% Transition Related Health Care Database

• By company/plan(?)

  • What procedures are covered
  • What hormones are covered
  • What do they claim is covered
  • What experience have people actually had with the coverage

• Instructions for gathering information about your plan

  • Exclusions
  • Formulary
  • Coverage limits (when they only pay $5 for surgery)

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Procedures

Medications

• cyproterone
• spironolactone
• finasteride
• estradiol
• progesterone
• testosterone
• GnRH analogue

Delivery Methods for Medications

• pill
• transdermal
• injectable
• implanted
• long-lasting injection

Surgeries

• Facial Feminization
• Mastectomy
• Phalloplasty
• Vaginaplasty
• Labiaplasty
• Breast Augmentation
• Orchiectomy
• Hystorectomy
• Oophorectomy
• Metoidioplasty

Others

• Therapy/Counselling
• Voice Retraining

Database Structure

Procedure Incident

• Date
• Plan ID
• Procedure
• Stated Gender (M/F/??? because it is possible to not know what gender your provider put on the application)
• Success

Coverage Statement

• Date
• Plan ID
• Procedure
• Claims to be covered (Yes / No / Unknown)

Documents

• Plan ID
• Coverage Statement ID
• Date
• MD5
• Path on disk

Plan

• Plan ID
• Company ID
• Name
• State
• Exchange color code (bronze, silver, gold, platinum, catastrophic, not-present, NULL)
• Medicaid (yes/no)

Flask API

Endpoints

• POST /api/v1/experience
• POST /api/v1/plan
• GET /api/v1/search
  • state (required)
  • dimension: one-of "company", "procedure", "exchange", "plan" (optional)
  • values (required if dimension is provided)
  • { 'plans': [plan response] }
• GET /api/v1/companies
  • { 'companies': [ list of companies ] }

API Data Structures

Report JSON:

{ date:
  gender:
  age:
  plan:
  company:
  procedures: [ { name:
                 success:
                }
             ]
  }

Plan JSON (for POST):

{ state:
  company:
  plan-name:
  type: (medicaid, private, bronze, silver, gold, platinum, catastrophic)
  exclusions: (all transition-related care, surgery, hormones)
  plan-document: file/link
  coverage-criteria: file/link
  formulary: file/link
}

Plan Reponse:

{ state:
  company:
  plan-name:
  type:
  plan-document-available:
  coverage-criteria-availabe:
  formulary-available:
}

Reports and Views

Reporting Plan Information

• Date
• Plan
• Procedure { name, included/excluded }

Reporting an Experience

• Date
• Plan
• Gender on Insurance
• Age
• Procedure { name, covered/not covered }

View for a specific plan

• Company
• Plan name
• List of procedures

  • stated info

  • experiential info

  • info: covered, not/covered

    The information would be a tally of reports, potentially broken down by time period so that if a plan changes what they cover, that can be made visible

Searches

• Plans by company
• Plans by state
• Plans by procedure
• Plans on the exchange
• Medicaid plans

I do not know what the search should make easily visible.

Database Access

(env)savanni@conway:~/src/trans-health$ PYTHONPATH=src python
Python 3.4.3 (default, Mar 26 2015, 22:03:40)
[GCC 4.9.2] on linux
Type "help", "copyright", "credits" or "license" for more information.
>>> import database
>>> s = database.connect('trans-health.db')
>>> s.query(database.Company).all()
[<database.Company object at 0x7f29e4a5dd30>]
>>> s.add(database.Plan(company_id=1, name='Super Plan!', state='TX', color_code='None', medicaid=True)
... )
>>> s.query(database.Plan).all()
[<database.Plan object at 0x7f29e4a885c0>]

To-Do

• Need to allow for people submitting/updating plans that already exist