11 April 2013

This Letter Will Save Lives

If you were to ask most people to name a state that has progressive policies when it comes to transgender health care, many would mention California.  After all, San Francisco was one of the first cities to include gender identity and expression in its anti-discrimination laws.  It was also the first American city to offer to pay for gender-reassignment surgery, hormones and other necessary treatments for trans people who are City or County employees.

Now the California Department of Managed Health Care (CDMHC) has ordered all of the state's health plans to remove gender identity or expression as a basis for excluding or refusing coverage.

Why does that matter?  Well, I can offer one example from firsthand experience:  After I started taking hormones for two years, my doctor recommended that I get a mammogram.  My breasts had grown somewhat, but more important, the fact that I was taking estrogen put me at somewhat greater risk of breast cancer.  At the time, of course, I hadn't undergone gender reassignment surgery so, according to many insurers (though, thankfully, not the one I had) would have considered me a male.  And, as others in my situation discovered, other insurers would not pay for a "man's" mammogram--or, worse, would accuse any transwoman or her doctor of fraud for claiming the procedure.

Or, let's say some insurer considered me female and I had a medical problem that was testicular in origin, or that had to do with my prostate.  That insurer would have rejected a claim for any treatment involving those issues.

Then there are trans men who have been taking testosterone and who, perhaps, have had "top" surgery, but not bottom surgery.  He might then need, say, a pap smear--which an insurer could deny if he is classified as male.  On the other hand, if he is still classified as female, he might be denied treatment for high cholesterol or other conditions for which he is at greater risk as a result of taking testosterone.

What insurers may not realize is how risky it can be to deny treatments to people who are transitioning.  As Masen Davis, the Executive Director of the Transgender Law Center said, "This one letter will save lives."

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