Positive Role Models Part II

We win our battles one skirmish at a time. It takes a brave person to stand up and say this is wrong and to fight for their rights.

Victory! Transgender Woman Wins Health Insurance Coverage for Mammogram
Transgender Legal Defense & Education Fund
Press Release
April 30, 2012

We are thrilled to announce that we have resolved a claim on behalf of Beth Scott, a 44-year-old transgender woman in New Jersey who had been denied health insurance coverage for a mammogram. Ms. Scott underwent the mammogram in June 2010 at her doctor’s recommendation. Aetna denied coverage for the mammogram on the grounds that it fell under her policy’s exclusion for treatments “related to changing sex.” As a transgender woman, Ms. Scott was assigned male at birth and developed breasts after undergoing hormone therapy. Aetna refused to alter its position throughout the lengthy appeals process.
[…]
Aetna reversed its position and paid for Ms. Scott’s mammogram in full. It agreed that the policy exclusion for transgender health care will apply only to treatments prescribed to change an individual’s sex characteristics, and not to any other medically necessary care. Additionally, Ms. Scott secured changes to the health plan ensuring that transgender people can access all necessary sex-specific care, such as prostate exams and gynecological care, regardless of whether they are categorized as male or female in insurance records. Many transgender people have claims rejected when an insurance company asserts that the procedure is not covered because it does not match the sex listed in the policyholder’s records. The plan will also allow individuals to correct the sex on their insurance records by presenting an updated ID such as a driver’s license, passport or birth certificate.
[…]
Exclusions for transgender health care such as hormones and surgery exist in most health insurance plans. These exclusions unfairly force transgender policyholders to pay out-of-pocket for medically necessary care. Often, as in Ms. Scott’s case, insurance companies also use such exclusions to deny transgender policyholders coverage for other medically necessary care that is in fact covered under the plan.

What will our next skirmish be? I would like to see all exclusion for trans-people  removed and Gender Affirming Surgery covered.

Then this Friday…