#Insurance coverage definitions

[asjinsurance]

The Ultimate Insurance Guide to Understanding Insurance Jargons: Demystifying Policy Terms

Insurance Jargons can sometimes feel like navigating a maze of unfamiliar terms and complex terms and words. From premiums to deductibles, policyholders are often faced with a barrage of terminology that can be confusing and overwhelming. However, understanding these terms is essential for making informed decisions about your insurance coverage.  In this comprehensive guide, we’ll break down the…

[scriptermubarak]

What is an insurance policy? Explanation of items to be included, necessary situations, and precautions for handling

What is an insurance policy? Explanation of items to be included, necessary situations, and precautions for handling What is an insurance policy? An insurance policy is a legally binding contract between an individual (or entity) and an insurance company. It outlines the terms and conditions of the insurance coverage provided by the company in exchange for the payment of premiums. Key elements…

[blockers-and-ectomies]

You can get unilateral oophectomy to have lower, still-present endogenous estrogen. You can take estrogen blockers as an endogenously E-dominant person (the meds are usually used for cancer), though osteoporosis concerns mean doctors don’t recommend it long term at a young age as meds to prevent/treat osteoporosis have side effects. You can probably alternate between T and E (especially since they metabolize into each other at high amounts).

You can get partial nullification to smooth away the wrinkly bits and keep the erectile bits, which can also be kept semi-recessed without metoidioplasty if applicable and desired while still smoothing below that. Conversely, you can remove the erectile organ and leave the rest. You can get urethral lengthening/relocation to put the urethra hole higher up/move it without metoidioplasty or phalloplasty or penectomy. Eunuch communities have been doing creative things with gonads, hormones, and genitals for a long time in all sorts of ways!

Generally you can add and/or remove things independently - the exceptions I'm aware of are: you can't have vaginectomy and keep menstruating internally; you probably can't have phalloplasty and keep original erectile tissue separately for double phalli; and current technology hasn't been able to create gonads or uteri.

(To folks who mention "you can keep your vagina and get a dick; you can get everything removed," I gently ask you also make clear "you can remove a vagina without getting a dick" as this is not actually self-evident! While nullification has been around in community for a while, the word vaginectomy has only recently started appearing in trans literature as separate from phallo/meta/scrotoplasty and nullification, and the words vulvectomy and labiectomy still don't appear - plus vulvectomy is also a bit vague as to whether it involves removal of the erectile organ ala total nullification, even under the insurance code for "vulvectomy, simple and complete.")

i wish people didn't make it seem like your options for medically transitioning as a nb/gq person are "do nothing" or "the binary opposite of whatever you started with"

[sheisraging]

If you're considering not voting or casting a pointless 3rd party vote in the upcoming US elections*, I'd urge you to read about Project 2025, which is the Republican transition plan for if they win the 2024 election (link is for the wiki page, not the actual website).

A short summary:

Project 2025, also known as the Presidential Transition Project, is a collection of policy proposals to fundamentally reshape the U.S. federal government in the event of a Republican victory in the 2024 U.S. presidential election. Established in 2022, the project aims to recruit tens of thousands of conservatives to the District of Columbia to replace existing federal civil servants—whom Republicans characterize as part of the "deep state"—and to further the objectives of the next Republican president. It adopts a maximalist version of the unitary executive theory, a widely disputed interpretation of Article II of the Constitution of the United States, which asserts that the president has absolute power over the executive branch upon inauguration.

Among the many horrifying and notable points:

Abolishing the Department of Education, whose programs would be either transferred to other government agencies, or terminated. Basic research would only be funded if it suits conservative principles.

Promotes the ideal that the government should "maintain a biblically based, social-science-reinforced definition of marriage and family."

Proposed recognition of only heterosexual men and women, the removal of protection against discrimination on the basis of sexual or gender identity, and the elimination of provisions pertaining to diversity, equity, and inclusion (DEI) from federal legislation.

Individuals who have participated in DEI programs or any initiatives involving critical race theory might be fired.

Explicitly reject abortion as health care

Revive provisions of the Comstock Act of the 1870s that banned mail delivery of any "instrument, substance, drug, medicine, or thing" that could be used for an abortion.

Restrict access to contraception.

Infuse the government with elements of Christianity, and its contributors believe that "freedom is defined by God, not man."

Criminalizing pornography

Combat "affirmative discrimination" or "anti-white racism," citing the Civil Rights Act of 1964.

Deploy the military for domestic law enforcement and to direct the DOJ to pursue Donald Trump's adversaries by invoking the Insurrection Act of 1807.

Recommend the arrest, detention, and deportation of undocumented immigrants across the country.

Promotes capital punishment and the speedy "finality" of such sentences.

Reform the Department of Health and Human Services (DHHS) so that the nuclear household structure is emphasized.

Give state governments the authority impose stricter work requirements for beneficiaries of Medicaid

Mandate that federal healthcare providers should deny gender-affirming care to transgender people

Eliminate insurance coverage of the morning-after-pill Ella (required by the Affordable Care Act of 2010).

Remove Medicare's ability to negotiate drug prices.

These are just a few things and I'm sure lots of people will be like lol this will never happen but lots of people said this about overturning Roe, as well.

*FWIW - I think it is absolutely valid to be angry, discouraged, and disappointed in our current administration.

Be mad at Biden! (though I would encourage looking into some of the actually positive things his administration has achieved).

But also consider what's at stake for a huge population of this country if we wind up with a GOP win.

[brain-rot-hour]

Another little update for you all

The house is "safe" in that once they return power and we have water it will be livable again for my sister and her kids. There's some smoke smell left but it's like....campfire? Oddly comforting. 7/10 only because circumstances.

I'm going to the DMV today to replace my license. I only JUST received a piece of mail that I could use as proof of address yesterday in the form of an Amazon package I ordered more than a week ago. A pack of fletches and side reins. Funny how fast things can change.

My husband's car was fully insured and we'll be getting a settlement from that, as well as my parents' truck that I was using and had JUST put on full coverage a week before this happened. We will, of course, be giving them the full amount.

My parents also have homeowners insurance so the barn and main storage building (and 20 years of "go put this out in the 1000 sqft") should maybe be covered. The buildings for sure though.

I believe that the bow that I got from my mentor (the only one that's broken me about losing) has a lifetime warranty from the bowyer that he may follow through on, even if I'm not the original owner

We know that two cats were inside the RV but the old barn cat has been seen and we go up to feed her every day. Still no news on our boys.

We definitely are not without. The local community and this amazing fandom have done so much for us that it's been overwhelming. I've had to swallow my pride and accept help from strangers the world over. There aren't enough thank yous to go around. If you've donated, please feel free to send me a chat or ask about a personalized sketch. It's not much but right now it is literally all I have to offer other than ALL my gratitude 💚💚💚

[transmutationisms]

thoughts on adhd diagonsis and the rising numbers of it? heard a couple different theories, including a school therapist saying that he thinks children are just getting misdiagnosed because they’re cutting recess times, but interested in your thoughts! lol

yea i talked about this a bit here but i would add for clarity:

this kind of narrative of 'rising rates of' [any dsm diagnosis, in this case adhd] is kind of misleading on the surface because these numbers, and cultural and medical attitudes toward these labels, vary widely. matthew smith gives a very abridged introduction to varying attitudes toward adhd globally, and points out that countries that have 'embraced' the adhd diagnosis and its corresponding drug treatments tend to be countries where pharma companies have pushed to expand their market for these drugs, and have been able to succeed in partnering up with local and regional medical guilds and practitioners' professional interests. which is to say that any 'rise' in 'adhd' should be interpreted with an eye to material factors, meaning, specifically, profit-seeking and broader patterns of imperialism and global market expansion.

none of this is to say that the impairments people experience in adhd are any less real, debilitating, or distressing. however, when we ask about those impairments becoming more widespread or severe, often the conversation becomes rapidly re-routed to cover only a narrative of individual cognitive or neurological 'failures' constituting a distinct 'disorder'. elided from this framing is the idea that an impairment of this sort arises not just from the individual's brain-mind-body, but from the extent to which that person is being accommodated by their social context, specifically demands for productivity, sustained attention, &c in the home / school / workplace.

the core research methodologies & data interpretation in the psy-sciences embed social valences into neuro-psychological investigations, heightening the perceived contrast between, eg, 'normal' and 'adhd' brains / neurotypes / &c. susan hawthorne points out that this is a powerful feedback loop: social values are embedded in the scientific investigations, the results of which are then of further social interest, and together social and scientific values tend to converge, mutually reinforce one another, and strengthen the ideas and data interpretations supporting the concept of a discrete, pharmacologically actionable, transhistorical and cross-societal brain disorder.

i truly cannot overstate the extent to which it matters that when ritalin arrived on the us market in 1955, psychiatric diagnosis of and pharmacological prescription for children's behaviours were in a very different state to how they are today. it is quite common (in psychiatry but also in other branches of medicine!) that diagnostic definitions and categories change, or even come into existence altogether, at the behest of pharmaceutical companies who need a diagnostic label in order to ensure insurance coverage for patients interested in taking their patented drugs. this combined with marketing direct to patients, and paid promotion to physicians, is a critical piece of the history of the adhd diagnosis.

because i always feel the need to make this crystal-clear: i do not oppose or object to people seeking or using stimulant medications lol. i <3 stimulants. that's not what this is about. i want you and me both to be able to use white-market amphetamines whenever we damn well please and you don't need to justify that on any moral or medical grounds. xx

[cripplecharacters]

hello! thank you for your work, ive learned a lot from this blog :) (smile). i am designing an OC who has a hypermobility spectrum disorder (i havent decided if it is hEDS or not because i dont really understand the difference between hEDS and other types of hypermobility; i am still doing research). i want her to sometimes use a wheelchair, sometimes use a cane, and sometimes not need a mobility aid, depending on how she is feeling. she is in high school, and i am not sure how having these good days and bad days would work. my friend with hypermobility said that she would probably keep a collapsible cane in her (rolling) backpack, but would she need to have a backup wheelchair at school in case she suddenly needed it during the day? would she only need a wheelchair if she planned on going long distances or had overtaxed herself the prior day? is it realistic for her to have such a wide range of mobility needs? thank you!

Hello!

A lot of people with hypermobility and chronic pain use a range of mobility aids depending on the day so that portion is definitely true to life!

However, there are a few things to consider with this concept, especially if you're going for realism.

Mobility aids are expensive. It sucks, but it's true. Depending on where your character lives and what their circumstances are, they may be able to get a wheelchair through their insurance but unfortunately many people are only able to get partial coverage at best (Though there are usually grants available to help cover the rest).

If they also have other mobility aids, that may cause some issues. Multiple mobility aids (Especially ones as large and expensive as wheelchairs) can cost a lot of money and, unfortunately, insurance and grants are less likely to cover it/more likely to cover less of it if you already have another mobility aid.

Depending on your character's needs and their situation, they may be able to get away with buying a cane second-hand or from Amazon or getting one from a drug store but getting a second wheelchair specifically to keep at school as a 'just in case' may be more difficult to the point where it wouldn't be worth it. Maybe she has another solution in place at school for if her cane isn't enough such as temporarily using a rolling office chair, going home for the day, or calling her parent to bring her wheelchair?

There are a few different circumstances that may cause her to need a cane versus a wheelchair on a given day.

Like you mentioned, overtaxing herself the day before or if she planned to go long distances can be some of them. Other examples can be suffering a dislocation or subluxation (Both of which are common in hypermobile Ehlers-Danlos Syndrome [hEDS]) during the day, especially in her lower joints; having a bad pain day (Which can be brought on by anything from sleeping weirdly to sudden changes in the weather [Link]); being in a place that isn't wheelchair accessible; etc.

As a note, there are a few differences between hypermobility and hEDS. hEDS comes with very strict diagnostic criteria involving things beyond hypermobile joints such as stretchy skin, certain types of scarring, dental crowding, etc. but I'd advise you to look into the full diagnostic criteria yourself.

Cheers,

~ Mod Icarus

[timkonshipper]

Tim Drake headcanon

He took a dip in the pit but came back from it stronger. It took a while to overcome the side effects but he redirected it into bankrupting Ra's and weakening his assasin empire.

He lured a couple hundred assassins away from Ra's to keep for himself. The small voice in his head told him he had already took a bunch of Jason's shticks and made them better so why not add another to the list.

He buys a big mansion somewhere in the middle of nowhere and starts his own assassin organisation

He takes the computer specialists and assigns them to scouting targets and draining their bank accounts(to be split among the assassins - tim had enough money).

He organises the rest by their specialities. Whenever he takes a new target he checks out their insurance coverage and replaces it with a really bad one. Then he sends out his groups according to the new insurance plan. For example if there is no dental insurance then the dental group will knock them up real bad. Combined with no money in their bank accounts, painful injuries and hospital bills that are not covered by insurance the targets feel emotionally drained(retribution for whatever they do to others). Then the special attack group ends them when they least expect it very painfully.

All in all he gets around gotham and branches out throughout the entire country.

But in the end he never has blood directly on his hands so he counts it a win.

He is also a shark in the boardroom and definitely uses his skills to his advantage. No-one questions him because they're scared shitless of him. He's practically a legend in the company.

Despite his many lucrative businesses he always makes time for date nights with kon and hangouts with kon, bart & cassie ♡ They all know of his assasin group but dont care since he's happy.

Also he ditches the dumb name and costume. He goes by peregrine and designs an actual costume - spiked leather jacket(inspired by kon), black onepiece(fitted with standard bat procedure) and black greek style circlet with wings(inspired by bart and cassie). He uses his bo staff but attaches retractable blades to make him seem like the bringer of death in a way

[doubleca5t]

Is there insurance for things like pest infestations or related damage?

I think some carriers might offer a specialty coverage for something like this but most home policies will not cover that. This is because a "loss" in insurance terminology must be sudden and accidental. In general, insurance companies do not want to cover wear and tear to the structure because it does not fit that definition and would discourage people from taking proper care of their property (i.e. why bother spending a bunch of money on building upgrades and maintenance when your policy will just pay for anything that breaks regardless). Because pest infestations represent gradual damage to the structure over a long period of time as opposed to a sudden loss, insurance policies will usually have a specific exclusion form for this kind of damage.

[all-that-glitters-is-goldfish]

How would you seduce podiatrist Larys?

I think the girlies need to hear this!

Oops! Here's a short story for you.

Title: Dr. Strong

Pairing: Modern!Podiatrist!Larys Strong/Female Reader with foot fungus

You were surprised that the student health plan at Westerosi University had coverage to see an on-campus podiatrist. It was disappointing not to have dental insurance, but your current dilemma involved your toes, and not your teeth.

Your mother drilled it in your head before leaving for school.

Make sure you always wear your shower flip-flops. Those communal bathrooms are bacteria mines! Her voice echoed in your brain as you made your way into the small, brightly lit office where a handsome, muscular, curly-haired receptionist sat, his eyes glued to the computer screen in front of him.

Of course, your mother was right. One time. One time without shower shoes and your big toenail on the right foot turns a shade of Simpson yellow.

Foot fungus. You were sure of it.

And it was your resident advisor who suggested taking a visit to Dr. Strong's office down at the student health clinic.

You hand your ID to the receptionist. The silver rectangular nametag had HARWIN written in bold print. His large hands point to an empty exam room to his left. "Room 4. My brother will be with you in a minute."

The posters with graphic images of foot diseases along the walls made you queasy as you make yourself comfortable, sitting down and taking off your socks and sneakers.

As promised, Doctor Larys Strong entered the room not 5 minutes later, his greasy curls falling over his eyes as he limped towards you.

You felt a pain in your heart, seeing his struggle as it came to your understanding that this job must be personal to him.

"Good afternoon. I'm Doctor Strong. And you must be Miss Y/LN."

"Y/N is fine." You smile, his blue eyes shining brightly as he returns it.

"So what seems to be the problem today?" He flips up the chart in his hand, clicking the back of his pen, already jotting down several notes.

"Well... um..." You place your naked foot onto the stool provided in front of the chair, flexing your big yellow toenail.

His eyes divert to the ground and his cheeks seem to redden.

"Oh god... It's bad isn't it?" You panic. You knew it. Your toe would have to be amputated.

"Well-" Doctor Strong begins, leaning down, carefully supporting his weight on the wooden cane he carried with him. "It's definitely not ideal."

A tear rolls down your cheek. "Are- Are you going to chop my toe off?"

Larys' eyes shoot up to meet yours, carefully examining your expression, unsure if you were being serious. "Chop it-? No! Of course not. I'm just going to prescribe some anti-fungal cream and advise you to keep your feet dry."

"Oh thank god." You breathe out a huff of air you hadn't realized you had been holding.

"Might I be so bold?" The doctor interrupts your thoughts. "As to mention that yellow is my favourite colour." He smirks, causing you to chuckle, a tiny snort erupting from your nose as well.

"Oh..." You twirl your ankle around, examining the infected nail. "It's actually... mine too."

Your heart flutters has he takes your heel in the palm of his hand. "I feel like your gentle foot would benefit from a massage."

"I don't know if my coverage-" You begin.

"It would be on the house." He replies, his nose pressing against the skin and taking a sniff.

You're surprised by his actions, but you admit that the attention feels nice. Cinderella had always been your favourite Disney movie growing up, and though your sneakers were no glass slippers, you had still found a prince.

"Would it be possible if I could take some pictures of your feet... for the medical journal I am publishing, of course. Some before and after shots of the treatment progressing." Larys asks, and you nod shyly as he pulls out his phone.

Your foot still rests in his hand, as he snaps a few pics. Moaning as he does so, causing you to raise an eyebrow.

"Is everything okay?"

He nods. "I've had many patients walk through those doors... but none with feet so... immaculate as yours."

He puts his phone away as he finishes, quickly jotting down some more notes and handing you a prescription pad.

"Apply this cream twice daily and we should start seeing results within the next couple of weeks."

You nod, as he holds out his free hand to help you from the chair. "Follow the instructions closely. We don't want to risk the infection spreading... though a pop of colour isn't the most... horrible thing..."

You feel your face heat up with embarrassment and flattery.

"I would like to schedule you in for another appointment 4 weeks from today."

4 weeks? Could the throbbing between your thighs wait that long for your feet to be touched again?

"Yes, Doctor Strong."

"Please, call me Larys."

Tagging: @pendragora @aemonds-holy-milk @chompchompluke @the-invisible-queer @simp-aholic @worms-on-a-single-stringand @madame-fear as if I haven't traumatized ya'll enough today

[justinspoliticalcorner]

Amanda Marcotte at Salon:

Republicans know that their war on legal, accessible birth control is unpopular. But that's not stopping them because, as they learned from convicted felon Donald Trump, the way to hide what you're up to is simple: Lie. Lie a lot. Lie every time you open your mouth. Lie with a straight face, and have faith that the weak "fact checks" offered by the mainstream media don't matter. The Republican comfort levels with lying are sky-high in the era of Trump. Speaker of the House Mike Johnson, R-La., does it with a smirk, satisfied that no one can stop him. It is somehow still staggering how much they lie about birth control and their nefarious intentions toward it. The good news is that Democrats are taking action to cut through the GOP's thick forest of falsehoods.

On Wednesday, Senate Majority Leader Chuck Schumer, D-N.Y., held a vote on the Right to Contraception Act, which guarantees the right of an individual "to obtain contraceptives and to voluntarily engage in contraception." The legislation also protects the right of licensed health care providers "to provide contraceptives, contraception, and information, referrals, and services related to contraception." Despite loudly insisting they have no desire to take away birth control, all but two Republicans voted against the bill. This follows a 2022 vote on the bill in the House, in which all but 8 Republicans voted against the right to use contraception.

Republicans' excuses this week ranged from obvious lies to obfuscation tactics which ultimately amount to lies. Sen. John Cornyn, R-Tex., called the vote "phony" because "contraception, to my knowledge, is not illegal." But of course, no one is saying it's illegal — yet. The point of Wednesday's vote was preventive, to ensure the right to birth control in the face of overt calls, including from Supreme Court Justice Clarence Thomas, to "revisit" the legality of contraception now that the right to abortion is no longer federally protected.  Sen. Katie Britt, R-Ala., whose State of the Union response introduced the nation to what a strange and dishonest character she is, went in for an appropriately weird lie. She falsely claimed the bill would "offer contraception like condoms to little kids." It does no such thing, though I have a lot more questions for Britt about how she thinks puberty works, and if it's induced by the sight of condoms instead of the natural process of growing up. 

Dishonest actors like Cornyn are being empowered by Trump, whose lies are even more hamfisted. Trump was recently asked by a reporter if he plans to restrict birth control and he simply said, "Some states are going to have different policy than others." Journalists know this is his way of avoiding a straight answer while letting the religious right know he supports any law they pass. Trump's campaign staff, clearly panicked that he'd let his anti-contraception stance slip, immediately took to Truth Social to claim he had "NEVER" and would "NEVER" support restrictions on birth control. This, however, is a blatant lie. During his time in the White House, Trump passed policies to cut off contraception coverage on health insurance, appointed health advisors who would like to see most methods banned completely, and ended federal funding for birth control at about 1,000 family planning clinics. 

Republicans use two big, interlocking lies to conceal an anti-contraception agenda from the public. First, they deny they intend to take birth control away, by limiting their definition of "birth control" to condoms and the rhythm method. To justify that shell game, they lie about how the most popular and effective forms of birth control work, claiming they are "abortion." They ping-pong between these two lies, so that the fact-checkers can never keep up. 

[...] So many lies in such a short sentence! Plan B is not an abortion. As the Washington Post noted, "Emergency contraceptive pills such as Plan B and Ella work by inhibiting or delaying ovulation, thereby preventing sperm from fertilizing the egg." The second lie is her implication that if folks "consider" something to be true, that makes it the equivalent of a fact. But many people also "consider" the Earth to be flat or believe Ernst is a hobgoblin in a lady suit. Doesn't make it true! Then there's the dishonesty of focusing only on Plan B, which is a drug stigmatized because it's taken after intercourse. What Ernst fails to mention, however, is that emergency contraception and the birth control pill are the same drug, just different doses. They work identically, by suppressing ovulation. The Christian right opposition to Plan B is a stalking horse for banning all hormonal contraception. Ernst's failure to admit that is a lie by omission. 

The Right To Contraception Act vote in the Senate laid bare the GOP’s hypocrisy on contraception: They seek to wage war on contraception and birth control by deceiving the people, including falsely equating most common forms of birth control and contraception to “abortifacients.”

[nothorses]

Hi there! I have a quibble that I hope comes across as good faith and not anon hate: you quote statistics from the 2015 Transgender Study in a way that I think decontextualizes them. For example, trans men are more likely to be denied coverage for surgery (but not top surgery, which is considered cosmetic for trans women. Also, FFS was not included in the study and is almost never covered). Trans men face more harassment from police but trans women are more likely to be incarcerated, etc.

The point of the post (which is here) was just to debunk the myth that trans women are categorically "more oppressed" across the board. The stats I pulled were just a number of (fairly random) examples to that end, and I clarify in the text of that post, in reblogs, and in subsequent posts that the point is not to create a definitive list of The Ways Transmascs Are Most Oppressed- it's to demonstrate that the common assumption that trans women always have the highest rates of violence/discrimination in all areas is, y'know, patently not true.

All of those statistics represent only a narrow slice of a much more complicated issue.

To use your first example, "trans men are more likely to be denied coverage for surgery (but not top surgery, which is considered cosmetic for trans women. Also, FFS was not included in the study and is almost never covered"...

From the 2015 USTS Report:

"Transgender men (57%) were more likely to be denied surgery coverage than transgender women (54%) and non-binary people, including non-binary people with female on their original birth certificate (49%) and non-binary people with male on their original birth certificate (35%)" (p.95)

To my knowledge, the USTS did not actually outline surgery coverage rates for specific surgeries. But they do talk about the rates at which different people want, or have had, specific surgeries:

So, right off the bat: you can see FFS (Facial Feminization Surgery) reported in Figure 7.14. But what strikes me more about these charts in this discussion is that it really does speak to a more complicated issue on the whole.

You could absolutely say trans men (26%) have top surgery more than trans women (11%), but that would also be misleading. 97% of trans men have had or want to have chest reconstruction or reduction, compared to 51% of trans women who have had or want augmentation mammoplasty... well, yeah, it makes a bit of sense that trans men have had this kind of surgery more. They want it more.

But for kicks, let's look at the "have had" vs. "want someday" ratios, for a better picture of what those denial rates might be: 37% of trans men who wanted top surgery (97%) have actually had it, vs. 27% of trans women who wanted it (51%). We don't know that "denied coverage" is the reason all of these people have not gotten it yet, but it's probably a factor; and yes, that does indicate a 10% gap with trans men ahead.

And for kicks, let's apply that same concept to a few other procedures. To use your other example, 14% of trans women who want FFS have had it. But that's also not a super popular surgery for trans women; electrolysis/laser hair removal is the most popular, and 50% who want it have actually had it. In comparison to the most popular surgery for trans men- top surgery; 37% who want it have had it- that's a 13% gap with trans women ahead.

Granted, electrolysis is generally less invasive and more accessible (though it also requires repeated appointments), but I also couldn't tell you how often it's covered by insurance.

You might also compare bottom surgery rates: 66% of trans women want or have had vaginoplasty, vs. 27% of trans men want metoidioplasty (meta), or 22% want phalloplasty (phallo). Of trans women who want it, 18% have had it. Of trans men who want it, 7% (meta) or 15% (phallo) have actually had it. That's a gap of 3% or 11%, with trans women ahead in both cases.

You may also note that for trans women, surgical procedures are not super popular; vaginoplasty is the most sought-after surgery, and it's also third on the overall list of procedures for trans women. Trans men do not have non-surgical transition procedures listed (or generally available, afaik). Which is, imo, important context for another relevant statistic: "Transgender men (42%) were more likely to have had any kind of surgery than transgender women (28%)".

My point is, again, just to say that this stuff is complicated. I grabbed those statistics because they were a quick way to demonstrate the more general point that this is not a black-and-white issue, that trans men do not oppress trans women (and vice versa!), and that trans men are not actually More Privileged In All Areas.

And like, yeah, when you look closer at the issues those statistics reference, there are more layers- that's the point! It's a 300 page document, you could have a lot of conversations around all of these numbers and what they mean.

The fact that I didn't have all of those conversations in that post was not an attempt to hide these complexities. It was a request that we start to engage in them, especially without gearing it toward the question "who has it worse?", when the actual questions we need to be answering are "why does that happen?", and "how do we solve it?"

What I wonder, also, is- what is your point in bringing this up? The examples you brought up were lacking context, and in one case fully untrue. I want to assume good faith as well, but your ask comes off as if you're trying to argue that transmascs never actually struggle in a comparable or unique way.

[cbk1000]

So, just got home from my appointment with my new doc. I gave him the Cliff Notes version of all the issues I've been having for the last few months, and I forgot a copy of the initial iron panel that I had done, unfortunately (I meant to bring it and even left it on my computer so I would remember; how did that work for you, dumbass?) but I remembered my numbers, and as soon as I told him what the results were for my initial iron panel, he immediately said, 'That's low."

I KNOW. PLEASE TELL DR. CRAZY THAT.

Basically, he listened to everything I said, asked relevant questions, asked if I'd had my thyroid levels checked (because thyroid can definitely cause some of these problems), said if necessary in future if there are still issues, we can do a thyroid scan, but let's get an updated iron panel done to see where I'm at and if we can increase my dose, work on the iron deficiency, and then go from there. I asked about iron infusions to speed things up, and he said, "Yeah, definitely, we can see if we can get that covered for you if you want to do that." I said I know insurances are a pain when it comes to coverage and a lot of them won't pay unless your hemoglobin is low, and that I have a health savings account and am able and willing to pay out of pocket, and he was like, "Ok, good."

He also offered to refer me to a hematologist, and I said I had thought of asking my last doctor for that, but he was difficult to work with (understatement of the year) and that I figured an appointment with a hematologist would probably be pretty far out anyway, and I'd prefer to try and get in a lot sooner if possible for an infusion. He said, "Yeah, hematology is always backed up." I did say I had been in touch with a telehealth hematologist about possibly ordering an iron infusion, but thought it would probably be faster to go through a local doctor if it was possible to get it ordered through him, but that's at least an option; he was glad to hear I'd been in touch with a hematologist. He wants to see where I'm currently at with my iron panel (I haven't tested it for six weeks) and then figure out what the best course of treatment is based on my numbers. (If I'm at a certain level, an infusion wouldn't be safe, because I'd risk overload, but considering that in four weeks of supplementing, I went up nine points, and then in another four weeks, I went down a point, I'm gonna' be extremely shocked if he comes back like, "Yeah, your ferritin went up to 150, so we can't do an infusion right now."

He actually even brought up POTS and said some of my cardiac symptoms were similar, and I said, "Yeah, I had thought of that, but my heart rate isn't really consistent." He asked if I meant that it wasn't going up when I changed positions, and I said, "Well, it's been coming down as I've been supplementing, and I don't think it would do that if it were POTS. Also, my normal resting heart rate is in the 60s, and on bad days, just lying down in bed, not doing anything, my heart rate is in the 90s. It goes up higher the more I exert myself, obviously, but even lying down doing nothing it's a lot higher than my normal resting heart rate."

I told my previous doctor all of this, and he just ignored all of it and continued to blather on about how the shot had given me POTS.

Do you know what this doctor did? He said, "Oh, yeah, probably not POTS then. Also, if cardiology already checked you out and they didn't even mention it as a possibility, it's probably not."

He also asked if I had a history of iron deficiency anemia, and I said I hadn't had labwork done at the time so I didn't know what my iron levels were or if my hemoglobin was abnormal, but many years ago after a blood donation I started feeling really sick, had the high heart rate and shortness of breath and could barely get off the couch, and I was still living at home at the time, and my mom was a nurse and just put me on iron supplements and that resolved my symptoms, and that those cardiac problems seem to just be how my body responds to low iron.

And he just. Took that at face value. Like, ok, you have a history of this, then, let's work on getting it sorted out and then look at other possibilities if it doesn't all clear up with iron treatment.

So I'm getting my iron panel done Friday, and then we'll go from there with treatment options.

[dontmeantobepoliticalbut]

Last week, the Supreme Court heard oral arguments in what could end up being its most consequential abortion decision since Dobbs. In a case pitting Idaho’s extreme abortion ban against a federal law known as EMTALA—that since 1986 has required hospitals to provide emergency care—conservative justices seemed to embrace the idea that states can deny crisis medical treatment to pregnant patients, even if doing so means those patients suffer catastrophic, life-altering injuries. “My reaction can be summed up as ‘appalled,’” says Sara Rosenbaum, emerita professor at George Washington University who is one of the country’s foremost experts in health policy issues affecting women and families. “Will [the court] really say it is fine [to enforce] a law that costs women their organs as long as they don’t die?”

It’s hard to think of a piece of progressive American health care policy since the late 1970s in which Rosenbaum hasn’t played a pivotal role conceptualizing, enacting, or improving. That includes the federal statute that guarantees the right of every American to go to a hospital emergency room and receive medical treatment before being sent somewhere else. The Emergency Medical Treatment and Labor Act requires hospitals to screen and stabilize anyone who arrives at the emergency room, including women in active labor. Narrow in scope yet vast in impact, the law has been a “force field around hospital emergency departments,” Rosenbaum says, protecting pregnant patients for four decades. Now, with the Dobbs decision, SCOTUS has “blown up medical care for childbearing people,” she says—and EMTALA could be the next major health care protection that the court decides to explode.

To more fully understand the implications of the case before the Supreme Court, we reached out to Rosenbaum to discuss the history of this unique statute and why it has become even more vital since the end of Roe v Wade.

You’ve called EMTALA “revolutionary” and “the most important American health care law that we have.” Why? What makes this law so special? 

It’s the only American law we have that guarantees access to care. For everybody. It doesn’t matter who you are—whether you have insurance or don’t have insurance, what color you are, how much money you have, whether or not you’re disabled. If you come to a hospital emergency department and you believe you have an emergency, they have to screen you. If it is an emergency, they have to stabilize you. The definition of an emergency isn’t that you’re in danger of dying; it includes situations that could lead to severe, long-lasting physical harm. And the decision about what is required to stabilize you—it’s up to the doctor’s medical judgment.

I would say EMTALA is really our only universal health care law.

This law is from 1986. What was happening in the ’70s and ’80s that made EMTALA seem so necessary?

A few things were going on. Back in the early ’80s, a decision was made that the United States was spending too much on hospital care. So Congress changed the payment structure for Medicare [the single largest payer for health care services in the US] to incentivize shorter stays. Pretty soon there were stories emanating from the press about a phenomenon they called “sicker and quicker,” where patients who actually had been admitted to the hospital were getting discharged too soon, when they were still unstable.

Another major problem was that indigent people were not able to get emergency care at all. There were a lot of stories of women being sent away in labor—not just pregnant patients, although that was the story that got the most play. In those days, many fewer women were eligible for Medicaid than are today and it wasn’t as generous. Only very, very indigent women could get Medicaid coverage.

Later in the 1980s, you also helped persuade Congress to vastly expand Medicaid for pregnant women, making it a federal requirement.

There’s no question that poor people bore the brunt, but they were not the only ones. For example, one of the most famous EMTALA cases from that period involved a patient with HIV—nobody would touch him. There have been many cases of fully insured people who, for whatever reason, hospitals just chose not to treat. People who were in a drunk driving accident and were out of control, for example, or mental health patients who were disruptive. Even if the patient was well insured, if they were a handful they would get sent over to the public hospital.

Hospitals are very good at getting rid of people they don’t want. And so, while indigent people were the immediate focus, there’s nothing in EMTALA that limits it to uninsured people. That’s the important thing.

Tell me about one of your pregnancy cases from this era.

One of the cases I worked on in the mid-’70s involved a Black woman named Hattie Mae Campbell who went into premature labor at her home near Holly Springs, Mississippi. She had Medicaid, but the local hospital refused to treat Medicaid patients. The baby was coming out. And the nurse stood at the door of the hospital with her arms spread wide, blocking the entrance, refusing to let her set one foot inside, because once a patient crossed over the line, there were legal arguments to be made that the hospital had begun the admission process. So she gave birth in the parking lot.

And we know that after the birth, the staff still refused admission. They provided a sheet to wrap the baby, then they transferred Campbell and her newborn to another hospital 30 miles away. How much of a factor was racism in these situations?

Race is always a factor—a combination of racism and the fact that people of color were even more poorly insured than white people.

Were there regional differences in how patients were being treated?

There were hospitals all along the Texas-Mexico border that would dress up [security] guards as immigration officials. They would station personnel at the door so you couldn’t come in. But this was going on everywhere. Rich states, poor states, affluent communities, not-so-affluent communities, racist communities, not-such-racist communities. It was happening everywhere because [private] hospitals felt that public hospitals or community hospitals should take care of patients they didn’t want.

You should understand that hospitals were set up to accept only the patients they want. That has been tempered a bit. In the case of emergency care, they can’t do that anymore. But it hasn’t changed that much. A hospital might want me for elective surgery but not my neighbor down the street who’s a Latina who has Medicaid coverage. I mean, they have all kinds of ways to avoid patients they don’t want, right? The type of insurance they take, the doctors they give admitting privileges to, deciding what networks to be part of.

That’s why EMTALA was enacted using Medicare, which is a national program, as the stick. If you as a hospital want to participate in Medicare, and you run an emergency department, then you must do these things as a condition of participation.

Even despite all these horror stories, I still have a hard time imagining how you and other public health advocates managed to get EMTALA passed.

There was no resistance in Congress. None. A Republican Senate, a Democratic House, virtually identical language in both bills. Signed by Ronald Reagan. It really was a different era in the life of the United States.

And then what happened?

Oh, then there was huge hospital resistance. Even though hospitals were very involved in designing EMTALA, it’s a pretty heavy-duty regulation. Over the years, there’s been a lot of resistance both to the requirement that hospitals have to do an initial screening and to the requirement that they have to stabilize the patient before discharging or transferring. There have been thousands of EMTALA cases. The federal government has brought them, private individuals have brought them.

There was a lot of resistance from attending doctors as well. The very first enforcement action was a birth case out of Texas. An OB-GYN who was supposed to be on-call went duck hunting, and when the hospital got a call that a woman had presented in labor, he said, basically, “I’m not coming in for her.”

In 1989, the language of the statute was tweaked to clarify that EMTALA didn’t just apply to the pregnant person, but also to the “unborn child.” Nowadays that goes right to the “personhood” argument of abortion opponents—indeed Justice Alito invoked it during oral arguments. Why was that language necessary then and how is it different from how it is being deployed today?

Because women were still giving birth in parking lots. Women in labor were still being spurned. That language is in there because women who literally had babies coming out of them were being sent away. Everybody understood that you had two medical crises going on here, the crisis of the mother and the crisis of the baby. Everyone, apparently, except the noncompliant hospitals. The concern was not just the pregnant woman, the way it is with some of the emergencies we’re hearing about post-Dobbs, where the fetus is utterly non-viable and the focus is rightly on the pregnant woman.

So the language was clarified: The baby was also a patient. Here on Planet Earth, there are two concerns in labor and delivery, the mother and the baby.

Was there any worry that at some point in the future, anti-abortion people might point to that language and say, as Idaho and Texas are arguing now, “See, EMTALA actually means we can’t do abortions because we have to care for the unborn child”?

That really was not ever the intent. No, no, no, no. We didn’t put that language in there because we were suddenly creating embryonic fetal rights. It’s just a complete misunderstanding of EMTALA.

The pro-choice world crabbed about the language but didn’t fight it tooth and nail because everyone understood the context was labor and delivery. And they were going to lose that [battle]—no member of Congress was willing to listen to nonsense at that point about “clean up your language.” I’ve litigated abortion cases since the Hyde Amendment [the 1976 law banning the use of federal funds for abortion under most circumstances], and I was completely not troubled by that language.

Was it always understood that in some situations, EMTALA might require doctors to do emergency abortions?

This issue of abortion as an emergency procedure has been grounded in EMTALA for a long, long time. There were already cases in the early ’90s of women coming to the hospital with a terrible pregnancy emergency where an abortion had to happen. Or they’d had an abortion that failed, or an incomplete miscarriage that needed an abortion procedure. So this issue [of whether EMTALA requires hospitals to perform emergency abortions] is not new. What’s new is Dobbs. What’s new is what the Supreme Court unleashed when it overturned Roe v Wade.

Pregnancy-related complications that might lead to emergency abortions—for example, when the embryo implants in the fallopian tube instead of the uterus, or when a woman’s water breaks too early for the fetus to survive—are a lot more common than many people realize. But pregnant people end up in the emergency room for all kinds of other reasons, too.

Pregnant people are frequent users of emergency departments. About one in 500 pregnancies goes to an emergency department at some point. Most of the attention has rightly been placed on emergencies where something terrible has happened to the pregnancy itself. But there’s a whole other group of emergencies that aren’t pregnancy-related—it could be appendicitis, it could be a car accident, it could be domestic abuse, it could be COVID.

The tendency when somebody is pregnant is to send them to the emergency department right away because you don’t want to take any chances. And sometimes in these situations, you need anesthesia, you need surgery. Sometimes, unfortunately, as a consequence of treatment you may have a demise. What Idaho has done is to make every pregnant person coming to an emergency department radioactive.

As someone who has spent your whole career steeped in health policy and health law, did you see this moment coming? When hospitals turn away pregnant patients with life-threatening emergencies? When a law as important as EMTALA seems on the verge of being gutted?

It was very evident, from the moment that the Dobbs decision was leaked, that there was just a total, fundamental clash between what states like Idaho with these terrible abortion bans thought they had the license to do and what EMTALA required.

When the Dobbs decision finally came down, my daughter called, incredibly upset. All of her friends were incredibly upset. I said, “Here’s my one piece of advice. You have friends all over the country. The ones who live in any one of the states that are going to impose a complete ban, tell them that they must not get pregnant. And if they do want to be pregnant, they must move away. Because a lot of things can go wrong in a pregnancy, and if anything goes wrong, they’re not going to be able to get emergency care.”

The other thing that I realized right away is that it would be impossible for doctors to practice in these places, and there would be a huge exodus of providers. And in Idaho that has happened. So people like me, who are steeped in health policy, understood immediately what was coming. But where we are now is worse than I could have even imagined it was going to be.

[sergle]

i know u said u don't have insurance, but have u considered just buying your own insurance? surely that will be less than 23k (i imagine it will be roughly 700 per month). u could even get on a PPO plan from a state with good medical coverage like Massachusetts (blue cross). even the out of network out-of-pocket maximum will be way less than 23k minus the annual cost of coverage.

okay, so the plan is: buy my own insurance (easy) (will be done quickly) (easy), find a hospital/specialist that takes said insurance (easy) (the places covered by insurance will definitely give me good results) (having my choices narrowed down won't sacrifice quality), or check the surgeons I've rustled up myself (the insurance will def cover). then I'll get the reduction (this will be quick) (there will be no hoops to jump through) (I will not have to explore "other options" for a number of months / up to a couple years to assure I've ruled out other means of pain management) (I won't have to do a ~year of physio) (I will qualify) (I won't have to wait a long time) (I will not have to be a certain BMI) and get the amount of tissue/weight removed that I've been wanting (the coverage won't specify the amount I'm to have removed), and bing bang boom, my life is fixed

[kawaakari-orchestra]

Pinned post ✨

Hello! This is Jay, and I've decided to make a separate blog for my fan proseka unit, Kawaakari Orchestra of KWKO for short. The reason for this is mostly my brain demanding for organisation, but also the reaction to them was incredible and I definitely want to talk about them more.

KWKO introductory post is here! More info under the cut.

What this blog will post:

- Area Conversations

- Self-introsuctions

- Welcome lines [probably]

- Memes

- Other curious tidbits of information

What this blog will post sometime in the future:

- Birthday/Anniversary Menu lines

- Seasonal/Holiday Menu lines

- Event summaries

- Card story summaries

- KWKO Kizunas

What this blog will not post:

- Full events [link only]

- Full card side stories [link only]

- Any song associations/headcanons (unless I suddenly learn to produce songs)

Please note that this blog will sometimes post content touching on or discussing several potentially upsetting or triggering topics, including the following:

- Child Abuse;

- Bullying;

- Mild violence and injuries, including discussions of eye injury;

- Suicidal ideation, including suicidal behaviour and past suicide attempts;

- Self-harm;

- Eating disorders;

- Substance abuse;

- Near death experiences;

- Chronic Illness, Medical Trauma and internalised, as well as external, ableism.

The aforementioned topics are unlikely to be portrayed in detailed or particularly descriptive manner. Nevertheless, reader discretion is advised.

All of the aforementioned topics will be tagged. The standard format for tagging will be [tw: "insert trigger"], as well as other formats to insure maximum coverage. The topics listed above will also be tagged at the beginning of each card story/event episode/etc when that time comes around.

Please contact me either on this blog or @shiraishi-kanade if you need additional trigger warnings.

Character symbols!

Saitsu Maki - 🦋

Kozaki Karin - 🦊

Shimizu Kairi - 🐚

Ekuro Suzuka - 🪁

Kaedehara Akari - 🍁

Fujisaki Reishi - 🌸

How can I interact with this blog?

- I will answer any asks to the best of my ability, unless the question is an explicit spoiler that will be answered later in the story!

- You can also submit an ask directed to a character (using their assigned emoji), and they will also answer to the best of their ability; however, you have to keep in mind that they would perceive you as a fan/viewer and can avoid your question or answer dishonestly.

- You can also send me your assumptions/theories/otherwise thoughts on plot development or future events; however, those will not be answered. You can specify if you want them posted or not and if yes I will answer with ✨ to say that I see and appreciate your thoughts but am unable to answer in a meaningful way due to inherently spoiler-y nature of the interaction.

- Feel free to send just about any questions, artwork (oh my god??), headcanons, memes, what have you. I greatly appreciate literally everything. Keep in mind that all KWKO characters are minors.

Main story/events when?

- Somewhere after I've done with my finals this year! I don't have the brain capacity to juggle this many things at once.

[ post dividers by @/cafekitsune! ]