What will it take to "insure" for gender treatment?

[Dawn D.]

Okay everyone, I need you input! I have a project I'm working on for a local Trans health council. We are looking at many issues concerning trans people. My assignment is the insurance aspect of it.

So here's some of the questions I have:

1. Should there be coverage mandated to include gender identity treatments?

2. What levels of coverage if any, should be mandated?

3. What are the reasons that coverage is typically not included now?

4. What will be necessary for gender transition treatments to be covered?

5. If insurance co.'s eventually do cover or are mandated to cover gender transition treatments, should there be any waiting periods for coverage to begin?

6. If someone who is diagnosed with GID cannot afford an insurance plan that covers treatment options, should there be a mechanism available to make sure that individual is covered and treated in some way? If so, how?

7. Should an insurance co. have the right to refuse to cover GID related treatments?

8. If anyone can answer this, please do! How do larger corporations (like those with 100% ratings through HRC), successfully negotiate out exclusions of gender transition treatments so that they are covered in their health insurance plans?

9. Should whatever those mechanisms are, for negotiation, be made available and economically viable, to smaller group plans to help smaller business' become more diverse?


Well, that's probably enough for now. Please any and all thoughts are appreciated on each of these questions. However, in the interest of research, I would really like to avoid debate between us over these questions in this thread. We can open up other threads for that.


Thanks so much!


Dawn   

[LordKAT]

1. Should there be coverage mandated to include gender identity treatments?
       I think medical insurance should cover any medical procedure needed.

2. What levels of coverage if any, should be mandated?
      SRS for sure, Mastectomies, therapists, hormones.

3. What are the reasons that coverage is typically not included now?
      Expense and peoples fear of encouraging what they believe to be a corrupt idea  instead of a medically necessary correction.

4. What will be necessary for gender transition treatments to be covered?
     Not sure but perhaps  a law like covering cancer screening is now.

5. If insurance co.'s eventually do cover or are mandated to cover gender transition treatments, should there be any waiting periods for coverage to begin?
     Only if they want a therapists letter showing it to be necessary.

6. If someone who is diagnosed with GID cannot afford an insurance plan that covers treatment options, should there be a mechanism available to make sure that individual is covered and treated in some way? If so, how?
     Same as others ore covered now for medical care,

7. Should an insurance co. have the right to refuse to cover GID related treatments?
      Yes, if the refusal is because a person is mentally unstable or has health reasons making a procedure at higher risk than usual for others who transition.

8. If anyone can answer this, please do! How do larger corporations (like those with 100% ratings through HRC), successfully negotiate out exclusions of gender transition treatments so that they are covered in their health insurance plans?
     Insurance companies offer lower rates for those who exclude transition related procedures.

9. Should whatever those mechanisms are, for negotiation, be made available and economically viable, to smaller group plans to help smaller business' become more diverse?


Well, that's probably enough for now. Please any and all thoughts are appreciated on each of these questions. However, in the interest of research, I would really like to avoid debate between us over these questions in this thread. We can open up other threads for that.


Thanks so much!


Dawn   

[tekla]

Insurance companies offer lower rates for those who exclude transition related procedures.

That's not exactly true, its more like its not a basic covered expense, so it costs more.  It's not a traditional exclusion.  So at the current time its treated like a rider.  Much like your standard renters insurance would not cover real works of art, and if you want them covered, its an additional rider on the basic policy.  So its not a matter of costing less to exclude it, its costing more to include it.

The best way to do it might be through a rather high co-payment that a person could meet by using medical savings accounts that would be tax free (pre-tax) in same way that some things like glasses get covered in some policies.

[Janet_Girl]

1. Should there be coverage mandated to include gender identity treatments?

Yes.  GID is and can be life threatening

2. What levels of coverage if any, should be mandated?

Because it is life threatening, any and all treatment should be covered.

3. What are the reasons that coverage is typically not included now?

Cost, I think.  Businesses don't care about employees health.  They only offer it to recruit new employees.

4. What will be necessary for gender transition treatments to be covered?

Everything from therapy through to SRS.

5. If insurance co.'s eventually do cover or are mandated to cover gender transition treatments, should there be any waiting periods for coverage to begin?

They should cover therapy following SOC rules.  This would make it up to the therapist.  Most insurance has a 90 waiting period.

6. If someone who is diagnosed with GID cannot afford an insurance plan that covers treatment options, should there be a mechanism available to make sure that individual is covered and treated in some way? If so, how?

This is one reason I feel we need a national health care.  Right now I am in pain and can't be seen by anyone unless I pay out of pocket.  Who can afford to see anyone.

This means that we would need something like Canada and England have.

7. Should an insurance co. have the right to refuse to cover GID related treatments?

No.  It is a life threatening issues.  Would they deny coverage for a heartache?

8. If anyone can answer this, please do! How do larger corporations (like those with 100% ratings through HRC), successfully negotiate out exclusions of gender transition treatments so that they are covered in their health insurance plans?

I think that they realized the true nature of GID.

9. Should whatever those mechanisms are, for negotiation, be made available and economically viable, to smaller group plans to help smaller business' become more diverse?

Yes.  They then can hire qulified people that they might not see, because of health care coverage.

[LordKAT]

Tekla,

I don't doubt that you are correct for the technical part of that. Money wise it amounts to the same thing. Cost for including it for everyone would mean all rates would be higher but not as high for the individual needing it. I always thought that was sort of how insurance worked besides you pay an amount that added up to more than you spent overall. It was just available when you needed it whether or not you had it paid in full or not.

[Naturally Blonde]

This questionaire is obviously aimed at people in America!

[Hannah]

Right now I am in pain and can't be seen by anyone unless I pay out of pocket.  Who can afford to see anyone.

There has got to be a sliding fee clinic in your area. Also the Oregon Health Plan has a rolling enrollment for adults in OHP Standard, it takes about 6 months to a year to get in but everybody who is qualified eventually gets in. They don't come looking for you though, you have to ask. They recently cut some dental and vision services because of funding issues, but the health plan is a state priority and is still quite strong, covering most mental and physical problems.

[Janet_Girl]

My name is on the list and I am hoping to be selected.  It would be nice to get some pain medications and maybe even HRT.

And I have not found anyone, but I will keep looking.

[Hannah]

I wish you the best, it takes so long sometimes 

My hope is that when whatever the national plan is surfaces that ohp will remain intact and under a lot less stress for those it misses, and it certainly will miss some. This health plan is really an exceptional project, and they ways the fund it are rather clever too. It really does make me proud to live here.

[tekla]

About the only way this is ever going to get covered for everyone (it is for several different groups already) is for the US to adopt a single-payer health care system, and that is not happening any time soon. 

[Dawn D.]

Hi all! Very interesting responses! Keep them coming! Thanks to you all for taking the time to think about this issue and make replies.


Dawn

[inoutallabout]

It is a cosmetic surgery and should be treated as such.  Switching genders remains a choice, the inability to mentally cope with one's birth gender is purely the whim of the individual.  Those seeking to change themselves should be held fully accountable for costs of making it happen.  Funding procedures for the sake of people's comfort of appearance will have no end.  For the life of me I cannot fathom why transsexuals should have coverage but genetic males and females seeking common operations that greatly boost their self image should not.  I will tolerate teenagers getting breast implants and liposuction paid for by third parties just as soon as I would transsexual operations, it boils down to the same thing: others should not be responsible for the dissatisfaction of one's insecurity in one's own appearance.  If someone is that adamant on getting a free ride then sue your father for sending the wrong sperm to that egg, and then include your mother in on it for carrying you.

In my humble, yet very firm opinion

[Autumn]

It is a cosmetic surgery and should be treated as such.  Switching genders remains a choice, the inability to mentally cope with one's birth gender is purely the whim of the individual.  Those seeking to change themselves should be held fully accountable for costs of making it happen.  Funding procedures for the sake of people's comfort of appearance will have no end.  For the life of me I cannot fathom why transsexuals should have coverage but genetic males and females seeking common operations that greatly boost their self image should not.  I will tolerate teenagers getting breast implants and liposuction paid for by third parties just as soon as I would transsexual operations, it boils down to the same thing: others should not be responsible for the dissatisfaction of one's insecurity in one's own appearance.  If someone is that adamant on getting a free ride then sue your father for sending the wrong sperm to that egg, and then include your mother in on it for carrying you.

In my humble, yet very firm opinion

Why aren't we allowed to troll trolls?

[Hannah]

If you want this you should have to make your case for public option gender change in front of a Death Panel. Sounds only fair. 

I sometimes think along those lines, usually when I'm using my health card for something expensive like bloodwork. I think: "Here I am getting $1500 in labs and somewhere in the state some little kid is going without vaccinations."

Well it's just not true. There is plenty for everyone, as we are proving here. It isn't easy but we are doing it, and without a sales tax...if we passed a state sales tax we'd be golden. Ohp is just an enhanced medicare, it's nothing special really or unique, but the importance the people place on it is. However, I wouldn't feel comfortable recieving such costly benefits unless things like prosthetic limbs, mastectomy reconstruction and so on were also available.

[inoutallabout]

Why aren't we allowed to troll trolls?

I apologize that I do not share your views, but stating a legitimate and logical perspective in a non-aggressive manner does not constitute trolling.  You may not agree with it, but slinging around insults over casual discussions is something I would consider more deserving of your own accusation.  Name calling won't do much to change my mind either.

[LordKAT]

WE are not switching genders, we form our bodies to match our gender more closely. Inability to cope with GID is not a "whim".

whim
  /ʰwɪm, wɪm/ Show Spelled Pronunciation [hwim, wim] Show IPA
–noun
1.    an odd or capricious notion or desire; a sudden or freakish fancy: a sudden whim to take a midnight walk.
2.    capricious humor: to be swayed by whim.

[DamagedChris]

It is a cosmetic surgery and should be treated as such.  Switching genders remains a choice, the inability to mentally cope with one's birth gender is purely the whim of the individual.  Those seeking to change themselves should be held fully accountable for costs of making it happen.  Funding procedures for the sake of people's comfort of appearance will have no end.  For the life of me I cannot fathom why transsexuals should have coverage but genetic males and females seeking common operations that greatly boost their self image should not.  I will tolerate teenagers getting breast implants and liposuction paid for by third parties just as soon as I would transsexual operations, it boils down to the same thing: others should not be responsible for the dissatisfaction of one's insecurity in one's own appearance.  If someone is that adamant on getting a free ride then sue your father for sending the wrong sperm to that egg, and then include your mother in on it for carrying you.

In my humble, yet very firm opinion

The issue I have with it being seen as completely cosmetic is that unlike a boob job or a nose redo the SRS can actually have an effect on more than just you feeling good about yourself--it also helps you get a job, reduces the visibility of the transperson and thus gives them a safer existence, and most teenagers wouldn't commit suicide over having too small of breasts.

Liposuctions and stomach stapling, in certain circumstances, IS covered if the person's weight is deemed a risk to their health and wellbeing. Without it those overweight people wouldn't be able to work or move around comfortably (thus effecting quality of life) and no one would walk up to a bedridden 500-lb man, a prisoner of his own body, and tell him it is purely cosmetic.

Without the surgeries, or at least hormonal treatments, MTF FFS and FTM top surgery, many of us would have a much, much harder time assimilating into everyday culture...there are no laws protecting hirees on how they look and if you look like a man in a dress many employers won't want you as a part of their company image. Genital surgery, however, generally doesn't effect your ability to work, so if they choose to not cover anything that would be it.

As far as it being a choice and being 'unable to cope with your chosen gender'...pumping myself full of antidepressants and other medications to make myself forget that I'm living my life as someone else is not coping. And, treatment for that depression and those medications are insured. Why not cover what can 'cure' the problem, thus improving quality of life, instead of just medicating someone into a mild coma or risking them hurting themselves (which would be more costly to the insurance company as well)?

[Dawn D.]

Okay, before this gets out of control, let me remind everyone that I specifically asked that this thread not become a forum of debate. And, I am not going to aim this at a particular person. After all, I love a good debate as well as the next person. However, this is a research project. I'll accept and consider ALL opinions relating to the questions I asked originally. So please, if you feel you must enter into debate, would you kindly create a new thread for it?

Thank you all so much for your consideration and participation!


Dawn

[inoutallabout]

Lordkat, thanks for the definition, a better choice of wording may have conveyed my view better.  Perhaps... "state of the individual."

The issue I have with it being seen as completely cosmetic is that unlike a boob job or a nose redo the SRS can actually have an effect on more than just you feeling good about yourself--it also helps you get a job, reduces the visibility of the transperson and thus gives them a safer existence, and most teenagers wouldn't commit suicide over having too small of breasts.

Liposuctions and stomach stapling, in certain circumstances, IS covered if the person's weight is deemed a risk to their health and wellbeing. Without it those overweight people wouldn't be able to work or move around comfortably (thus effecting quality of life) and no one would walk up to a bedridden 500-lb man, a prisoner of his own body, and tell him it is purely cosmetic.

Without the surgeries, or at least hormonal treatments, MTF FFS and FTM top surgery, many of us would have a much, much harder time assimilating into everyday culture...there are no laws protecting hirees on how they look and if you look like a man in a dress many employers won't want you as a part of their company image. Genital surgery, however, generally doesn't effect your ability to work, so if they choose to not cover anything that would be it.

As far as it being a choice and being 'unable to cope with your chosen gender'...pumping myself full of antidepressants and other medications to make myself forget that I'm living my life as someone else is not coping. And, treatment for that depression and those medications are insured. Why not cover what can 'cure' the problem, thus improving quality of life, instead of just medicating someone into a mild coma or risking them hurting themselves (which would be more costly to the insurance company as well)?

I feel prescription coverage could be provided, even coverage for doctor fees and bloodwork.  The part where I have the largest objection is that I do not feel it should be the job of government to provide healthcare for what I still feel are cosmetic procedures.  I believe if one is contributing to a third party via work or privately, then heck yeah.  You pay a bill each month specifically for that purpose, that's fine.  If taxes were raised appropriately for federal healthcare, as in one is contributing towards it, then I'm on board.  As far as giving people a free ride, I will always stand against it.

People who need actions regarding their weight should be responsible for it.  There's plenty of preventative measures to gaining weight, once again I feel that other taxpayers should not be responsible for the decision of someone to let their weight get out of hand.  Even diabetics and people with a predisposition towards such can manage, I worked in the fitness industry for years and can personally attest to that... I've seen some amazing things happen with will power, education, and consistency.  Regarding mental treatments, I still feel that keeping a level head and a balanced, realistic view about life is the best method towards not only alleviating that, but also for maximizing one's appreciation and outlook on life in any situation.  People say, all the time, "be happy with what you've got and don't let what you haven't got drag you down."  Why doesn't anyone follow that?

Self image can be crucial to mental health, especially in severe cases of dysphoria such as gender dysphoria.  However, that does not make transsexuals the only humans that can greatly benefit from cosmetic procedures.  The fact remains that the body of a transsexual is physically stable and functional, even if the owner doesn't want that body.  Semantics regarding already being this gender or that gender will always be a controversial subject.  While one may feel like the opposite gender and greatly desire to be, one is still making a journey from one to the other.  The justification may be factual, or it may simply be a crutch, I'm not to say either way.  I know I hold a personal stake in it just as everyone else on these forums does, but that doesn't blind me to my opinions and I won't contradict myself purely for my own peace of mind or that of someone else.

Personal financing and/or saving up for the operations is the only way I feel SRS should be handled in my country.  If one wants to be something badly enough, then they can work hard for it.  It's easy to let others shoulder the bill, but I don't feel it's a morally sound concept by any stretch of the imagination.

Now, that's that for my take and I still stand by it firmly.  If I'm incorrect, perhaps gaining wisdom with age and/or seeing my culture change to fit a different mindset will get my mind on the right track. 
Post Merge: February 05, 2010, 12:48:32 PM
And um, I just saw your post Dawn.  I'm sorry for getting things off topic, consider me both apologetic, and dismissed:D

[Miss LXC 2.0]

Being cis-gender and heterosexual is very much a choice. Period