Despite our efforts to work with Medicare, we have been unable to contact any Medicare personnel who can guarantee approval and reimbursement nor has anyone offered contractual agreements with us to provide service. Our intention had always been to accept Medicare. In our test cases with Medicare coverage, there continue to be denials of our claims. Until we receive affirmations of coverage, the language suggests only a lifting of the ban. This should have the positive effect of no longer allowing private insurers to deny coverage with the argument ‘Medicare has an exclusion ‘. In time, we do expect to offer Medicare coverage for transgender surgery but cannot do so at present with such uncertainty still in effect.