ACA/Obamacare non-discrimination gender identity surgery

[sarahbear]

With the new health law gender identity is specifically mentioned as cause for non-discrimination. Besides this the health law says that if a procedure is covered for non-trans people then it must be covered for trans people basically. So could this be used as a basis to get surgery covered if your insurance covers vaginoplasty for non-trans people?

[Dee]

Interesting question.  I did a quick search, and this is really all I could find:

http://www.hrc.org/blog/entry/whats-in-the-aca-for-transgender-people


Though, it was a quick search; but it sounds much like what you said, it's mainly non-discriminative, in that coverage cannot be denied if it's available to others.  And vaginoplasty (or, 'vaginal rejuvenation' for cis-females) looks to be considered elective.  So I'd imagine it's not in any insurance plan, regardless of trans- status.

Something that was interesting in the HRC page, though, is that California, Colorado, Vermont, DC, and Oregon are "[putting] new rules are in place to eliminate many transition-related exclusions, and expect to see more states join this trend in the coming years."

That last part sounds pretty hopeful.  It would be nice for the hefty premium on my individual-payer policy to go towards something helpful...

[Jean24]

Something that was interesting in the HRC page, though, is that California, Colorado, Vermont, DC, and Oregon are "[putting] new rules are in place to eliminate many transition-related exclusions, and expect to see more states join this trend in the coming years."

That last part sounds pretty hopeful.  It would be nice for the hefty premium on my individual-payer policy to go towards something helpful...

That would be a dream come true. Unfortunately I would have to move away from home but I guess I can always move back later

[tgchar21]

As I've said before the main thing changing in favor for trans* people is that one's status can no longer be used as a pre-existing condition (up until now insurance companies could use any little medical flaw to deny you coverage, so denying trans* people coverage there is going out the window with denying people for other reasons). What hasn't changed is that insurance companies are still not required to cover (for the most part) the procedures specifically related to transitioning.

[Tori]

Well spake.

And for those that need a cool doctor. They do exist.

If you live on a metro, great. If not, move or complain. In either case google works. Be sure to mention "informed consent".

[stephaniec]

there was something on the news lately about transgender care through medicare and public aid. I think they were still in the process of deciding to cover it , such as srs

[sarahbear]

The medicare/medicaid thing you heard about is that HHS is considering adding coverage for surgery instead of blocking as they've done since 1981. It seems like this may happen so if that's how you get health coverage it could be useful but also will help influence other insurance policies.

[sarahbear]

Though, it was a quick search; but it sounds much like what you said, it's mainly non-discriminative, in that coverage cannot be denied if it's available to others.  And vaginoplasty (or, 'vaginal rejuvenation' for cis-females) looks to be considered elective.  So I'd imagine it's not in any insurance plan, regardless of trans- status.

Dee, vaginoplasty is used by women for medically necessary reasons also like for people with MRKH. I had briefly thought my insurance would cover my surgery earlier this year but then found out that the medical code I asked about was not for trans people but it was for vaginoplasty. For women that need reconstructive surgery it seems like the level of complication could be similar to the mtf surgery so if that's covered I think it should be covered for me also. I realize that it's not an exactly same procedure but if nothing else it's the same name and same result with similar methods.

I think one question I have is to figure out the best way to try to challenge the coverage exclusion with my insurance.

[kariann330]

No matter what law is passed in the US, our surgeries will ALWAYS be viewed as an elective procedure. The most that might change if obumnercare isn't repealed or defunded is HRT being covered by an insurance company, and being transgender can no longer be used to deny coverage as a preexisting condition.

[DrBobbi]

Obamacare doesn't specifically address transexual concerns regarding surgery. Here in California the Dept. of Insurance and Dept. Managed Health Care MANDATES by law all related surgeries, including FFS and Breast Implants for Transexual patients. Doctors or Insurers can also be cited under Penal Code Section 422 (Hate Crime) for exclusionary practices. You can find the actual law and letter on my FB timeline. A few other states are adopting California's language.

[Sybil]

Obamacare doesn't specifically address transexual concerns regarding surgery. Here in California the Dept. of Insurance and Dept. Managed Health Care MANDATES by law all related surgeries, including FFS and Breast Implants for Transexual patients. Doctors or Insurers can also be cited under Penal Code Section 422 (Hate Crime) for exclusionary practices. You can find the actual law and letter on my FB timeline. A few other states are adopting California's language.

I think I may be reading this incorrectly. Are you saying that insurers in California are required to cover FFS and BA for transsexual patients? I've never heard of anything like this.

[LordKAT]

There is like 5 states that have that law.

[Allyda]

Do you know if Florida is one of the States that have this law? I plan to start hrt hopefully with the help of my doctors in January however if it comes down to it I've done my research and will begin on my own if necessary. Hopefully Florida is participating with my home state of California's language.

[Jennygirl]

It is my understanding that the non discrimination act in California only pertains to medically necessary surgeries and that SRS now has to be considered medically necessary. This coverage or change in policy has to go in effect on Jan 1st, 2014. Anthem has already released information reflecting this new policy: http://www.anthem.com/medicalpolicies/guidelines/gl_pw_a051166.htm

FFS covered by insurance in California? I am finding this very hard to believe. That would be a dream come true.

[Tori]

If you change your face Jenny, I will reach through this computer screen and virtually smack you. Well, that is a bit harsh. Just don't go extreme. Most of us would pay a lot of money to look like you already do.

[Jennygirl]

If you change your face Jenny, I will reach through this computer screen and virtually smack you. Well, that is a bit harsh. Just don't go extreme. Most of us would pay a lot of money to look like you already do.

HA well I better prepare my virtual cat-like reflexes!

I'm having a type 1 brow bossing procedure (shave only, not reconstruction) in 2 weeks to remove the bossing bumps over my eyebrows. It's a minor procedure (not like a type 3 reconstruction) so hopefully I won't be getting any virtual smacks in the first place.. The difference should be minimal. My eyebrows will be raised a bit too though

[Tori]

I will let the swelling reduce before the virtual smacking.

Good luck!