Slog Music

Music, Nightlife,
and Drinks

Wednesday, January 9, 2013

Oregon Bans Discrimination Against Trans People by Health Insurance Companies

Posted by on Wed, Jan 9, 2013 at 7:34 AM

Washington Blade:

Transgender advocates have applauded new regulations that ban private health insurance companies in Oregon from discriminating against trans policy holders. The guidelines the Oregon Insurance Division of the state Department of Consumer and Business Services announced on Dec. 19 specifically prohibit health care providers from discriminating against a policy holder based on their actual or perceived gender identity and expression. Under the guidelines, providers cannot deny coverage of hormone therapy, hysterectomies, mastectomies and other medically-necessary treatments for gender dysphoria and sex-reassignment surgery that are covered for non-trans policy holders.


Comments (11) RSS

Newest First Unregistered On Registered On Add a comment
@12 You make a strong case, except I'm not sure the terms "reconstructive" or "abnormalities" apply to someone born with a normal body of a particular sex but with a brain that makes them feel like the other sex. I raise again the question about body integrity identity disorder... let's assume that's something someone is born with... should they be able to get their desired amputation(s) covered by insurance? And if they don't, is that discrimination against them, or it just a sad fact that they can't receive coverage for their desired "treatment"?

The term "discrimination" is thrown around a lot, but it ought to be limited to cases where two people under similar situations are treated differently for reasons irrelevant to their situation (e.g. someone forced to move to the back of a bus because of their skin color). Choosing not to cover a series of gender reassignment procedures due to a psychiatric condition is not the same scenario as choosing to cover the same or similar procedures due to a physical illness like cancer, whether it's the direct treatment in question (hysterectomy) or a reconstructive treatment after the direct treatment (breast augmentation). It may be a good idea to cover the former, but I don't see it as discrimination not to.
Posted by madcap on January 10, 2013 at 2:37 PM · Report this
@10 Good point about breast augmentation following mastectomy, although in that case, there is a clear cause and effect- the woman has lost a body part that she had due to the treatment for a disease (or high potential for a disease), and the augmentation is meant to reconstruct that.

Whether the augmentation is therefore medically necessary is thus debatable, but there is a clear operation that was medically necessary (the mastectomy) and I think a case could be made that the augmentation ought to be covered as a continuation of that procedure.

In the case of a MTF transgendered person, a breast augmentation would be a procedure by itself, not based on any medical condition other than gender dysphoria, which again, is a psychiatric condition. I'm curious if there are any other such psychiatric conditions for which major surgery is prescribed and covered. For instance, can/should people with body integrity identity disorder have an amputation covered by insurance?
Posted by madcap on January 10, 2013 at 11:11 AM · Report this
@4/@8 - breast augmentation following mastectomy is fairly standard and completely covered. Women don't need that breast to live... rather it can be considered a fundamental aspect of their physical identity they have lost.

@9 Elective is a term used to describe not the *need* of a procedure but simply whether it can be scheduled. For example, most heart surgeries are elective as opposed to emergency... whether or not a procedure is "elective" doesn't actually speak to the necessity of the procedure.
Posted by squirrely girl on January 9, 2013 at 6:08 PM · Report this
keshmeshi 9

Now I'm wondering what the distinction might be between what's considered medically necessary and what's considered cosmetic. A double mastectomy for a transman seems like it could go either way. I'm sure he would feel it necessary to get that surgery in order to transition fully, but then there are plenty of cisgendered men who have large mammary glands. If they got breast reduction surgery, that would be considered cosmetic and would not be covered by insurance.

The same thing with transwomen. Is it medically necessary for them to get breast implants? There are many cisgendered women who are flat chested, but insurance does not cover implants for them. Is the body dysmorphia diagnosis sufficient to make mastectomies and implants medically necessary?
Posted by keshmeshi on January 9, 2013 at 3:34 PM · Report this
This seems like an expansion of the term "medically necessary". Gender dysphoria is a psychiatric condition. Are there any other psychiatric conditions for which major surgery is considered medically necessary?

Also, since medical necessity currently means something to treat an illness, injury, or loss of function of a body member. Is gender dysphoria therefore to be considered an illness? Is that any better than calling it "gender identity disorder"?

Just because a treatment exists for one case (say, uterine cancer) doesn't mean that it's medically necessary and thus should be covered for any possible cause for which it may be considered a treatment. Plastic surgery may be medically necessary for someone who has been shot in the face, but that doesn't mean I should get it covered for myself to please my vanity, and if my insurance chooses not to cover it for that latter reason, that doesn't mean I'm being discriminated against.

Again, I am not necessarily opposed to covering gender reassignment surgery via insurance, but I'm hesitant to support it under the 'medically necessary' label.
Posted by madcap on January 9, 2013 at 3:30 PM · Report this
James6 6
#5: Also, that "medically necessary" requires no hyphen.
Posted by James6 on January 9, 2013 at 10:48 AM · Report this
Backyard Bombardier 5
@4: The point you are missing is that there are surgical interventions which are medically necessary for the treatment of gender dysphoria.
Posted by Backyard Bombardier on January 9, 2013 at 10:29 AM · Report this
I'm confused. Does this mean that, say, FTM transgender individuals are entitled to have a hysterectomy covered by insurance even if the only reason they 'need' a hysterectomy is because they're transgender?

If so, what is medically-necessary part? Treatment for a psychiatric condition? Are there any other examples of major surgery that is considered medically-necessary due to a psychiatric condition?

Furthermore, how is not covering such a procedure discrimination, since that scenario would never apply to a non-transgender woman?

Now both transgender and non-transgender females (by which I mean biological females, born with a uterus) might need a hysterectomy for other reasons, such as cancer, and of course should receive equal coverage for that.

I'm not necessarily opposed to covering gender reassignment surgery, but this sounds like a back-door way to achieving that by calling gender reassignment "medically-necessary".

Or maybe I'm missing some big points here, so I am happy to be made better informed.
Posted by madcap on January 9, 2013 at 9:48 AM · Report this
Bugger I meant "elective" and also misread your comment. That's what I get for slogging before coffee.
Posted by wxPDX on January 9, 2013 at 8:56 AM · Report this
@1 but the point, if I read correctly, is to get insurers to cover gender dysmorphia. In insurance land, non elective will never be covered. But if you can get them to acknowledge a legitimate problem and then cover it, you're good.
Posted by wxPDX on January 9, 2013 at 8:54 AM · Report this
Yep. The only thing wrong with this is that there shouldn't be a hyphen after "medically." That's a non-elective punctuation removal procedure right there. If a breed standard woman needs non-elective hormone therapy, then a trans woman should also be eligible for non-elective hormone therapy.
Posted by DRF on January 9, 2013 at 8:22 AM · Report this

Add a comment

Commenting on this item is available only to registered commenters.

All contents © Index Newspapers, LLC
1535 11th Ave (Third Floor), Seattle, WA 98122
Contact | Privacy Policy | Terms of Use | Takedown Policy