One year from now, more employers than ever before will cover transgender surgery as part of their health insurance plan. While this is much-needed progress for transgender people, implementation issues will unfortunately create new hurdles to living in one's true gender.
The coverage is a requirement in the 2012 Corporate Equality Index. An employer must contract for the coverage by June of this year and coverage must be effective January 1, 2012 in order to score 100 percent on the 2012 CEI.
This change will impact all transgender people even though many do not need or want surgery. That's because insurance company exclusions of transgender surgery, and in some cases any transgender care, have tended to make medical care providers regard anything transgender-related as frivolous.
The consequence of this is shocking. The recent National Transgender Discrimination Survey -- Report on Health and Health Care showed that 19 percent of the respondents of all ages were refused care because of their transgender or gender non-conforming status, 28 percent were subject to harassment in medical settings, and 2 percent were victims of violence in doctor's offices.
It's unclear if all 337 employers who scored 100 percent in the 2011 CEI survey will be able to arrange for the new coverage in time. The chief diversity officer of one employer told me that adding the coverage is his number one priority in 2011. Yet I'm guessing the change is big enough that some companies will fall from 100 percent in 2012.
While 85 of those employers already cover transgender surgery in some way, the challenge for all employers will be that the 2012 CEI requires coverage of surgery deemed medically necessary by the World Professional Association for Transgender Health (WPATH). It may take some employers longer than others to accept that procedures such as facial feminization surgery, usually dismissed as "cosmetic" in current coverage, should be covered.
For those employers large enough to "self-insure," conformance with WPATH requirements can easily be written into the health plan. But for other employers who must take the "plain vanilla" insurance offerings, many health insurers in the U.S. do not even offer a rider covering transgender surgery, and those who do typically impose requirements that differ from the WPATH requirements, usually in more restrictive ways.
One restriction in standard riders concerns the procedures involving breasts. For a person transitioning from female to male, a mastectomy is recognized by WPATH as the first step typically undertaken in a gender transition. For a male to female, WPATH sees breast enlargement as warranted after 18 months in cases where hormone therapy has not led to adequate breast tissue growth. But most standard insurance riders set an 18-month delay for any breast procedure, unacceptable for those transitioning to male.
Even with the most WPATH-compliant coverage, a significant hurdle will be that few of the current transgender surgery specialists accept insurance. In fact, most require prepayment of the full cost. Many employees are just not going to be able to come up with that kind of cash, and it's going to be a while before the market forces providers to accept insurance.
For those who can pay in advance, the insurance company's inexperience with transgender coverage could leave the employee hanging. In one company already providing coverage, a patient obtained the required pre-authorization letters from a therapist and the primary provider of care, received approval, and underwent surgery, only to find the insurance company refusing to pay because it decided after the fact that the employee's primary provider of care should have been a mental health provider. The patient is now scrambling to be pre-authorized after the fact.
Of course, most insurance companies limit payment to the "reasonable and customary" (R&C) amount for the particular surgery. Surprisingly, insurance companies already have these amounts determined since most transgender surgery procedures are actually the same procedures performed for non-trans people under different circumstances (for example, construction of a penis for a man who has been in a tragic accident). An employee could be caught short if the R&C amount ends up being less than trans surgery specialists normally charge.
And then there is a common requirement of using providers within the employee's home state. With so few surgeons specializing in transgender surgery, will this leave the employee with coverage, but no qualified surgeon? Or will it encourage the employee to gamble on a surgeon who has little experience with the procedure?
Regardless of the hurdles, the new coverage is timely. The recently-released U.S. Department of Health and Human Services' Healthy People objectives for the next 10 years include, for the first time, a specific objective of recognizing transgender health needs as medically necessary. The change in attitude brought by the new surgery coverage will go a long way toward achieving this objective.
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Rev. Patrick S. Cheng, Ph.D.: The Truth Will Make Us Free: A Queer Year in Review
Sex reassignment surgery - Wikipedia, the free encyclopedia
Transgender Surgery Female to Male FTM Breast Reduction Surgery
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" This is considered a cosmetic service and is excluded as detailed in your explanation of benefits."
Hormones are not cosmetic!
site:huffingtonpost.com dadt -intitle:dadt
About 142,000 results
site:huffingtonpost.com enda -intitle:enda
About 629 results
DADT was for the LGB community
ENDA was for the LGB&T community
Every other western democracy does very well without them and 36 countries achieve better healthcare. Every country achives much lower cost.
I see there are some leaving comments here that don't understand what it means for someone who is transgender and needs this type of care. You are welcome to read what I told the University Council if you like. I 'hope' it helps you have at least a little more understanding.
http://www.facebook.com/note.php?created&¬e_id=120468284690065&id=148416985209839
Furthermore, those transfolk on Medicaid and Medicare are specifically *denied* coverage!
Oh, and according to the Social Security Administration, a diagnosis of GID is a non issue. Gotta love it, right?
To say that wanting gender reassignment surgery "sounds like instant gratification" or that gender disphoria is not a medical condition suggests that you're either being very flip or that you know very, very little about the issue. It's fine to have an opinion about everything, but you might consider doing a little reading first.
But that is exactly what current medical research has identified in the case of transsexuals. Transsexual brains are sexually dimorphic in the opposite direction of their visible anatomy. This is not equivalent to people wanting to get a facelift or liposuction. We're not talking about "feelings," we're talking about brain structure.
The findings of medical science in this area also fit the evidence gleaned from decades of case histories in the treatment of transsexualism. Reparative therapy techniques for transsexuals have been proven not to work (not a single long-term success story based on roughly a century of evidence trying every known psychiatric technique). However triadic therapy (involving hormones, real life transition, and surgical anatomical correction) has been also been studied for a few decades at this point, and has shown a very high (95% plus) rate of success.
Neither the medical nor the therapeutic evidence fits the assumption that transsexualism is a matter of "personal choice," which is why the relevant medical professions have issued formal statements calling for medical coverage.
As for coverage of surgery, my HMO initially said they would reimburse me but afterwards went back on their word and made it impossible for me to collect. I have also experienced a tremendous amount of discrimination, from losing custody and then contact with my daughter (because of a religious custody evaluator) to finding it impossible to secure employment as a nurse. The application process would go smoothly until they found out that I had practiced under a male name.
I hope for a better world for foregoing generations who want to feel normal for the first times in their lives.
Thank you for your story. There are people who love you, I am certain.
BZ.
In my experience the bottom surgery is most important to people who identified as straight before they came to terms with being trans.
Well, maybe about as excited as when that GWB tax cut for those making over 200K was extended.