Still too Many Insurance Companies Still Deny Trans Health Care

By TMPlanet

An investigation by the California Department of Managed Health Care found that Health Net, a health insurance company in the state, discriminated against seven transgender people between 2013 and 2015. The patients were denied coverage for gender-affirming surgeries such as testosterone injections, bilateral mastectomy, facial feminization surgery, and gender reassignment surgery, according to the San Francisco Chronicle¹. One of many insurance companies that still want classify transgender health care as an elective cosmetic procedure.

Health Net was ordered to pay $200,000 for violating state anti-discrimination laws, and to update their policies to comply with state law by September 30, according to a letter of agreement. It’s a huge win for transgender rights to healthcare in California, but also highlights out how difficult it is for transgender people to access gender-affirming treatments.

California is one of only a handful of states that has anti-discrimination laws requiring health insurance companies to provide coverage for gender-affirming surgeries. Last year, the most recent data, shows that 14 states had laws explicitly banning transgender exclusions in both private health insurance and Medicaid, according to the National Center for Transgender Equality. Five more had laws offering some protection for transgender people, banning discrimination from private insurers or Medicaid but not both. The other 31 states had no protections whatsoever.

 

Health issues of trans
Higher rates of depression and suicide. Higher rates of smoking, alcohol and drug abuse. Higher rates of physical and sexual abuse. Lack of basic primary/preventative care (refusal/harrassment or postponed care) Higher rates of HIV. Unsupervised hormone use. Poor access to health insurance and coverage of needed services. Task Force National Transgender Discrimination Survey (6450 participants): 41% suicide attempt rate compared with 1.6% general population. 26% physically assaulted and 10% sexually assaulted due to transgender bias. 28% reported harassment in medical setting, 2% physical violence. 2-4x the national unemployment rate, worse for people of color. 4x national HIV rate. 19% reported refusal of care based on transgender/gender non-conforming status. 50% reported teaching their healthcare providers. Over 25% report abusing drugs/alcohol to cope with mistreatment because of gender identity. One Colorado – Becoming Visible, 73 -> 86% covered by insurance from 2013 to Sanchez, et al. Health Care Utilization, Barriers to Care, and Hormone Usage Among Male-to-Female Transgender Persons in New York City. Am J Public Health April; 99(4): 713– Unsupervised hormone use prevalence 30-60% among M-F transgender persons in urban settings.

Yet, even in a state that has had a law explicitly banning discrimination from health insurers since 2012, transgender people still faced discrimination and restrictions to coverage.

That can mean that transgender people aren’t able to afford hormone replacement therapy that, for example, would deepen a transgender man’s voice and facilitate body hair growth. Trans people have also been denied coverage for top surgeries that would augment breasts for a transgender woman or remove them for a transgender man, and other treatments to aid in transition on the misguided idea that these treatments are not medically necessary.

Even health screenings that are considered medically necessary for everyone else, like prostate exams for transgender women and pap smears for transgender men, are more difficult to access once a person has legally changed their gender identity.


Cole Hayes, a transgender man who was seeking a hysterectomy, wrote about his experience in The Advocate in May. “Initially, my insurance said no to paying for the hysterectomy — not because I hadn’t completed the list of medical prerequisites, but because I was a man,” he wrote. “It didn’t matter that I was a trans man with a uterus. The insurance company doesn’t give men hysterectomies; there was nothing else the people there could tell me other than that their policy hadn’t been updated in quite a few years.”

The California law, as well as guidelines the governor of New York sent to health insurance companies in a letter on Wednesday, forbid health insurance companies for denying coverage for gendered screenings and treatments like these just because a person’s legal gender doesn’t match the gender of those who typically need the treatment.

But California, New York, and the 12 other states that have forbidden discrimination from health insurance companies are the standouts, and there’s so much more work that needs to be done to ensure that Hayes and other transgender people have access to the care they need. “Feeling human, healthy, and comfortable shouldn’t be considered cosmetic,” Hayes wrote. “In my case, the removal of my reproductive organs is a medical necessity, not only for my transition but for my overall health.”

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  1. The coverage by the San Francisco on the California Department of Managed Health Care.
  2.  Map: State Health Insurance Rules by the National Center for Transgender Equality.
  3. My Health Care Is Not Cosmetic: COLE HAYES,  a 25-year-old trans man living near Seattle, recently told The Advocate.
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20 Trans People Talk About What Dysphoria Feels Like

A simple wiki definition given for gender dysphoria: ‘The condition of feeling one’s emotional, and psychological identity as male or female to be opposite to one’s biological sex.” While the definition sounds simple enough, it’s far from being so simple for millions of trans people. In fact it’s one of  the greatest factors in the high numbers of suicides within our community, along with social prejudice, lack of access to fair employment, housing, and opportunities.
I recently asked some of our most devoted Friends of TMP to share with us, and our cis allies in their own words, what dysphoria feels like to them. While America debate our bathroom use and speculate on our intentions, let trans people tell you how trans people feel.

“Dysphoria for me is living on a small Caribbean island, and everybody knows who you are. When it comes to having an open relationship with a man, it becomes very difficult. Even though I am passable, it’s hard to find a man who is comfortable dating a trans woman, openly in public.”
Tori Culmer

“Dysphoria is something I’ve never not  had. Growing up, I hated looking in a mirror due to it being disassociated from my reflection, and my body…still don’t. There is still utter disgust at seeing my body in a mirror, and panic when out, when I have to use a toilet, and paranoia that they can tell I’m binding.”
Tiernan Tomlinson

“Dysphoria for me is like….I’m being crushed. I can’t breathe…can’t feel…can’t empathize. These feelings of hopelessness, and despair are overwhelming.
I get it really bad at work, it’s fucking terrifying. I don’t really wanna go into it. I can become very violent. I’ve not yet started medically transitioning, and really want to start HRT. I’m waiting on uncertain letters, from uncertain doctors, in uncertain times. All I can do is wait.”
Nathan Greig


“Dysphoria is like an out of body experience. I feel lost, confused; like I don’t know what I’m doing. I feel so doubtful of who I am. I know I’m definitely not a man, but feel so far from a woman. It makes me look at all the things I hate about myself: my too-wide shoulders, my too-small hips, my too-small breasts. It makes me hyper aware, comparing myself to every girl who walks by.
It kills me.”
Anais Majewski

“It was hard for me because I knew I wasn’t lesbian completely. I hate my boobs, but I was willing to carry my partners baby because, she doesn’t have the equipment, being a trans woman. We got engaged, and though we can’t afford our surgeries yet, we still give each other the freedom. Instead of calling her ‘Brandon’, like her parents do. In front of them I call her ‘Abby’, she’s my wife, and I’m a pregnant daddy, not a mommy.”
Jaimmy Jury

“Dysphoria feels like a bad pair of fitted pants. You look at yourself in the mirror, and your not happy. Your initial thought is to remove the pants because you look bad in them. For me, that’s what it feels like in my skin. I was born female at birth, and I hate looking at my chest everyday. I bind all the time, and I can not step out of the house without wearing one. I won’t feel OK in my body until I have top surgery.”
Aiden DiRe

“My dysphoria for what’s between my legs is the worst. I’m not able to get surgery to fix it yet, and everyday feels like torture. On my most dysphoric days, I feel like ‘Wesley from the Princess Bride’, when the machine was turned up to 50 in the ‘Pit of Despair,’ and like Wesley, the only thing that keeps me going on those days is the love that I have for my girlfriend.”
Regina V. Gallico

“It’s definitely gotten so much easier since time has passed. I’ve learned a lot. I won’t always pass to everyone, and that’s okay. If I look feminine sometimes, that’s okay too. I’m kind of feminine for a trans man, and at first it was so embarrassing, and uncomfortable, but I’ve really come to embrace it, because we are all  unique parts of a large community. I used to have terrible dysphoria. Some days, I would even wear two binders at once, (don’t do that, it’s not safe), but now I don’t even need to wear one most days. I’m so much happier now.”
John Neu

I get a lot of specific dysphoria. Especially over my voice, feet, and hands. I have to really work to remind myself my extremities are proportional, and do not make me stand out any more than any other tall cis woman. There are lots of cis women, even popular celebrities, and my cis sister, that have deep voices. I worked hard at changing my voice, and this is as good as it’s going to get. Sometimes it just gets overwhelming though, and it feels like I’m being suffocated.”
Erin R. Alexander

“Dysphoria, for me, is hard to describe. In pre-HRT days, I really didn’t know what was going on with me. I just felt disconnected from myself. I could never really relate to my guy friends, and I wanted to be included in the activities my girl friends did. When I tried befriending another girl, she would interpret it as flirting, sometimes to the point where they thought I was creepy, because I was always enthusiastic about hanging out with them. I drank a lot in my 20’s, and did a lot of cocaine. It wasn’t until I was 33 that everything started to make sense, especially after a dream I had, where I saw myself as a woman, and felt so empowered, and full of life. HRT did away with a ton of that dysphoria, but now it’s more specific. Now, I sometimes feel like I’m some kind of alien consciousness stuck in a human host that doesn’t reflect who I know myself to be. I’m so much happier now though, despite those moments.”
River Laurie

“Dysphoria for me feels a bit like this photo, it is confusing or was for me. I still look a little like ‘The Hunchback of Notre-Dame’, cause I slumped my body a bit so my t-shirt would fall from my chest. Also walking against the wind was not cool, I’m talking pre binder time, and since there were no packers, I also stuffed myself with socks, in the crotch that is. I am all post op, and still can feel it at times, but it is less invading, and less depressing. Like some women here, yes I wanted to have kids. I mourned that lost opportunity, but now at 55, I’ve accepted it. When the dysphoria got less, and surgery certainly did help, my mind opened more, and I could appreciate being trans a lot more because it also gave me things like inner strength. I am more open to things I don’t understand right away, and more of this.”
Sam Omen

“I’m 28, MtF pre-everything. I’ve always been like this. My mumsie, a war veteran, has always been supportive of me. We have mainly lived in ‘ironclad red states’, due to the cost of living being within the  budget as it were. In an effort to protect me though, considering what I am, my mumsie home schooled me entirely. She is extremely sharp witted with a massive intellect, so my whole life has on the one hand been like a giant 28 year college degree. She has taught me a fiercely strong faith, assuring me that God loves me, and that the hate that is spewed at trans people is a corruption of Jesus’s teaching, and to treat all people with love. I will say this though, I have no friends except for mumsie, because of what I am. I have never been on a date because of what I am. I have never had sex, or one bit of a romantic relationship because of what I am. Dysphoria is the reason that I don’t fear hell, because I already know what hell is like. Hell and Dysphoria are the same thing, because in the words of Jesus on the encounter film “there is no love in hell, no kindness, no happiness. Hell is torment, a torment that eats at you from the inside.”…in closing , let those who would raise cane against this post look upon me, what they consider to not be human or even a woman.”
Grace A. Ashcraft

“My dysphoria, means boys will never date me because I haven’t had any surgeries. Dating is impossible, because I always have to throw out a disclaimer for what they’re really getting into. Trans pride feels more like a defective label, since I’m never good enough for anyone.”
Jaelyn A. Harris


“What Dysphoria feels like for you? For me it’s the knowing that I’m not truly seen, like I”m constantly wearing a disguise. It hits me hardest when I’m perfectly content, and happy in what I’m doing, and then I catch my face reflected in a glass or a mirror, and I’m suddenly reminded of how I’m seen; that my face is that of a man. It’s honestly completely jarring, then I’m suddenly aware of it,
and I think everyone is starring at me, and I want to just vanish from existence.”
Lianne Hobbs

“Dysphoria sucks!!! As a 43 year old FtM pre-op everything, it’s harder some days than others. It comes out of the blue on the weirdest of times. Some days it doesn’t bother me at all. My triggers are also pretty strange. Sometimes going by women’s clothes in a department store, someone not calling me by my preferred name, and or pronouns, or just knowing that I am still menstruating sets me off, etc. I cannot wait for the day that I am completely post-op. It gets so bad in fact, that I wish I could cut myself open, and walk out of this false shell in which my total male soul dwells. I have a support group in which I attend, and very close friend, an MtF pre-op everything, that helps me deal with things. Love them all dearly. As I have people who love, accept, and or understand me. I feel as I could rule the world. Thank you for giving me a chance to voice my side of this issue.”
Mykel T. McCown

“I’m thankful I don’t endure too many episodes of being mis-gendered anymore. When I do, it’s some family members that just simply refuse, and it feels like someone just snuck up behind me and slammed me with a baseball bat. I literally jump, and feel like I’ve been knocked in the middle of an NFL stadium, full of people, bare naked. I hate it with a passion.”
Sabrina Samone, TMP


“This past fall, I let my hair grow again. It triggered quite a bit of dyshhoria. I wrote about it on my ‘Every Day Trans‘.
blog ‘
C. J. Levine

“Dysphoria used to just be this overwhelming feeling that everything is wrong, and if I could just remove myself from this shell it could all be ok. It used to be rage, and self loathing, depression, and self harm. Since treatment, and for the six months of HRT, so far it’s been more manageable.  The single most wonderful day of my life so far was when I got this cut, and color last Friday. I cried so much. It was the very first time that I could clearly see Alexia in the mirror. The very first time, I didn’t worry about passing, or how anyone else in the world perceived me. I saw a beautiful woman looking back at me. Now I have that moment. Now I know my truth. It feels like a little lantern I can hold up against the daily dysphoria. I’m confident that I’ll eventually have enough little lanterns that the dysphoria will become just a tiny nuisance.”
Alexia L. Partridge

“Dysphoria is something I haven’t had much of recently. Yet, the times I feel it are on the rare everyone is starring at my chest, and that they see me as female because of it. Also, I feel it when someone is extra “bro-y” to me. That’s more with random people who don’t know me though. I guess the way my dysphoria shows itself now is that I don’t feel like I fit into male or female anymore, and I get flustered when someone asks what I am, mostly online because I live as male in day to day. Even when people say I’m FtM. I used to say that, but now I feel trans accurately describes me. It’s like something at the tip of your tongue you can’t express.”
occasions I don’t have my binder. I feel like…
Remy Fecteau

“Dysphoria has caused me to hate myself much of my life, and self harm in more ways than one should from physically hurting myself. Doing things to sabotage my own life; to make things even worst for myself, and has kept me hiding away from people all my life. I kept myself at a distance
from almost everyone, though am taking steps to try to change my social anxieties, there’s always going to be issues with that thing downstairs so long as it remains there, so it doesn’t matter who I have in my life, or what activities I fill my life with, the pain I experience with living with a part that doesn’t belong. A part of me will always be that thing to cause me to walk the edge of a chasm. So many countless times I thought, if only I can just do it, be rid of it, from cutting it off to smashing it, already tried, and failed several attempts, then I could finally get on with my life, and breath a sigh of relief, if I survive. The only thing keeping me from being rid of it myself, is knowing if I did, then I would never have any hope of being complete and that could be just as bad as living with the damn thing. If I’m on the estrogen, I am less likely to have thoughts of self destruction, than those times I was not taking it, but still every so often I still get those moments where I feel things will never change. A feeling of deep hopelessness, and that I will never be able to be completely at peace with myself. Someday I hope to be truly happy in my own skin, be able to see myself, every part of me and love it all, and also perhaps allow myself to be loved as well. There’s that dream, I still hold onto that things will be right, that I will look down or look at myself in the mirror and smile, not just my face but every part of my being will shine, no more personal dysphoria, no more fears out there, no more needing to hide anything about me.
Megan Roberts

“Dysphoria leaves it’s mark with me daily. I’m reminded in every corner of my life, that I can’t carry my  own child. My body wasn’t designed to nurture life, as my natal-female friends were. I have to fight back tears anytime I read about a friend whose expecting, or weddings, or dreams, and the only light I can see in those moments, is the reflection in the mirror.”
Jennifer R. Stevens

 

 

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