The Ick Factor In Insurance (Part 2)

Yesterday I wrote about how progress for insurance coverage is slowly moving forward, but the article, "Momentum grows for sex reassignment surgery coverage" also was about how healthcare coverage is spotted. Some procedures are covered by some insurance companies and not covered by other insurance companies.

The decisions on health plans are rarely comprehensive. The Office of Personnel Management, for example, is allowing but not requiring insurers to add coverage through their Federal Employee Health Benefit plans. Patchwork state systems mean regulators’ decisions may apply to a limited number of plans. Only three states and the District of Columbia have added the range of gender dysphoria treatments to Medicaid benefits.

Even for plans that offer coverage, the line between procedures that are “medically necessary” versus cosmetic can blur.
[…]
Insurance companies say they are committed to nondiscrimination and ready to offer plans covering surgery when payers request it or regulators require it. Even when a policy includes coverage, however, issues arise over what’s elective versus essential.

In their coverage descriptions, major insurers like Aetna and UnitedHealthcare will pay for changes to private body parts, like vaginoplasty and testicular prosthesis. Mastectomies for female-to-male patients and breast implants for male-to-female patients are usually covered, too. Procedures such as facial feminization or voice modification surgery are generally excluded as cosmetic.

While advocates say that insurance for facial feminization or voice modification surgery should also cover the surgery because they are necessary for trans-people to integrate in to society and in special circumstances they are covered. For cancer patients the insurance companies cover the surgery and the same thing is true for facial surgery. Just because it is called is facial feminization is the same as facial reconstruction surgery.

“It’s important that a person undergoing gender-confirming surgery is brought into the wide range of appearance variation for people of the desired gender,” said Patrick Johnston, head of the California Association of Health Plans. But, he continued, “it remains important in controlling health care costs to continue the distinction between medically necessary services and services designed to improve appearance generally, no matter who the person is.”

Hopefully it will not take more court cases for us to get the insurance coverage that we need.