to clear a face Let alone its equivalent “downstairs” Making it near impossible for a minority most in need of treatments to afford 65 hr when were not even making one. Let alone that most practicing refuse to do pre-op work. Most practice flash thermolysis which has the highest regrowth, rare to find blend in Ohio. Lasers have proven beneficial for certain body types yet initial cost dwarfs whatever we cant afford electro wise. A friend, same age, lives fulltime passed group home to suicide ward, wraps her face in scarves never having been able to afford any electro treatments. Says “the islamophobia is better than the transphobia. ” Even having won treatments for both face and genital work, I cant find an electrologist in the state willing to become a one time out of network Medicaid provider. .

A precedent has already been set indicating that depilatory treatments are “medical care” for insurance purposes (Abernathy v. The Prudential Insurance Company of America, No. 21178, Supreme Court of South Carolina, March 31, 1980) Supreme Court affirmed a verdict for the plaintiff, noting that there is no requirement that “medical care … be performed by or under the direction of licensed medical personnel”. Further, the court held, since plaintiff underwent treatments pursuant to her physician’s advice, such expenses were medically “necessary and were not excluded from coverage under the policy”.

WPATH medical necessity statement “Available routinely in Canada, the United States, and in many other countries, these treatments are cost effective rather than cost prohibitive. In the United States, numerous large employers (e. g. , IBM, the City and County of San Francisco, University of California, etc. ) , including many with international employee bases, have negotiated contracts with their insurance carriers to enable medically necessary treatment for sex reassignment to be provided to covered individuals at little or often no additional premium cost. “ “. . genital reconstruction (by various techniques which must be appropriate to each patient, including, for example, skin flap hair removal, penile and testicular prostheses, as necessary), facial hair removal. . ” “These procedures are not “cosmetic” or “elective” or for the mere convenience of the patient, but are understood to be medically necessary for the treatment of the diagnosed condition. ” In 2008, the American Medical Association, the American Psychological Association, and the National Association of Social Workers all issued statements in support of eliminating barriers to healthcare for transgender and transsexual people. WPATH Clarification on Medical Necessity of Treatment

In 2015 someone fought caresource and won for laser treatments. I need further info (helps pwease) All I have to go on is “the King trial” named after the laser-tech Lana King at UC who couldn’t give out another patients info. Claim ID through Caresource; 171003 M 230

Hear’ are the keys to coverage. , . , . . C BY-SA-NC

AFTER you get a prescription reimbursed by the insurance Co. you file for reimbursement of electrolysis treatments. They will still maintain hair removal is cosmetic, however, too much hair in all the wrong places is a medical problem and if needed visit a second doctor to get a second opinion as they have to pay for this too. You will have to appeal their decision and you have 3 appeals to go through. At the third appeal you challenge them. NEVER SURRENDER THE POWER. MAKE THEM KNOW YOU ARE NOT TAKING ANY NONSENSE and you will beat them in court because of �industry precedent�. They have a contract to pay for all diagnosable and treatable diseases and electrolysis is the �current standard of medical treatment for this condition�(remember this phrase…it is vital to your argument). *Has a sample letter to insurance as well*

Pain Management- “get a prescription reimbursed by the insurance Co. . ” Over the years I have tried handfuls of NSAID’s- which are only good for reducing swelling after the fact; Ibuprophen, Tylenol, meloxicam also tried opiates which do help somewhat, Vicodin, morphine, and Tylenol 3 As well as pain creams, specifically EMLA which is 2. 5% lidocaine/prilocaine- in conjunction with Tylenol 3 (codeine) for electrolysis treatments is what I used as “prescription reimbursement”. what I would consider the lowest form of effective pain management. A compound pharmacy in Florida custom-rx. com can make you a 20% prilocaine/lidocaine cream (8 xs stronger than EMLA) with. 25% phenylephrine (same level as preparation-H) Surgeon in Cleveland says she has an anesthesiologist that for 2 k will keep you numb for 8 hrs. A sympathetic dentist might also numb around the mouth prior to treatment Stay hydrated!

Sample Letter A. a medical condition causes the hair growth. B. permanent removal of hair is necessary to restore the patient to normal function. C. the physician can measure the effectiveness of medication by monitoring the presence or absence of new hair growth in the areas involved only after electrolysis therapy. Since no two patients respond in a similar manner to a given dose of any medication, dosage MUST be individualized to minimize potential � side effects�. Electrolysis, therefore, is instrumental in establishing the most effective dose of medication, consequently, the electrolysis procedure is diagnostic as well as therapeutic. D. To achieve maximum benefits for the patient with Hirsutism it is necessary to include electrolysis of the follicle concomitantly with medical therapy or else the patient is denied the benefit of the current body of medical knowledge regarding treatment of her condition. Also, it is unethical for a physician to withhold any information from a patient that the physician knows to be effective. E. Electrolysis is standard, current medical practice and is the only permanent treatment for hirsutism in this medical condition and has been certified as medically indicated and necessary by a disinterested physician, Dr. …… , a Board Certified Endocrinologist (or Gynecologist). F. There is industry precedent in Massachusetts and a number of states for coverage of this procedure.

Important phrases… 1. A hormonal imbalance resulting in hirsutism (excessive and abnormal hair growth not normal in a female 2. Is NOT COSMETIC in these patients. 3. A medical condition causes the hair growth. 4. Permanent removal is necessary to restore the patient to normal function. 5. the physician can measure the effectiveness of medication by monitoring the presence or absence of new hair growth ONLY AFTER electrolysis therapy. 6. no two patients respond in a similar manner to a given dose of any medication. � 7. dosage MUST be individualized to minimize potential side effects. 8. Electrolysis, therefore, is instrumental in establishing the most effective dose of medication. 9. the electrolysis procedure is diagnostic as well as therapeutic (this is vital because ALL DIAGNOSTIC TESTS ARE COVERED 100% IN VIRTUALLY ALL POLICIES). 10. To achieve maximum benefits for the patient it is necessary to include electrolysis. 11. or else the patient is denied the benefit of the current body of medical knowledge regarding treatment

Continued Letter. . 12. It is unethical for the physician to withhold any information from a patient that the physician knows to be effective. 13. Electrolysis is current standard medical practice. 14. the only treatment for hirsutism in this medical condition. 15. has been certified as medically necessary by a disinterested physician (this means the physician has no vested interest in electrology other than to see the patient get the most effective treatment with no financial gain for the physician). 16. there is industry precedent for coverage for this procedure (in law they often resort to �precedent�so this VIP). In addition, read the policy to see if there is any wording that refers to � diagnosable and treatable disorders�which this is as opposed to a �cosmetic procedure�. Electrolysis for cosmetic purposes would be limited to eyebrows, underarms, bikini line, raising the hairline on the forehead. All other areas could be part of a medical problem.

So I Documented Medical Necessity went to my primary care; (F 64. 9) is gender dysphoria, (L 68. 0) is hirsutism, depression is (F 32. 9)- all letters had extensive documentation of how t affected me from each ones clinical position (mental health uses DSM, medical uses ICD 9 and 10) primary care referred me to dermatology, procedure code (17380) as part of sex reassignment , again used gender dysphoria (F 64. 9) had that reverified thru another dermatologist (CPT 17380) and again also hirsutism (L 68. 0) and gender dysphoria (F 64. 9), this letter mentioned legal cases that set precedence. primary care then referred me to an electrologist of my choosing for the treatment of hirsutism. PCP also wrote another letter using gender dysphoria (F 64. 9), hirsutism (L 68. 0) and depression (F 32. 9) talks of my dysphoria being mostly in my facial and genital hirsutism again procedure (CPT 17380) again i now had a psychiatrist then write me a letter, procedure (CPT 17380) for hirsutism (L 68. 0), gender dysphoria (F 64. 0) major depressive disorder recurrent (F 33. 9) and generalized anxiety disorder (F 41. 1) "these disorders are worsened by hirsutism" went back to that last dermo who referred me to electro of my choice again procedure (CPT 17380) for hirsutism (L 68. 0) filed for prior authorization at this point. 50 hrs we asked for were approved!

But didn’t stop there. . started building the necessity again this time for laser inclusion and surgical. dermatology referred me to a lase technician CNP who documented medical necessity (CPT 17999) laser code, for hirsutism (L 68. 0) and gender dysphoria (F 64. 9) a letter from my therapist documenting meeting DSMV criteria for gender dysphoria, and states that the hair removal is a part of genital surgery not a separate procedure. primary care referred me to a surgeon using both hers and sychs letters. who used (CPT 16035) vaginoplasty, creation of neovagina with graft (CPT 57292) and complete amputation of penis (CPT 54125) tissue grafting (Z 94. 89) surgical prep (Z 01. 818) hirsuties (L 68. 0) intersex condition (Q 56) m-f transsexaual person on hrt (Z 79. 899) also (F 64. 0) prescribed electrolosys (CPT 17380)- 30 min intervals laser hair removal (CPT 17999)- 30 min intervals laser hair removal (CPT 96999)- 30 min intervals

I’ve been trying to become an electrologist, and have researched it to the point I would call it purposeful systemic barriers. . (this is an old flash thermolysis machine)

Corruption between the Do. H and Electrology Association of Ohio Back in 1989 the Department of Health decided it needed to review state licensure on the field of electrology. They turned to those practicing to develop the new requirements. Those within the Electrology Association who to this day are the only ones influencing the Do. H who never bothered to make a committee, decided that this was a great opportunity to insert measures of “job security”. Like a 150 hrs of head and neck massage no electrolosis in the world uses. So in 1993 OAR code OAC 4731 -1 -07 went into effect that requires to become a licensed electrologist in Ohio you must attend a school based in Ohio, surrounding State’s licensures are not acceptable. licensure for other states cant work here nor can I go out of state to seek the schooling denied here, while effectively closing the field off from new ideas and concepts. Keep in mind this is a matriarchal field; Janic Raymond (author of the transsexual m empire, a book that got trans care removed from Medicare in the 70 s) that she “. . didn’t want to stop the science of trans healthcare, because she could see its intersectional uses, just make it inaccessible. . ”

So who benefited when restriction was put into place? For starters all currently practicing at the time were grandfathered in meaning most practicing have never had the extra training now demanded. What this effectively does is ensure that they don’t have to be competitive with pricing or technique as most towns are left with one or two practitioners who have a monopoly on clientele. Most practice flash thermolysis, which again has highest regrowth= perpetual clientele, no one is seeing trans patients as projects to be completed The field is left entirely proprietary even having won treatments I cant find a single electrologist willing to work with Medicaid, left to beg for reimbursement or beg cis people to do what I’ve been wanting to do for the community for years. 2 schools are left as gatekeepers charging 17 k out of pocket purposefully insurmountable leaving one who wished too make an impossible decision between the cost of their own surgery or spending their life helping others. I believe both could still happen if only there was a community as this takes a village.

I Want to Help the Most marginalized Pro-bono for the indigent Sliding scales Advocate for insurance claims Partner with another health facility (dermatology) Potentially partner with some non-profit who could find me grants, or forgive my already mounting student loans after 14 yrs…(hey Equatas!)

This is what I’ve been called to do You can find my research at: https: //kittysbelle. wordpress. com/2015/10/28/necessity-ofelectrolysis-laser-permanent-hair-removal/ - Heres a FB group about it too - https: //www. facebook. com/groups/1020380451379215/ My go fundy’ currently for pre-op cost (I keep a savings equal to it towards schooling): https: //www. gofundme. com/kittysbelle