Have You Had This Problem?

I have, I’ve had to fight the insurance company to get my PSA test covered…

Obamacare’s Failed Transgender PromiseThe health law requires insurance companies not to deny coverage based on gender, but advocates say enrollees are still being turned down for services for that very reason.By Lisa Gillespie
Kaiser Health News
July 20, 2015

Transgender people are still fighting for access to crucial health services, despite the Affordable Care Act’s requirement that insurance companies not deny coverage based on gender or health history.

The issue stems from the requirement that enrollees check a single gender box when they sign up for a plan sold on the individual or small group markets, according to advocates and health care providers.

“What happens is that the health insurance companies have specific codes and they put you in as female or male; you only get services that go with that code,” said Robin Maril, senior legislative counsel at the Human Rights Campaign, an advocacy group for lesbian, bisexual, gay, and transgender people.
[…]
As a result, they might still need annual mammograms or pap smears even if they are transitioning to men, or prostate exams if they are transitioning to women—not to mention treatment for problems typically regarded as gender-specific. Those could range from sexually transmitted diseases to life-threatening illnesses such as cancer.

Yup. That’s me; it takes almost six months to straighten out payment for my PSA test. Even when I explain it to the insurance company or the doctor’s office billing department I still have problems.

The article goes on to state…

But that doesn’t always work [putting a statement in the patients file], says Dru Levasseur of the Transgender Rights Project at Lambda Legal. Most insurance billing systems are automated, and reproductive services like mammograms and prostate exams are flagged with a corresponding “female” or “male.”

Levasseur says the service is denied automatically if the gender and service don’t match. To allow payment, he and others say, an insurer could put a hold on the claim, verify it with the health care provider, and then manually override the code. “The onus should be on the insurance companies,” Levasseur said.

That is what happens to me, I end up fighting the insurance company and the doctors office.

CTAC (CT TransAdvocacy Coalition) was asked to comment on Medicare’s 50^th anniversary and our comment was,

25. Medicare Can Be a Source for LGBT Inclusive Medical CareThe Center for Medicare Advocacy
By LGBT Aging Advocacy (Connecticut) and CT TransAdvocacy Coalition
July 7, 2015

…So too, transgender people should also be able to receive health care and Medicare coverage based on their medical needs, not on their gender identification.  “Treat the body, not the gender” is how transactivists summarize the distinction. Medicare recently rescinded its coverage rule that denied coverage for gender identification-related surgery and services.

And we shouldn’t have to fight each time to get the coverage that we are entitled to.