Healthcare & Insurance

“Are you sexually active?” a doctor asks. "Yes," a female patient responds.

“Do you take birth control?” they ask. “No,” she answers.

“Do you use condoms?” “No...”

"Are you trying to have a baby?" "No."

“So then how are you preventing pregnancy?” “...I’m gay.”

I have heard something similar to this only end it with “I’m trans.”

That was from an article in USA Today,

How doctors' assumptions about LGBTQ patients can be harmful to their health
By Sara M Moniuszko
October 1, 2021


Dr. David Jaspan, chair of OB/GYN for Einstein Healthcare Network in Philadelphia, says, unfortunately, this situation is not unusual.

"It's very common, because that's classic training," he explains. "It just gets down to this like 'traditional' medical line of questioning which is old, antiquated and now not appropriate for (everybody)."

Other members of the LGBTQ community have also spoken out on social media about uncomfortable encounters stemming from assumptions about sexual orientation and gender identity to the gendered language in hospitals.

Experts say the lack of LGBTQ-inclusive care is caused by a variety of factors, but the need to improve the system is vital in preventing potential detrimental outcomes for people in this community.

So which do you like better?

The healthcare providers reading off the list of silly questions to us or they filling in the obverses answers to questions like “Have you ever been pregnant?”

Why is this still an issue?
Stigma is one piece that contributes to a lack of LGBTQ inclusivity.

Dr. Leonid Poretsky, an endocrinologist who is the director of the Gerald J. Friedman Transgender Program at Lenox Hill Hospital in New York, says he and his peers are still trying to "de-pathologize" transgender identities.

"There's nothing wrong with being transgender; it's not a disease," he says. There is still progress to be made, he says.

For insurance, medical coding systems can make providing care a challenge.

Yeah, it is. The insurance company blows a gasket when they a bill for a mammogram and a prostate exam… Does not compute! Does not compute! So there is a little box that they have to check for the computer to okay both exams.

I got stuck in the middle of the insurance company vs. the doctor’s office battle. But I have seen improvements, the medical offices are learning how to code us and the insurance companies are realizing that there are trans people out there.

And that's exactly what happened. The situation turned into a lawsuit, which ended in a victory: all trans care in the state of Pennsylvania being covered by Medicaid.

"That changed everything because then we had an opportunity for patients to gain access to care, without having to fight about it not having to pay out of pocket, not having to do it in an inappropriate, perhaps not professional location," he added.

The same for Connecticut, it took a couple of cases but the insurance companies finally saw the light. I tell people if they get denied by an operator, hang up count to ten and call again, sometimes it is just an operator who didn’t know or they could of have been a bigot.

"(We) said to this person, we can write down abnormal uterine bleeding and pelvic pain and get it approved (by insurance), or we could do what we want and do what's right and say it's for gender affirmation. We'll get rejected, and we'll fight it."

And if physicians lack understanding of certain identities, like a trans woman who still needs prostate cancer screenings, vital steps could be missed.

"So a physician not prepared to deal with this population may be missing important health care issues and screenings," Poretsky says.

There are so many trans women out there that will not tell their doctor that they’re trans and never have their prostrate examined, they are putting their lives at stake by not tell their healthcare provider their medical history.