Insurance carriers vow equal coverage for transgender patients

By Katie Kerwin McCrimmon

The Colorado Association of Health Plans has become the first trade group of its kind in the nation to promise equal coverage for transgender patients.

Colorado is always first in health care. It seems like were right out front, said Ben Price, the associations executive director. As far as industry trade groups, I havent heard of another group that has done this yet. I know a few are looking at it.

As shopping for health plans intensifies before next weeks deadline to get coverage starting on Jan. 1, Price released a statement assuring customers that exclusions will no longer apply.

We would like all consumers to know that they can shop for health insurance coverage with confidence. All CAHP member carriers are conducting a thorough review of their coverage and processes to ensure they will cover medically necessary services for transgender individuals to the same extent that those services are covered for non-transgender individuals enrolled in the same benefit plan, Price said.

His group began working together to come up with a unified policy after a couple of members declared that exclusions barring care for transgender patients were wrong.

Advocates for transgender people are hailing the decision as a civil rights victory for patients who in the past faced explicit language barring care for them.

They were considered to have a preexisting condition. Many transgender people couldnt even buy into plans or the plans wouldnt cover certain services for them, said Ashley Wheeland, an attorney and health policy director for the LGBT advocacy group, One Colorado.

Wheeland has been working with health carriers for months to ensure equal treatment for transgender patients after Colorados Division of Insurance issued a bulletin in March barring discrimination based on gender identity or sexual orientation. Many plans sold in Colorado and around the country prevented transgender patients from receiving hormone treatments or gender reassignment surgeries.

Earlier this year, a transgender teen settled a civil rights case with Kaiser Permanente. (Click here to read Transgender teen settles landmark case.)

In response to pressure from One Colorado and other health advocacy groups, Colorado HealthOP, a new insurance carrier, then became the first in the state to pledge that none of its plans would have arbitrary condition-specific exclusions that target any population. (Click here to read Health co-op first to rule that transgender exclusions are wrong.)

Kaiser Permanente then followed suit.

At the time, Wheeland said the carriers decisions marked a huge step forward in transgender health since many LGBT patients often faced arbitrary rejections for coverage of services.

Wheeland said theres no guarantee now that all health plans will cover the same level of care for patients. But, if an insurer covers a service like chest reduction surgery for a straight patient, they will also need to pay for it for a transgender patient.

Were really happy that all the health plans have been receptive and have started to move forward in providing care that transgender folks need, Wheeland said.

Price warned consumers that the fine print in some plans might still include outdated language barring care for transgender people. Those plans had to be submitted months ago and the Colorado Association of Health Plans is working with Colorados Division of Insurance to expedite updated versions of each plans Evidence of Coverage (EOC).

Consumers may see gender identity disorder (GID) exclusions still listed on carriers EOCs. EOC forms currently being used were typically generated last year before further clarity surfaced regarding Colorados anti-discrimination laws, Price said. As such, consumers should know that carriers are working to ensure GID exclusions listed in current EOCs will not be enforced and that GID exclusions will be removed from future EOCs.

Anyone with questions should contact a carrier directly to get details about coverage.

Plans cover different things, so its not cut and dried, Wheeland said. The first plans to come forward looked at this from a civil rights perspective, that they should be providing this care. They were helpful in starting this conversation.

Wheeland said that so far, four states and the District of Columbia have clarified that anti-discrimination laws apply to transgender health care. The other states are Oregon, California and Vermont.

Were the first where youve seen our Association of Health Plans come together as a group. Were leading on that, she said. I think its really important that they responded to whats being asked of them. This is really exciting in Colorado.

Other states are likely to move forward with explicit protections for LGBT patients since the Affordable Care Act also requires equal access to care. Nearly all the provisions of the act start going into effect on Jan. 1.