My insurance company doesn't know what I am. It seems to decide my sex based on what it doesn't want to pay for.If I make a claim for something male-related, like testosterone or Finasteride (okay, it's for prostate cancer, but it's supposed to prevent male-pattern baldness), my insurance company says I'm female and denies the claim. If I make a claim for something female-related, like a PAP test or pelvic exam, the company says I'm male and denies the claim.
I'm usually able to get a reversal (except on the Finasteride--they don't think male-pattern baldness is medical, not realizing the number of people who would be sickened if they saw what I looked like with no hair). But I'm hoping that the new U.S. Tax Court decision on transition surgery as a medical necessity will eventually affect insurance-company attitudes toward all medical care for trans people.
Initially, the finding, which says that transition surgery is an allowable medical expense for tax purposes, will help some trans people at tax time. Hopefully, it will have implications for insurance companies, who will no longer be able to argue that transition surgery is cosmetic in nature and therefore not eligible for insurance coverage.
But what I'd eventually like to see is insurance companies forced to abandon male/female delineations when it comes to paying for various medications or treatments. I realize that they are trying to protect against fraud, but I question how serious or widespread any fraud involving male and female sex categories might be.
If a doctor diagnoses prostate cancer, it's likely that the person has a prostate. It doesn't really matter if the person is male or female. If a doctor diagnosis ovarian cysts, it's likely that the person has ovaries. It's like one of those logic problems you used to hate in school. My 10-year-old nephew could figure out as much.
With more trans people coming out and seeking care for medical transition, with the intersex movement arguing for the delay of medically unnecessary surgical interventions until a person is old enough to decide for him- or herself, and with the multitude of imperfections found in just about every human body in existence, it would seem to make sense to treat people on the basis of their need for a particular intervention rather than an "M" or "F" on an insurance application.
Stuff like this makes my hair fall out. Thank god for Finasteride.
(Note: Congratulations to GLAD and to Rhiannon O'Donnabhain on their victory with the U.S. Tax Court. O'Donnabhain put herself out there for years at great personal sacrifice to win this victory for the trans community. If you're not familiar with this case, go to the GLAD Web site linked to in the story and read about it.)
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She's a hero, plain and simple, and I'm touched and heartened to see that some people will sacrifice personally to fight a good fight.
I'm terrified about my insurance company "putting 2 and 2 together" and denying any number of things retroactively.
Whenever I see a new doctor and the paperwork requires an answer to the gender question I usually leave it blank and hope they don't ask.
I don't get estrogen through my insurance, but I do get finasteride and a number of other things. I assume my doctor knows what he's doing and how to code it...but in a way many of us live our lives hanging out, in danger of being trimmed off.
So far so good. But I would be lying if I didn't admit a certain level of anxiety that always exists.
Just curious Matt, do you think that the Washington State non-discrimination law can be used to force the insurance companies to stop denying transgender related treatment? Also, what do you feel about the fact that the state will allow a gender change on a DL but will force you to surrender same, when applying for a enhanced license?
Kimberly (warning: verrrry long answer)--I honestly don't know, but I would think not, in answer to your first question. I'm not a lawyer, but as long as insurance companies remain private, they have a great deal of control over what they will and won't pay for. And as long as Gender Identity Disorder remains in the DSM as a mental health condition, there could be questions about whether or not transition is a legitimate remedy (medically necessary).
We already know that it has been determined to be so by WPATH and by some medical and psychiatric organizations, as well as by the U.S. Tax Court, but there has been no definitive finding or agreement on such. So I think insurance companies could argue that there is no proof positive yet that this is a medical condition that requires transition for medical reasons.
Most insurance companies won't pay for "experimental treatments" for such things as cancer, and they could argue about transition treatments in a similar vein. They are not discriminating against cancer patients when they deny certain treatments that are not "proven," so they would not be considered to be discriminating against trans people by denying certain treatments.
I think it's a battle that will end up in the courts at some point in the future, because I don't think that even the U.S. Tax Court finding will be the deciding factor for insurance companies. They really are very powerful in this country, and they will avoid paying for anything they don't have to pay for.
The positive thing is that, no matter how you feel about HRC (and I have my own feelings that I will keep quiet about), they are starting to make some inroads with their Corporate Equality Index, in that they have added some trans measures that corporations have to live up to in order to get a 100 ranking, and some corporations take this very seriously now.
One of the choices that corporations have is to have in place an insurance policy that covers transition medical expenses. Unfortunately, there are other choices corporations have in order to comply, so because this will be a difficult thing to do, most will probably go with the easier options. But I think that LGBT organizations will continue to put pressure on corporations to have benefits that are more favorable to trans people.
Corporations might end up taking the lead by insisting that their insurance policies cover transition surgeries. And corporations are very powerful, too. They may be the ones to break down this barrier under pressure from LGBT organizations. Once the biggest corporations start telling insurance companies, "We won't take out a policy with you unless you cover transition," the insurance companies will start listening. That's capitalism. But I don't see it happening for a while.
I'm sure there are others more well versed in this than I am, so I would love to hear other people's input.
As far as the second question, that I don't know about at all. It appears that the enhanced license acts as a passport as well, which would lead me to believe that it would follow the U.S. passport guidelines--which means that many trans people are out of luck. Their travel is restricted because they cannot get a passport without proof of surgery, once again making us second-class citizens and confining us to certain borders.
Matt, thanks for the answer. First point: If the state of Washington forbids health care providers of practicing discrimination on the basis of orientation (read:gender) and require equal treatment, and other health insurance companies cover transsexual surgeries and care, and more cities and municipalities cover care, which all give credence to the standard of necessary and customary care, how can the insurance companies deny care? And how can the argument of "experimental" be used when so many entities, public and private, deem it customary care? What's the tipping point?
Second point: If the state requires equal accomodation from public and commercial enterprises (Washington Revised Code RCW 49.60.030) how can they be exempt from the requirements of accomodation of access without being sued for sexual discrimination themselves?
I am pursuing a birth certificate gender marker change in Colorado and understand that Phyliss Frye used the argument that requiring gender surgery for marker change constituted coercive choice, and amoung other things, limited access due to not only financial ability, but physical ability as well, begging the question of what does a TS do if they medically can't bear the stress of surgery? She also had an interesting argument about sex determination at birth was only a "prediction" of gender in later life based on visible characteristics.
Daya,
I sypathize with your plight, and share some of your reluctance to be seen as TS, but I have had no doctors treat me with anything but complete respect. My ins co also thinks me female, and has covered hormones and mammograms as a matter of course. Don't know what might happen if I had prostate cancer, but Washington law seems to preclude them from cancelling my policy. Unless they could argue fraud, but if Washington sees me as female, it might be difficult to do.
As you said, hard not to feel some anxiety, as if we don't have that built in.
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