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

[Korlee]

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

I agree that it should cover things that are needed.

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

I do think much of it should be covered.  A few things on case by case I think.

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

I think many still see at as they did in the past.  So they feel offering coverage would compromise their views on many things.

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

Kinda out on that one.  However I think it should be more updated then this 1950's system.

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?

I believe the wait should be very short.  A letter from a therapist and verification it is real.

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?

I believe we need a better system all around.  I think the current bill is a bogged down pos in America.  However nothing?  That just isn't acceptable anymore.

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

Yes, but only if it is a major health issue.  As in at that time that procedure would cause more harm then good.  However it would need to be a major issue not a minor one.

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?

Dunno the answer to this one.

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?



inoutallabout - I think you compromised yourself in other ways to stick by your views.

[LordKAT]

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

Yes, but only if it is a major health issue.  As in at that time that procedure would cause more harm then good.  However it would need to be a major issue not a minor one.

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?

Who gets to decide if it is a major health issue? If the insurance does then it will always be a major health issue, which it is. A major health issue is what should be covered.



As an aside, I talked to my insurance company. They did say that the company has the option to exclude gender associated treatments. Those treatments are included in the basic plan and excluded later, not added as a rider.

[Miss LXC 2.0]

I know that the VA health system has afforded me reduced treatments. As the only information I was able to discover to take to my VA primary health physician was from the Boston VA, it facilitated opening of lots of doors. I was lucky that my physician interned at the Boston VA.
The following is an excerpt from a document on the Transgendered American Veterans Association website:
http://www.tavausa.org/Management%20of%20Transgender%20Veteran%20Patients_7.08.pdf
"PATIENT CARE MEMORANDUM-11-046-LM July 2008
MANAGEMENT OF TRANSGENDER VETERAN PATIENTS
1. PURPOSE: To establish guidelines for the safe, ethical, and appropriate management of
transgender individuals within VA Boston Healthcare System. This policy applies to any
individual who self-identifies as transgender (an umbrella term, see definitions below) seeking
care at any VA Boston Healthcare System facility. This policy applies irrespective of the
veteran's status with regard to gender revision surgery and therefore includes those who have
had gender revision surgery outside of VHA, those who might be considering such surgical
intervention, and those who do not wish to undergo gender revision surgery but self-identify as
transgender.
2. BACKGROUND: Nationwide, there is a VA prohibition against providing gender revision
surgery or sex reassignment surgery (SRS). However, VA Boston Healthcare System has a
number of transgender patients seeking 'usual and customary' treatment. Some transsexual
patients have completed or are en-route to full transition from one gender to another. This
transition often takes years for a patient to fully complete; some never fully complete the
transition. Moreover, other transgender individuals prefer to live outside the traditional
boundaries of gender which may not necessitate surgical interventions or other elements of
transition. Thus, VA Boston Healthcare System cares for transgender patients who present at
multiple points on this transition continuum, including individuals who are not seeking SRS.
Therefore, transition status cannot be a prerequisite for providing appropriate healthcare.
3. POLICY:
a. When a transgender veteran presents for health care at any VA Boston Healthcare System
facility, including specific male or female health issues, the veteran will be provided health
care, consistent with VHA policies for all patients. Health care will be delivered to that
veteran, based upon that veteran's self-identified gender, recognizing that unique health
issues are associated with some transgender patients.
As an example, a male-to-female transsexual will be referred to as "she" in all contacts and
documents irrespective of appearance and/or surgical history. It is appropriate for such
treatment to occur in women's health clinics and in women's housing for residential and
inpatient programs. If the veteran is taking hormone therapy, there may be increased
medical risks for blood clots, breast cancer, pituitary and liver problems, as well as
cardiovascular disease. Moreover, there may be screenings that are appropriate to conduct
(e.g., prostate exams) or not to conduct (e.g., pap smear) that are not typical procedure for
staff in women's clinics. However, appropriate screenings to address these issues will occur
and are the responsibility of the provider to monitor.
b. Veterans will be addressed, and referred to, on the basis of their self-identified gender (e.g.
"she" for a male-to-female transgender individual), regardless of the veteran's appearance
and/or surgical history. Computerized documentation of gender should also be consistent
with the veteran's self-identified gender, including salutations on computer-generated letters
to patients. Transgender veterans are encouraged to request this documentation change."
Basically they have to treat you as a human being, but no re-routing of the plumbing. Patience with the VA staff learning to treat you properly is a good thing.
The VA does help with the treatments because I cannot afford traditional insurance and health care through my current job. The occasional person looking at my chart and addressing me by my birth gender is ok.

[Korlee]

Who gets to decide if it is a major health issue? If the insurance does then it will always be a major health issue, which it is. A major health issue is what should be covered.



As an aside, I talked to my insurance company. They did say that the company has the option to exclude gender associated treatments. Those treatments are included in the basic plan and excluded later, not added as a rider.

I'd say major would be at that moment it would do more harm then good.  We are talking about it hurting your system in way the body can't repair, instead of a possible clot a guaranteed to happen unless you take drug A for a month.  Things along that line.

You missed my point.  They will still get treatment but they need to clear something up so it is safe for them to do so.  There are a ton of procedures out there that ask you to wait or something similar if it is going to hurt you more then help you at that moment.  Sometimes it is something insurance should cover in these instances.  Sometimes it is not because the issue was person caused all the way down the road and can be cleared by them through effort. 

Ya, depression blows but it isn't an excuse to do half the crap people do to themselves.  Such as getting fat enough to need a stinking cut off valve in their throat to save their life from over eating.

[LordKAT]

I'd say major would be at that moment it would do more harm then good.  We are talking about it hurting your system in way the body can't repair, instead of a possible clot a guaranteed to happen unless you take drug A for a month.  Things along that line.

You missed my point.  They will still get treatment but they need to clear something up so it is safe for them to do so.  There are a ton of procedures out there that ask you to wait or something similar if it is going to hurt you more then help you at that moment.  Sometimes it is something insurance should cover in these instances.  Sometimes it is not because the issue was person caused all the way down the road and can be cleared by them through effort. 

Ya, depression blows but it isn't an excuse to do half the crap people do to themselves.  Such as getting fat enough to need a stinking cut off valve in their throat to save their life from over eating.

Actually I didn't miss the point. I did believe it needed clarifying. I don't consider having to quit smoking before getting hormones to be a major health issue. I still did it and was glad insurance was willing to help by covering chantix.  Skipping paying for it just because I smoked and wasn't forced to isn't the issue. The addiction still exists now.

Some weight issues are due to things other than "overeating". Why refuse to treat that issue.

[Korlee]

Actually I didn't miss the point. I did believe it needed clarifying. I don't consider having to quit smoking before getting hormones to be a major health issue. I still did it and was glad insurance was willing to help by covering chantix.  Skipping paying for it just because I smoked and wasn't forced to isn't the issue. The addiction still exists now.

Some weight issues are due to things other than "overeating". Why refuse to treat that issue.

I didn't think it needed more added to it because I thought most people outside of insurance companies?  Had a different rating system for what would be considered a major health issue.  A major issue that stops treatment usually means loss of life, an organ, something that is huge from starting a new treatment because of a previous condition.  Something that makes such a huge liability you'd be pressed to even get a doctor to okay it without insurance.

Smoking is something that can cause harm in the long term or not.  My father and his father were chain smokers but never got a thing.  My father still has not had a thing from it.  While it would hamper treatment it isn't going to make you keel over and die from combining the two. 

I disagree with them covering the smaller thing that was and is within that persons control because they lacked self control or restraint.  That person should have to fix that on their own then be able to move on.

I meant it more along the line of an issue they caused themselves.  Not from someone being big boned, or an imbalance in body regulation.  My aunt has something like that.  I forget what it is called off the top of my head but she can't control it.  Anyways, I was just citing it as an easy example. 

However I can see with you I shall need to tag and check every post before hitting submit.  If I can get over my lazyness.

[Nimetön]

It is my job, and also my private inclination, to respond to questions regarding decisions by providing an impact analysis of the decision itself.

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

Paychecks and benefits must be reduced to compensate for the added cost of health insurance.  If jobs can be moved to a region with comparable talent at lower cost, then each such measure will increase that effect.  Further costs include compliance (man-hours of lawyers to determine what the law actually requires and how to comply with regulation and to document that compliance, a considerable sum) and liability (the cost associated with lawsuits from groups such as HRC and from individual employees).

Given that transsexuals are extremely rare (1:4e4), it probably won't hurt much, but on the same token, support will be fairly lean when money is already tight.

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

Same answer; mandate what you will, business practices will adjust accordingly to survive competition.

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

Politically, garnishing an innocent man's wages to pay for a medical condition that he does not have tends to reduce his willingness to vote for your party.  If the beneficiary tells him that he is a criminal or oppressor, his votes shift further.  If his taxes increase, and wages decrease, during a recession or depression, further.  If he has young children and a mortgage, further...

Economically, see above.

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

If a given transsexual employee is highly productive, and demonstrates this clearly, they could negotiate for expanded health insurance as part of their employment package on an individual basis. 

(NB: The heavily-tattooed and multiply-pierced Sociology-graduate at the cash register, telling me about 'gender theory' and arguing for tax increases, is not 'highly productive.'  The slightly-bearded girl who writes rockin' code and designs motherboards is 'highly productive.')

On a collective basis, however, the current and foreseeable economic conditions suggest that most transfolk will, over the coming decade, be rather more concerned with food and housing than with transition.

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?

Goes to cost.

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?

The resulting mechanism would increase personal taxes (cost of living, requiring higher salaries) and corporate taxes (lower profit margins).  The effects are as described above, proportional to costs associated, and affect the entire economy in the theater of operation (including all local businesses and private household economies).

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

Insurance companies are private corporations in a market, offering a service in exchange for a profit.  Like any other human being, the insurance company owners must have the power to refuse business.  Deviation from this principle incurs the costs described above.

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?

No idea.

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?

Diversity is a mechanism as outlined above (labor cost, compliance, liability) without any benefit that I am aware of (no increase in productivity) and carries with it the 'silent fear,' the effect of speech-suppression measures used by the corporation to protect against lawsuit.  As a result, it serves as a strong incentive for offshoring.  In essence, it serves to increase diversity in a shrinking workforce.

The common thread in these observations is that each benefit comes with both a direct cost, paid in taxes, a series of indirect costs involving lowered wages, reduced benefits, and reduced employment figures, and finally a series of political repercussions involving voter alienation and economic emigration.  The voters must decide if they can afford these costs, on top of other costs already incurred for similar measures, as a time when debt is already high.

In summary, everything has a cost, including other people's money.

- N

[Edit: As a postscript, as the original poster has asked us for "any and all thoughts" but has asked us to refrain from debate, I will not offer surrebuttal for this post.  Rebuttal, however, may prove useful to the original poster.]