Health Insurance Prejudice - The Quotes
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A Bitter Tasting Medicine
Christine Burns finds she’s not alone in the world.
Why is the health insurance business too afraid to even consider people’s needs on their merits?
May 25th, 1997
When I started asking around for other people’s experiences with private health insurers, both in the UK and abroad, I wondered whether legal recognition, a bigger market … and a greater likelihood that people had been insured from childhood … led to a difference in attitude.
Not so, it seems. So long as people are fundamentally ignorant and afraid of what transsexual people are, their almost panic-stricken haste to slam the door in our faces leads to some astonishing results.
Yet it’s not all bad news either…
A Transsexual Man in the United States…
JG tells of how his insurers refused six times to pay for a hysterectomy, even though it was necessary for quite different reasons to his transsexuality. He writes ..
My limited understanding of insurance practices in the USA is that — like everything else here where virtually nothing is uniform beyond the results of bigotry and oppression — experience varies widely. Some trans people are able to get transsexual procedures and treatments covered, while others are not, even in the face of specific exclusions, even using the same underwriting insurance company. Everyone has some unique twist on their medical/insurance experience. I even know one of one TS-identified woman who does not intend to have genital reconstruction who was denied health care coverage until after she is post-op, but she does not want the op! The company she applied with excludes TS coverage, too, but they implied that they would accept her if she had completed transsexual surgeries—just so long as they don’t have to pay for it, or any complications of it.
Personally, I had to out myself to my insurance company when I needed a hysterectomy. They refused to pay, even after the pathology report came back proving there was disease and the surgery was medically necessary. I resubmitted the claim continuously for 6 months, and they finally paid it, but I had to borrow $10,000.00 to pay for the procedure up front because I am transsexual, and the hospital and doctors would not do it "on spec" as I suspect they would for an ordinary woman whose doctor ordered the procedure.
An Australian Woman…
Australian states vary in their attitudes towards the legal recognition of transsexual people, yet KC of Sydney reported a very different story…
After I had SRS I notified various organisations of my new status, including my private health fund. They must have known of my new status simply because I lodged claims for various parts of the operation and they had paid without demur. I do not recall receiving any response.
As for Medicare, which is our government system of theoretically universal health cover, they use various item numbers on which they pay and I believe some of these are gender linked. A man, for instance, would not be able to claim for a hysterectomy, a woman might be queried if she requested repayment for a prostate treatment. But whether the Medicare computer has me listed as male or female I do not know, since I have not had to make any gender-linked claims. I have, however, drawn attention to my post-op status at various "official" medical examinations since I do not want to be denied benefits at some time in the future on the grounds that I concealed relevant medical history. I have not had any adverse reactions to my revelations (some questioning, but no more than I would expect from an interested professional) and certainly no suggestion that my rights were jeopardised.
I think your insurance company should be dragged through the courts and forced to justify their reasoning in denying your health cover.
And meanwhile, back home …
SM, a senior administrator responsible for her own organisation’s health insurance contracts hre in the UK, found her original insurers only too happy to pay for a treatment which would be ruled out if it were labelled as transsexual surgery. This underlines the point that there is nothing unique about the procedures which transsexual women and men undergo. At the same time, it’s clear that the correspondent is farfrom certain about whether they are covered properly by their new insurance though …
The Group Health Insurance Scheme was originally with WPA and they very decently picked up the tab for my orchidectomy [removal of testes] in April 93 - it was recommended by my GP on medical grounds not connected with Gender Identity Disorder ! I changed over in August that year and WPA duly amended their records without demur. I had Gender Reassignment Surgery in December 94 (privately and at own expense, though I rather wish I’d put in a claim to see what happened!). In June last year, on the advice of [our] Insurance Brokers, we transferred the scheme to PPP specifically on condition that they underwrote existing members with no additional reservations.
I assume that all is well in my case (the fact that I actually control the Scheme may not be entirely irrelevant!) but I shall do some specific research in light of your shoddy treatment and let you know what I discover. It is certainly the case that both WPA and PPP declare in their brochures that they do not cover "sex change operations" or any conditions arising as a result of such surgery - but they don’t say that they won’t cover those who’ve had such surgery in any other circumstances.
So when is a treatment not a treatment?
The mere fact that there is such astonishing inconsistency over the attitude of insurers towards transsexual people says enough in itself. One could understand insurers being unwilling to fund the treatment itself were customers to have clearly joined up knowingly intending to make a claim just to get it paid-for. Yet the treatments themselves … orchidectomy, hysterectomy, hormone replacement therapy, for instance … are all perfectly legitimate treatments in other contexts. Furthermore (as in the example above) insurers seem quite willing to pay out for them at other times … except when they’re labelled this way.
But none of this adequately explains why any insurer should sensibly seek to completely exclude customers once they’ve undergone surgery and recovered. There are only a handful of surgeons performing this work in the UK and none of them reports any significant long term complications arising from the procedures they’ve carried out. Where complications do arise, they most likely surface very soon after surgery, and are almost always rectifiable. These procedures have been performed in numbers over the last thirty years too … with some cases going back to the 1950’s … so where is the evidence that a hysterectomy carried out on a transsexual man is any different in terms of post-operative risk than the same procedure carried out on a middle-aged woman?
In others words, why is a procedure to remove a physically healthy organ considered worse than a procedure to remove a diseased one?
It couldn’t be that one case of medical need is judged more deserving than another, could it?
Christine Burns
(Feature Copyright © 1997)
