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Oct. 6, 2015: The Health Insurance Game

October 7, 2015

With all of the advances in transgender rights, I think health insurance is one of the last areas of change. (Isn’t health insurance among the last areas of change for anything?) Mara’s employer’s previous health insurance provider was no exception. But her employer has signed on with a new provider, and she is checking to see if gender-reaffirming surgery is covered. The policy literature she has is vague. Among the exclusions: “genital surgery for the purpose of changing genital appearance” and “reshaping normal structures of the body in order to improve or change your appearance and self-esteem and not primarily to restore an impaired function of the body.”

OK, so does this insurance company consider GRS a cosmetic surgery? If it acknowledges that being transgender is a medical issue (hence, covering hormone therapy), why would it call the surgery cosmetic? Also, gender-reaffirming surgery has very little to do with appearance; and it definitely has to do with impaired function of the body. The American Medical Association has deemed the surgery as medically necessary, according to Lambda Legal. And in California, where we live, the California Department of Managed Care has said that insurers offering coverage here must include this medically necessary surgery, according to the Transgender Law Center.

But not every trans person needs to have bottom surgery, according to Transglobal Magazine, and this fact may lead insurers to deny that benefit to people who do need it. There are so many gray areas here. But when someone is experiencing dysphoria to the extent that only GRS/full transition will quell it, insurance companies and doctors should take that person seriously.

Gender dysphoria is a medical condition that cannot be reversed or prevented. People who bring on their own health issues by overeating, smoking, drinking too much alcohol, and taking drugs are covered. People who are born trans aren’t always covered. Someday, the health insurers and medical community will get it.

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