(Now that I have your attention — read on)
In January 2103, when I was in the early stage of gender transition, my physician prescribed estrogen cream for me. I had my prescription filled and turned it in to United Healthcare, the insurer where I worked. They denied the claim.
Seems “men” don’t take estrogen. But they will pay for hormone replacement therapy for people female identified at birth.
This was quite an eye opener for me. I’d never been denied anything before. This was a first … but it wouldn’t be the last.
I have since spent so much of my own money on transition-related, medically necessary procedures I could have bought that new Lexus and a two-week trip to Europe. None of it was paid for by insurance.
That really sucks. It sucks worse for people who don’t have a retirement account that they can bleed dry like I did.
The state of trans healthcare in the United States is an embarrassment. At best, it’s a patchwork of coverage that will get you part of the way through, or in some states like California, all of the way. At worst, it’s doctors who are so uncomfortable with you they deny you care at all, usually after mis-gendering you.
It’s embarrassing, humiliating and unacceptable. Virtually nothing is taught in medical school about trans health; it’s often the trans patients that are educating our doctors!
Charlize Marie Baker has a well-documented medical history of gender dysphoria, and was fortunate enough to find a judge in Collin County who granted her name change in November 2014. She is now recognized by all governmental agencies as female, including on her driver’s license and Social Security card.
But when she submitted a claim to her employer’s insurance company, Aetna, for breast augmentation, it was rejected. She was also denied short-term disability to recover from the surgery, which she ended up paying for out of her own pocket.
This denial is clear discrimination, as Aetna covers mastectomy for female-to-male transgender patients, and breast reconstruction for female patients who have had mastectomies due to disease.
To single out trans women for denial of coverage just isn’t right.
What makes Charlize different from most is that she filed a lawsuit in federal court on Monday, Nov. 16, seeking damages from Aetna, for both the cost of the surgery and recovery of wages lost while she was recovering. It also seeks unspecified punitive damages as well.
If successful, this case could set a precedent that will change the way insurance companies treat transgender health.
I spoke to Charlize and her attorneys Michael Hindman and Kasey Krummel on Tuesday, Nov. 17, and they feel they have the law on their side.
I asked Charlize how it made her feel when Aetna referred to her surgery as “cosmetic.” She answered, “Diminished as a human being. Disrespected. There was no regard for my dignity.” She described having her body match her gender as “absolutely an essential part of transition.”
Charlize is represented by the Dallas law firm of Hindman/Bynum. I asked Michael Hindman about what message the lawsuit is sending to not just Aetna, but to all insurers. He said, “Primarily, there are very clear standards of care for gender dysphoria. Most important for each individual is proper medical care determined by the doctor and patient. Blanket policies such as these that pick and choose what will be covered are not adequate.”
He went on to point out that were Charlize in prison, this would all be covered under the Eighth Amendment of the Constitution. She would literally receive better care as a prisoner than as a valued member of her workplace and society.
Here’s the kicker: In 2001 the city of San Francisco made its insurance coverage trans inclusive. The cost of services per employee per year was minimal, with costs per insured per year averaging between 77 cents and 96 cents — less than a dollar per year per enrollee (according to the HRC).
Really? All this resistance over less than a dollar a year?
Maybe employers and insurers are unaware of just how inexpensive it would be to add trans healthcare to their group policies. There just aren’t that many of us. And gender dysphoria, though often fatal, is curable in most cases.
It’s also not chronic. Unlike diabetes treatment, once ours is done, it’s done.
Though this lawsuit has just been filed and may not be settled for quite some time, it could have far-reaching implications for the trans community nationwide. If successful, this suit would provide guidance for all insurers regarding coverage of trans healthcare.
It would also provide the first real opportunity to recover damages from discrimination. Presently, even cities with equal rights ordinances don’t provide a strong deterrent for discrimination. Most apply a $500 fine and move on. The person discriminated against is unable to recover back pay or seek re-instatement.
That will change if this suit is successful.
The Don Huffines of the world will still seek to place obstacles in our way. No doubt, the 2017 session will be rife with bathroom paranoia throughout the halls of Austin. Hopefully, sanity will prevail.
In the mean time, we will watch with anxious anticipation as this first volley in defense of trans health is fired into the federal court system.
I, for one, am grateful to Charlize Baker for having the courage to move forward in what will no doubt be a long and contentious battle. She and her attorneys, Mr. Hindman and Ms. Krummel, are determined to see this through — all the way to the U.S. Supreme Court if necessary.
Hopefully, justice will prevail. Lives depend on it.
Leslie McMurray, a transgender woman, is a former radio DJ who lives and works in Dallas. Read more of her blogs at lesliemichelle44.wordpress.com.
This article appeared in the Dallas Voice print edition November 20, 2015.