The Impact that Insurance Companies have by not Providing Transgender Healthcare

By: Lue Kendall

According to the Human Rights Campaign, only thirteen states ban insurance exclusions for transgender healthcare and provide inclusive health benefits for transgender state employees. In states such as Texas, it is legal to discriminate against someone’s housing, employment, public accommodation, and education based on their gender identity, nor do they provide trans-inclusive health benefits to state employees. If states like this allow insurance companies to not cover transgender surgeries, this puts people so much more at risk because they are unable to get the surgeries to transition to the correct gender. Research shows that about 1.3 million adults in the United States are transgender, and about 40% have attempted suicide.

“I believe from hearing countless experiences from my clients along with transgender speakers and advocates I’ve heard that transitioning is THE best treatment and cure for gender dysphoria,” says Dr. Owen, a licensed clinical psychologist and gender therapist. Gender dysphoria is, “a distressed state arising from conflict between a person's gender identity and the sex the person has or was identified as having at birth”

“I’ve seen people in extreme distress, to the point of wanting to/trying to kill themselves, start to feel significantly better and much more confident and optimistic once they are able to medically transition (or start this process).”

In South Dakota, a law has just been made that it is a felony to perform transgeneder surgeries on someone under the age of 18. “Denial of gender affirming care poses an extreme danger to transgender youth.”

Dr. Owen agrees. “I think if laws like this are made we will unfortunately see the rate of suicide attempts for transgender youth, which is already staggeringly high, continue to increase.”

“issues I have encountered have been when a minor (under 18) was seeking gender confirmation surgery. I have seen this not be covered by insurance companies despite my recommendation for them to do so.” states Dr. Owen, when asked if she gets push back from insurance companies when they ask for her documentation on a transgender patient seeking surgery. “I have also seen some clients have insurance plans that will not cover certain surgeries period” As previously said, transitioning is the best cure to gender dysphoria. If insurance companies don’t provide coverage for the surgeries necessary to medically transition, it will mean that people will have to pay the full price for surgeries.

But what is the problem with paying full price? A female-to-male (FTM) Mastectomy, also known as chest masculinization surgery, costs an average of about seven-thousand dollars to ten-thousand dollars for patients that don’t have insurance for it. A male-to-female (MTF) Breast Augmentation can cost about nine-thousand dollars. Without insurance, full Genitil/Bottom surgery for FTM patients is about six-thousand dollars, and Genitil/Bottom surgery for MTF patients is about twenty-thousand dollars. This presents a huge problem because most people can not afford to pay for these surgeries. If someone is working a minimum wage job, they would not be able to get any surgeries needed for helping to fight dysphoria.

For people under the age of 18, Insurance Company “Blue Cross Blue Shield” states that “The candidate [has needed to] complete a minimum of 12 months of successful continuous full time real-life experience in their new gender, with no returning to their original gender.” This causes a huge problem, because if someone who is transgender is unable to transition, or someone who is Non-Binary does not want to live as the opposite gender. “If the candidate does not meet the 12 month time frame criteria as noted in item 2.[previous quote]above, then the treating clinician must submit information indicating why it would be clinically inappropriate to require the candidate to meet these criteria. When submitted, the criteria in item 2. [previous quote]will be waived unless the criteria noted in item 2. [previous quote]above are specified as required in the candidate’s health benefit plan.” This is a massive problem. If someone is under the age of eighteen is seeking surgery, they might have known they were transgender, only starting to socially transtition few months prior, and not have to wait an entire year having to bind and pack.

In conclusion, the impact that insurance companies have by not covering these surgeries is huge for both youth and adults. Healthcare providers are in agreement that these procedures are medically necessary, but if they are not covered by insurance they are incredibly expensive. In Texas, and many other states, there are no protections for the LGBTQ+ community, and there is much room to advocate for change.