SAN FRANCISCO — When Gina Duncan decided to undergo the medical treatment that would make her a woman, she had plenty to fear. The reactions of her children, her professional colleagues and friends. How her body would respond to hours on the operating table. If, at the end of it, she would look female enough so strangers wouldn't gawk.
What the Orlando mortgage banker didn't have to be anxious about was how she would pay for two of her surgeries. Her employer of 10 years, Wells Fargo, included breast augmentation and genital reconstruction as coverable expenses under its employee health plan. Duncan was told the San Francisco-based bank already had had 16 other employees transition to new genders and assigned a benefits specialist to walk her through the process.
"They had a template in place, and it was surprisingly supporting and mentally encouraging," said Duncan, 55, who four years later still works for Wells Fargo. "So much of what I'd heard involved people who ended up losing their job, losing their family, losing their friends, becoming destitute."
With little fanfare, more and more large corporations, including Coca-Cola, Campbell Soup and Walt Disney, have expanded their insurance coverage to meet the needs of transgender workers. The trend follows a concerted push by transgender rights advocates to get employers and insurers to see sex reassignment the way the American Medical Association does – as a medically indicated rather than an optional procedure.
"We understand people simply get appendicitis, and it is something our community deals with through insurance," said Andre Wilson, who counsels companies on transgender issues as a senior consultant with San Francisco-based Jamison Green & Associates. "That's what we need to understand about transsexualism. Not everybody will be diagnosed with Gender Identity Disorder, and in fact, few people will be. But the people who are diagnosed with it really need treatment."
Among the corporations providing transgender-inclusive health benefits are some leading Wall Street and Main Street brands.
American Express, Kraft Foods, AT&T, Yahoo!, Eastman Kodak, Sears, Morgan Stanley, Price Waterhouse, General Motors and State Farm are among 85 large businesses and law firms that cover the cost of at least one surgery, according to a 2010 survey by the Human Rights Campaign, the nation's largest gay rights group.
The number is expected to spike this year, when HRC adds availability of surgery-inclusive medical benefits for transgender employees or transgender dependents to the criteria in its annual corporate diversity report card.
To maintain the coveted 100 percent rating when the next Corporate Equality Index is published in the fall, companies will have to offer at least one insurance plan that covers at least $75,000 worth of surgery and other treatments recommended by a patient's doctor.
"A lot of people are pretty surprised that alongside the cosmetic and experimental treatments that are excluded from mainstream plans, you can see very broad exclusions related to transgender care," said Deena Fidas, associate director of HRC's Workplace Project. "In raising the bar...we are addressing the root cause of the problem."
Stephanie Battaglino, an assistant vice president at New York Life Insurance, has been working with a senior executive at her company to add transgender health benefits to the employee insurance plan. Battaglino, 52, started her transition five years ago, becoming the first New York Life employee to do so openly. To finance her surgeries, which were on a list of procedures not covered by insurance, she borrowed from her 401(k) account.
"I've often said to friends, `My transition at work went really, really smoothly, and if I had to do it again, the only thing I would change would be if I had my surgery covered,'" she said. "To know it was covered and completely reimbursed would have cast everything in a much different light."
New York Life has been open to the changes and expects to have the expanded coverage in place soon, Battaglino said. But that doesn't mean the learning curve has been easy to negotiate.
The company initially was uncomfortable agreeing to $75,000 of allowable coverage, she said. But she said that concern was alleviated when it was explained that only two or three employees would likely need the benefits.
"The big misconception is we are going to go broke and all these transgender people are going to come out of the woodwork asking for gender reassignment surgery," she said.
Once she was diagnosed and decided to seek treatment two years ago, Sara Schnorr, a partner in the Boston law firm of Edwards Angell Palmer & Dodge, "poked around" to see if another firm already paid for sex reassignment as part of its group health insurance.
"When you go to work every day, if you are gay or lesbian, you look no different," Schnorr said. "But if you are transgender, you have to make some pretty big changes to your physical appearance. It's not really like you can be stealth about it."
Schnorr decided to stay with the firm where she had worked for 31 years and to come out to her partners. Before she went on leave for her first surgery, which would feminize her facial features, they agreed to secure a rider to the firm's insurance policy that would allow her to be reimbursed for at least genital reconstruction and breast augmentation.
"I was ecstatic," she said. "For me, this is yet another example of how human this law firm is in wanting to take care of its employees."
Some businesses see covering the cost of transgender surgery as not only an important human resources statement, but good business sense.
"Wells Fargo elected to offer this benefit to be competitive as an employer and also to support our comprehensive corporate commitment to diversity," company spokesman Mary Eshet said.
Joanne Herman, the author of "Transgender Explained For Those Who Are Not," said both corporate America and insurers need to understand that genital surgery is not the be-all and end-all in making a person's appearance match the way he or she feels inside.
For men becoming women, undergoing facial reconstruction may be even more important because it will affect how they are perceived and treated in public, Herman said. The same is true for female-to-male transsexuals and breast surgery. Yet standard insurance plans typically dismiss both as cosmetic, even though people with untreated Gender Identity Disorder are at high risk of suicide and those who get treatment become better workers.
"If you are transsexual, living as anything other than that is a very bleak experience. It's amazing how much happier I am, how much more productive, social and involved I am as Joanne," she said.