Author Topic: Insurance Company Refused to Pay for Transgender Teen's Health Care  (Read 844 times)

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Offline Laura1951

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A major insurance company is refusing to pay for a trans teenager’s health care


https://www.lgbtqnation.com/2020/12/major-insurance-company-refusing-pay-trans-teenagers-health-care/


LGBTNation by Molly Sprayregen on December 3, 2020

The family of a transgender teen is suing his insurance company for denying coverage for his gender-affirming care. They charge it is a violation of the Affordable Care Act.

Lawyers for 15-year-old C.P., as he is referred to in court records, filed a complaint in Tacoma, Washington against Blue Cross Blue Shield of Illinois (BCBSIL). The complaint says BCBSIL denied coverage to C.P based on an exclusion in the terms of his health plan, which stated that benefits would not be provided for anything “for, or leading to, gender reassignment surgery.”

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Unequal health coverage for transgender youth and adults is problematic.
“When you’re ready, start living your truth. That’s when the magic happens.”

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Offline Rakel

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Re: Insurance Company Refused to Pay for Transgender Teen's Health Care
« Reply #1 on: December 07, 2020, 07:45:35 pm »
This is unfortunate and all too common.

All health insurance companies offer many different plans. You must read the plan to see if it covers transgender surgery or not. Blue Cross Blue Shield in my state offers a one time coverage of GCS.




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Offline sarahc

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Re: Insurance Company Refused to Pay for Transgender Teen's Health Care
« Reply #2 on: December 07, 2020, 08:44:58 pm »
For my edification, does anyone know the current state of WPATH standards as it relates to surgery for underage trans patients?

Sarah
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48 years young.
Known that I am trans since...forever.
First therapy session / decided to transition / hair removal: October 2018
HRT: January 2019 (journal https://www.susans.org/forums/index.phpVF/topic,244009.0.html)
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Offline Devlyn

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Re: Insurance Company Refused to Pay for Transgender Teen's Health Care
« Reply #3 on: December 08, 2020, 03:27:53 am »
For my edification, does anyone know the current state of WPATH standards as it relates to surgery for underage trans patients?

Sarah

I'm unaware of WPATH changing anything in the Standards of Care.
Veteran, US Army

Offline TheWomanWithinMe

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Re: Insurance Company Refused to Pay for Transgender Teen's Health Care
« Reply #4 on: December 09, 2020, 12:29:54 am »
The timing of the request for services and subsequent lawsuit could have been better.  With the pandemic waging throughout the world insurance claims are through the roof.  As access to doctors, emergency rooms and surgery facilities have been dramatically curtailed people have been putting off getting treated and conditions that could have been treated for a couple of hundred dollars end up costing an insurance company 10s of thousands of dollars instead.  Many insurance companies are likely to pay out more than they take in. Insurance premiums are likely to be increased to cover all the conditions they currently cover to make up for their losses.

For every elimination of an exclusion 1000s of people would line up to take advantage of the increased coverage.  Lifting an exclusion could cost an insurance company tens of miliion dollars a year.  No one including those asking for exclusions want their premiums raised so that everyone can get all the care they want.  I support increased transgender coverage but unsure how it can be accomplished. It will be interesting how the lawyers proceed and what positive or negative outcomes it may have on the transgender community.

This is a touchy case.  Slowly but surely our community is garnering limited support inside the insurance companies, other businesses, governments and our neighbors.  Real support will likely require many more years.  Transgender advocacy could exponentially increase that support if done with great care. Unfortunately there is no unity amongst us so the public will get a scattershot of advocacy attempts. Some might further our cause but most will likely fall flat and we might actually loose some supporters as a consequence.



Offline sarahc

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Re: Insurance Company Refused to Pay for Transgender Teen's Health Care
« Reply #5 on: December 09, 2020, 05:21:59 am »
The timing of the request for services and subsequent lawsuit could have been better.  With the pandemic waging throughout the world insurance claims are through the roof.  As access to doctors, emergency rooms and surgery facilities have been dramatically curtailed people have been putting off getting treated and conditions that could have been treated for a couple of hundred dollars end up costing an insurance company 10s of thousands of dollars instead.  Many insurance companies are likely to pay out more than they take in. Insurance premiums are likely to be increased to cover all the conditions they currently cover to make up for their losses.

Actually, in the United States insurance claims are generally down, and the reason is that people are putting off a lot of expensive, “elective” surgeries, like knee replacements. The reduction in elective procedures this year is why hospital revenue is actually down in 2020 and why some hospitals will need a bailout.

And speaking of knee replacements, my view is that if people can get knee replacements paid by insurance so they can enjoy playing sports, I can get GCS so I can live a sane life.

Sarah
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48 years young.
Known that I am trans since...forever.
First therapy session / decided to transition / hair removal: October 2018
HRT: January 2019 (journal https://www.susans.org/forums/index.phpVF/topic,244009.0.html)
VFS: September 2019; three-month report here
Full-time: April 2020
FFS: August 2020
SRS: January 2021

Offline TheWomanWithinMe

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Re: Insurance Company Refused to Pay for Transgender Teen's Health Care
« Reply #6 on: December 10, 2020, 01:34:45 am »

My view is that if people can get knee replacements paid by insurance so they can enjoy playing sports, I can get GCS so I can live a sane life.

Sarah
You have a valid point there.  But there are a lot of other valid points that could be made in support of this case or against it. If the lawyer in the above mentioned case read your point of view to the jury how many of them would take it to heart and rule in favor of the family suing the insurance company.

There may be a valid point of view that could overwhelming sway every jury nationwide to support requiring insurance companies to stop excluding transgender health care from their policies. Without the transgender community coming together in significant numbers to advocate for change that viewpoint will likely never be thought of and shared with those that might be able use it to advocate to our collective benefit. If such a person or persons has stepped up to take on that role.



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