Suing for equal health coverage

by: Robyn
Fri Jul 01, 2011 at 15:00:00 PDT

http://www.docudharma.com/diary/26700/suing-for-equal-health-coverage

Alec Esquivel, 42, is an Oregon transman.  He works as a law clerk for the Oregon Court of Appeals.  Alec's doctors said it was a medically necessary procedure to have a hysterectomy because of his heightened risk of ovarian and uterine cancer due to the hormone therapy he began in 2001.  Providence Health Plans, third-party insurance administrator for the state, and the Public Employees Benefit Board denied coverage for the procedure, stating

    services related to a sex-change operation, including evaluation, surgery and follow-up services are not a covered benefit of your plan.

Alec is therefore suing the state of Oregon and the PEBB to cover his medical care related to the hysterectomy as well as $250,000 in damages and attorney fees.

I'd just be happy if someone sued to have hormones covered. 

It isn't equal health coverage they are suing for, the coverage is equal as it is denied to all, not just a group or individual. They are suing for fair rights to adequate health coverage. That makes a difference. The Obama thing may have cut prior existing clauses but not exclusions. This may work under Oregon's laws. It would be a start.

Quote from: LordKAT on July 02, 2011, 12:07:23 PM
It isn't equal health coverage they are suing for, the coverage is equal as it is denied to all, not just a group or individual. They are suing for fair rights to adequate health coverage. That makes a difference. The Obama thing may have cut prior existing clauses but not exclusions. This may work under Oregon's laws. It would be a start.

OPM, under President Obama aegis, is currently working with Federal Employees health providers so as to cover SRS and HRT.

Kate D

The city of Portland will now cover SRS for all city employees.  When will the major healthcare providers catch  up.

Let's assume that most health insuraces start covering SRS:

Would the price for the uninsurace go up and down, why?

Would more surgeons offered it?

Kate D

Quote from: kate durcal on July 02, 2011, 06:35:54 PM
Let's assume that most health insuraces start covering SRS:

Would the price for the uninsurace go up and down, why?

Would more surgeons offered it?

Kate D

Some insurance companies have researched that question and determined that paying for GRS is less expensive than the cost of denying the coverage and litigating over it.

Quote from: kate durcal on July 02, 2011, 12:40:25 PM
OPM, under President Obama aegis, is currently working with Federal Employees health providers so as to cover SRS and HRT.

Kate D

Unfortunately that isn't true now nor does it cover many people like me who aren't federal workers.

Quote from: LordKAT on July 04, 2011, 02:07:52 PM
Unfortunately that isn't true now nor does it cover many people like me who aren't federal workers.

True it will be only for Fed emplyees, but taken together with the fact that almost all top 500 companies health insuraces benefits cover srs and hrt, it follwos that other employers will follow suit.

Kate D

Quote from: kate durcal on July 04, 2011, 03:35:57 PM
True it will be only for Fed emplyees, but taken together with the fact that almost all top 500 companies health insuraces benefits cover srs and hrt, it follwos that other employers will follow suit.

Kate D

This is likely but the timing may be a while. The US is famous for slow changes legal wise.  Perhaps it will be  a step in the right direction for health and rights issues.