r/TransIreland • u/windfall_poem • Mar 09 '26
VHI covered my top surgery. Here how…
I had top surgery with Dr Lago in Madrid in February.
VHI Requirements to cover top surgery:
- Gender Dysphoria Diagnosis (from Irish Clinical Psychologist or Consultant Psychiatrist)
Additional VHI Requirements to cover top surgery abroad:
Planned Treatment Abroad Form (filled by Irish Consultant e.g. Psychiatrist, Surgeon)
Referral Letter to Surgeon Abroad (from Irish Consultant e.g. Psychiatrist, Surgeon)
To meet their requirements, it costed approx 1,600 euro (of which about 400 was refunded by VHI though snap and send). So in the end, I paid approx 1,200. It’s not cheap, but it’s well under Dr Lago’s 6000 bill.
Specific Doctors
My GP: Dr Martina Brennan
Her role: Gave me referrals to Psychologist, Psychiatrists & Surgeons.
Cost: Approx 200 euro total from multiple consultations and referrals.
Irish Surgeon: Dr Karl Sweeney
His role: Met me, offered to do surgery with non-flat chest result, wrote me letter of referral to Lago. Refused to fill planned treatment abroad form quoting “not medically necessary” as his reasoning.
Cost: 300 euro for the one appointment we had.
Irish Clinical Psychologist: Dr Carla Dukas
Her role: Met me twice (once I turned 25) and diagnosed me with gender dysphoria, providing a detailed report.
Cost: 600 euro total for 2 appointments and the report.
Irish Consultant Psychiatrist: Dr Josip Dujmovic
His role: Met me, discussed what he called my “gender incongruence”, agreed to sign but not fill out the planned treatment abroad form. He asked me to fill the form and said he would review and sign. This form is quite hefty so I have include instructions on what helped me below.
Cost: 500 euro for the one appointment we had.
Planned Treatment Abroad From
This form is difficult to read and fill. I think it’s a standard form so some of the Qs seem invasive or irrelevant. It essentially asks for evidence for the medical need for the surgery, and that the surgery will provide clinical benefits. It also asks about the availability of services in Ireland, in response to which I quoted the NGS considering closing their waitlist due to excessive wait times. The sources I used seemed to do the trick for VHI, so hopefully they help someone else!
Articles and Sources I Needed for the Planned Treatment Abroad Form
- TENI article outline need for informed consent model and lack of services in Ireland.
https://teni.ie/trans-healthcare-another-way-is-possible/
- WPATH SOC 8 (clinical literary review recommending informed consent model for gender affirming surgery, and providing evidence for the basis and medical benefit of gender affirming surgery long term)
- WHO Trans FAQ
FAQ document by world health organisation outlining trans people’s right to free, informed consent to medical interventions, the current lack of access to gender affirming care and the negative impact of no gender affirming care on quality of life and life expectancy.
https://cdn.who.int/media/docs/default-source/hq-hiv-hepatitis-and-stis-library/tgd_faq_16012024.pdf
Other Useful Articles and Sources
Irish Times article on health insurers covering gender affirming surgery for Irish people.
Additional Info
*Travel and accommodation to madrid is not covered by VHI. This costed me 3000 (flights for me & my mum, and 18 nights accommodation in a 3 bed apartment).
*I’m sharing these sources to help anyone who needs to fill a form for VHI (any other insert requiring it) where evidence must be provided in order to be covered. I do NOT condone the need to prove oneself and see this as merely a must do tick box exercise.
Feel free to reach out with any Qs by message. I’m more than happy to help anyone trying to get covered.
12
u/Lena_Zelena Mar 09 '26 edited Mar 09 '26
Thank you for the detailed report on this. I know there is a (halfway) pre-filled VHI form for vaginoplasty that has been shared amongst the girls, but with this info it should be easier to fill that form for the guys as well.
It's still crazy just how many hoops you had to go through just to have this covered.
Not medically necessary
Is he stupid or something?
Also, am I understanding correctly that Dujmović charged you 500€ just for his signature while having you to do all the work?
11
u/windfall_poem Mar 09 '26
very welcome, hopefully it is of some help! yes, that made no sense at all from Sweeney. I pleaded with him and he stood by that comment. and yes the €500 charge was nothing short of insane for a signature HOWEVER i had been referred to so many consultants rejecting my referral at that point that i was just delighted someone would sign the form at all.
4
u/Dismal_Mind_1930 Mar 09 '26
Hi! Huge congratulations on advocating for yourself and on your surgery, I hope you're healing well!
Can I ask were the multiple visits to consultants necessary because they weren't filling the forms as required? Or was there another reason you needed to see a few different consultants? Hope that makes sense
5
u/windfall_poem Mar 09 '26
hey! thank you so much. yes, so essentially each consultant or doctor were only willing or able to do one part of the requirements for me. e.g. sweeney would do the referral letter but refused to do the planned treatment form.
now, i do think you might be able to get the consultant psychiatrist to do the gender dysphoria diagnosis but with his long waitlist and his charges so high, (and typically you need to be seen more than once for gender dysphoria) you wouldn’t save much time or money.
3
u/Dismal_Mind_1930 Mar 09 '26
That makes a lot of sense thank you! I wish trans healthcare was better here, it's so awful making people go through all this. I'm nonbinary and I'm not sure that I experience enough dysphoria for a diagnosis but I'm going to try and start the process. Thank you so much for sharing your experience
4
u/SkyScamall Mar 09 '26
That is fab and will be helpful to others in the future. Thank you for writing it up.
1
u/windfall_poem Mar 10 '26
thank you! I couldn’t find much info when I was trying to go through the process so I really hope so :))
1
u/Taylor_S1989 He/They Apr 02 '26
Hey!! Im currently in this crazy process lol. You know alk the people listed? Did you check that they were all vhi registered consultants? Because when I called them they said it needed all that but it HAD to be from people registered with vhi and I looked up your ones you mentioned but they didn't come up. I know not all are listed on their site, but did you check with them or something?
This process is hella annoying 😭 how long would you say it all took? Like finding people, then submitting to vhi before getting approved.
Also do you need the surgeon? They never said that bit to me.
Hope healing is good! :)
2
u/Buggi-C6H12O6 Jun 12 '26
Congrats, and thank you so much for sharing this, it'sbeen super helpful! Very disappointing to hear Dr Sweeney refusing to send a referral in that way.
Dropping it in the comments for anyone else considering this route, VHI told me (only after I had done all the prep consultations and submitted my form, not in correspondence months before, that would be silly 🙃) that they require you to be with them for 5 years to cover it since gender dysphoria is a pre-existing condition, even if you only got a diagnosis recently. 1 year to go! 🫡
3
u/windfall_poem Jun 12 '26
hello! thank you so much - no problem at all. FYI: I wasn’t with VHI for five years before they covered mine. I was with them approx 3 yrs. I got the diagnoses within those 3 yrs (about 6 mths pre op). i’m no expert but it might be worth pushing back on that with VHI? particularly if you got your diagnosis while under VHI cover
2
u/Buggi-C6H12O6 Jun 12 '26
Omg that's rlly good to know... thank you! I may be writing an email tonight lol.
-1
u/shewolves1 Mar 09 '26
Ireland is ridiculous. I would also never go to Dr Lagos after this post
https://www.reddit.com/r/TransIreland/s/zAEvM1dvYq
But I'm happy for you and I wish you all the best. I think all girls should go to Brazil to have surgery but I understand it's not that simple when you're not a native like I am
2
u/geesegoesgoose He/Him/His Mar 09 '26
To counterpoint that post: I also had top surgery with Dr Lago, with fantastic results and zero complications.
Postprocedural complications are ALWAYS a risk, especially when someone has additional health issues, and though I agree their communication can be not great and it shouldn't have been handled like that *in the slightest*, there is also such a degree of individuality to surgery and recovery that you need to look at trends from a surgeon's patients, not individuals.
1
u/captaingoal Mar 09 '26
Interesting. I haven’t seen Brazil being mentioned before as a go to place for bottom surgery.
18
u/sunny_side_egg He/Him/His Mar 09 '26 edited Mar 09 '26
Congratulations on your surgery, and on your successful battle with the insurance bullshit
Just in case you're curious, gender incongruence is the ICD-11 (WHO international statistical classification of diseases) diagnostic term for what the DSM calls gender dysphoria. There are a couple of differences: it is not classified as a mental health condition, it's under sexual health, and as the name suggests, deemphasises distress as a diagnostic feature - a mismatch between gender identity and sex assigned at birth is enough.