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July 31, 2014: “Medically Necessary”

August 1, 2014

Illinois just became the ninth state (plus the District of Columbia) to ban discrimination of transgenders by health insurers. Here’s the link from the Transgender Law Center:

Theoretically, insurance in those states must cover “medically necessary” care for transpeople. To me, that includes gender confirming (formerly gender reassignment) surgery. But most insurers don’t cover it.

Mara’s appointments with her endocrinologist are covered. Her hormones are covered, too. But not surgery. Even though California (where we live) and Washington State (where her employer and its health insurance provider are based) are two of the other states with transgender insurance nondiscrimination laws.

So, do these insurers think that GCS is not “medically necessary?” Opponents ask why insurers — and other people on the insurance plans, since the cost is spread among the insured — should have to pay the $20,000 to $30,000 that GCS costs in the U.S. It sounds like a lot of money.

We met a transwoman who is a doctor, working for a major health insurer. She said that, when the cost of covering GCS is spread over the pool of insured people, it’s minimal. For a company the size of Mara’s employer (about 700 people), it’s 19 cents in premiums per person, per month.

And consider that the cost of treatment for people who get cancer from smoking is often much higher. So is heart surgery and diabetes treatment for people who have unhealthy eating habits and are sedentary. But all of those conditions and treatments are covered, even though the people receiving them had a choice to put down the cigarettes, or the junk food, or whatever.

Transgenders don’t have a choice. It’s about who they are, not what their habits are.




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