Chaz Bono sparked controversy when Dancing With the Stars announced the openly transgender celebrity would be one of the contestants this season. But public outcry isn’t the only discrimination trans people face.
While more health insurance companies are including gender reassignment surgery in their plans, discrimination often takes place after the surgery, especially for those with individual plans, activists say.
Not only can plans be more expensive due to possible health risks, especially if the person has bottom surgery as well as top surgery, but some seeking health insurance under individual plans are turned away altogether for pre-existing conditions. Bono has received testosterone treatments to deepen his voice and provide facial hair and had his breasts removed, but has not had bottom surgery, saying it is still too risky.
“It has been virtually impossible for transgender people to obtain health insurance in the individual market for this reason,” says Harper Jean Tobin, policy counsel for the National Center for Transgender Equality in Washington, D.C.
Tobin expects this to change in 2014, however, when President Barack Obama’s health reform bill, the Affordable Care Act, completely kicks in, including new insurance market reforms that won’t allow any adult to be turned away for pre-existing conditions. Those rules now apply to those under age 19, which Tobin says includes some young trans people who have been affected by these bans in the past.
Until then, the Human Rights Commission identifies several areas of discrimination against transgender people in its page on Health Insurance Discrimination for Transgender People:
· Denial of coverage for claims related to gender transition. This includes claims arising from complications from medical treatment for gender transition.
· Denial of coverage for claims for gender-specific care based on the person’s gender marker on insurance forms. The commission cites as examples: a male-to-female person who develops prostate cancer, or a female-to-male person who develops ovarian cancer.
· Denial of coverage for claims unrelated to gender transition. For example, the commission stated, an insurer argues that a medical concern is the direct or indirect result of transgender-related treatment such as hormone therapy.
Tobin concurs that these are among the main problems, for those trans people who even have coverage. She says some insurers use transition-related plan exclusions to deny coverage for all kinds of care, from cervical or prostate cancer screenings to liver damage, blood clotting or bone fractures.
“Insurance companies often try to interpret any plan exclusion as broad as possible, asserting any conceivable relationship between something that is excluded and something that would otherwise be included. That’s not a problem unique to transgenders, but it often affects them,” Tobin says.
Tobin says, for example, an insurer might argue that the insured person wouldn’t have had a fracture or liver damage if he or she hadn’t been on hormone therapy.
“These denials are usually spurious, and the improved protections for claims denials in the Affordable Care Act should help curb some of the most egregious abuses, but won’t end the exclusions themselves,” Tobin says.
There is growing support for health insurance coverage for transgenders. The American Medical Association joined the movement to end discrimination in health insurance for transgender people in June 2008, when it passed a resolution at its annual meeting that the association supports public and private health insurance coverage for treatment of gender identity disorder as recommended by a physician.
Susan Pisano, spokesperson for America’s Health Insurance Plans (AHIP), a national trade association representing the health insurance industry, says the organization has not surveyed its members on the issue of transgender people and did not know their policies on pre-existing conditions. Pisano echoed Tobin’s assertion that as of 2014, pre-existing conditions will go away anyway.
In the meantime, Errin Auxier, a 50-year-old transgender entertainer in Chicago who goes by the stage name Honey West, is afraid to switch individual insurance plans at this point. Auxier is an insurance risk, having had hormone therapy to get breasts. Auxier has not had bottom surgery, largely due to the cost and the fact it is not covered under Auxier’s individual policy.
Pisano says she didn’t have an answer for Auxier’s dilemma, which also will be resolved in 2014. Until then, Pisano says transgender people need to check the laws in their state and with their insurers to see what their policies cover.
Tobin says another issue relates to gender coding of procedures. In order to avoid erroneous or fraudulent billing, some procedures are coded for gender by insurers, but this could inadvertently lead to a denied claim for a trans person who legitimately needs the procedure.
For instance, Tobin says a transgender man may be listed as male in insurance and other records, but may need cervical cancer screenings. The insurance claims for that screening will bounce back. Likewise, a transgender woman may need prostate cancer screenings and a mammogram post-transition.
“The computer systems won’t know what to do with this unless the insurer creates an exceptions process in the coding,” Tobin says.
A growing number of private and public plans have instituted this process, but many still don’t, or providers don’t know how to use it.
“This is less a case of insurance companies intentionally denying needed care and more a case of unintended consequences,” Tobin says.
