Fighting for Coverage—Navigating Insurance for Gender-Affirming Surgery
Binary to Binary: A Gender Transition Roadmap
by Susanna Blake, Part 6
Click here to read Part 5.
Medical Insurance
Part of trans advocacy for Caroline was pinning down her medical insurance coverage. I had to challenge her employer to reveal transgender surgeries covered by her policy (contract) by arranging a meeting with In-House Counsel and the Head of Benefits. Even with a month to investigate her coverage, they arrived at the meeting not even knowing if breast augmentation (top surgery) would be covered. Fortunately, it was—along with vaginoplasty or vulvoplasty and labiaplasty (bottom surgery).
Later that year, when Caroline had switched to her 18 months of COBRA coverage, her former employer gave no notice that they were changing insurance companies. I had to quickly research her new coverage and re-qualify her for transgender surgeries. Luckily, the new policy added coverage for her tracheal shave. I was thrilled when, in January, the new company sent an eight-page contract and said they would reimburse her at the highest paying first tier for the four surgeries. We knew from the start that we would be paying cash for her rhinoplasty and forehead re-contouring.
In August, when we were all packed, less than 48 hours before departure to Arizona for the first five surgeries, we received a formal letter that the insurance company had decided to reimburse her for her four medically necessary procedures at their lower paying third tier.
Needless to say, I was infuriated.
On the phone, I successfully challenged the insurance company, arguing that they could not drastically reduce the coverage when none of the eight reasons they could deny coverage (spelled out in the January contract) were applicable. When I threatened to go to NPR or The New York Times with the story, they backed down.
Part 7: Surgery, Setbacks, and Strength—A Mother’s Role in Gender-Affirming Care
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