Sunday, January 31, 2016

They Will Do Anything To Get Out Of Paying

Insurance companies are known for trying to weasel out of paying for a medical claim and especially if it involves trans people.
UnitedHealth Medicare plan must cover U.S. sex reassignment surgery
By Brendan Pierson
January 29, 2016

A U.S. government panel has ruled that a privately run Medicare plan must cover sex reassignment surgery for a Texas transgender woman, a decision her attorney said was the first of its kind.

Charlene Lauderdale, a U.S. Air Force veteran, first sought surgery through her UnitedHealthcare/AARP Medicare Complete insurance plan in November 2014. The federally funded plan, operated by a unit of UnitedHealth Group Inc, denied the request.

An administrative law judge with the U.S. Department of Health and Human Services ruled last April that the plan must cover the surgery, and the agency's Medicare Appeals Council upheld that decision this month.
This strikes close to home because I have UnitedHealthcare/AARP Medicare Complete.

Back in May of 2014 the U.S. Department of Health and Services review board overturned the ban that prohibited Medicare from covering transition-related medical procedures for transgender people. But still insurance companies tried to avoid paying.
According to Young, many transgender patients have been unable to get coverage for sex reassignment surgery because insurers or contractors hired by Medicare to make such determinations have decided the procedure is cosmetic, or not medically necessary, among other reasons.

Young said the decision in Lauderdale's case was the first time HHS ordered a Medicare Advantage plan to cover sex reassignment surgery. Though the decision is not legally binding on other cases, Young said he believed it would set an important "guidepost."
So what this means is that other trans people will still have to fight for their legally required coverage.

For those of you who can't get to sleep I suggest reading the decision here.

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