Insurance Victory

An issue that has caused frustration, sadness, and exasperation (and that is just for me- imagine how my clients must feel!) is the issue of exclusions for transition-related services for transgender individuals. Most healthcare plans have specific exclusions for anything related to gender transition. This includes but is not limited to hormone blockers, hormones, and needed surgery for transgender individuals.  In my opinion, this is as outrageous as healthcare plans excluding other major medical conditions. These exclusions leave me feeling very helpless, as I can see so clearly what my clients need: medical transition. And I cannot provide this!

As important as being able to access medical transition is being able to access EARLY medical transition when clinically necessary. However, even with the support and assistance of their parents, many transgender youth run into roadblocks when trying to get hormone suppressors. They are outrageously expensive, and most health insurances have exclusions that state they will not pay for anything related to gender transition. (Can you imagine, being one of these preteens/teens who are right on the doorstep of getting the treatment they so desperately need to survive, but they cannot afford it?)

Such is the same for many of my transgender adult clients. Surgery is an important part of the transition for most of my adult transgender clients, and yet most insurances will not cover it. This is a major power problem for those who cannot afford to pay for such surgeries out-of-pocket. It is my opinion that they shouldn’t have to.

On April 9, 2013, a ground-breaking ruling was made on this issue:

“California’s Department of Managed Health Care (DMHC) has ordered California’s health plans to remove exclusions of coverage based on gender identity and expression…The newly issued DMHC letter instructs health plans to revise current plan documents to remove exclusions and limitations related to gender transition.  For transgender people, how and when they transition is typically a private decision made with their doctor. The American Medical Association, American Psychological Association, American Psychiatric Association, and the American Academy of Family Physicians have all deemed transition-related care to be medically necessary for transgender patients.” Read more about it here.

I am truly curious to see how this plays out with all of my clients, and hope it is in reality as good as it sounds! To progress!

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