A Colorado transgender woman’s insurance company has denied her coverage for gender reassignment surgery she says is medically necessary and should be ensured by state law and policy.
Ashlyn Trider, 33, said Aetna Life Insurance Company’s refusal to pay for gender reassignment surgery prescribed by her doctor violates Colorado law. The Transgender Legal Defense & Education Fund has demanded Aetna reverse its decision.
“This is a medical condition. I was born with it,” Trider said. “It’s medically necessary surgery. My doctor has strongly urged this procedure get done. It’s pretty straightforward.”
The denial of coverage violates Colorado law, said TLDEF attorney Ethan Rice. State law and Division of Insurance 2013 guidelines require companies to cover medically necessary care for transgender policyholders on the same terms as all other policyholders.
“It’s pretty clear guidance,” Rice said. “The crux here is that a lot of insurance companies are still excluding coverage. Governments are taking action to end discrimination, but the transgender community still struggles to get the care (it) needs.”
Colorado is one of 10 states, along with the District of Columbia, barring health insurance discrimination against transgender people, Rice said.
Colorado Department of Regulatory Agencies bulletin B-B.49 states health insurers cannot deny coverage of treatments for transgender policyholders if the same treatments are covered for other policyholders.
Aetna officials say they can’t discuss any health information about members without signed waivers, but the denial letter sent to Trider says her “plan has a specific exclusion for the requested service or treatment.”
But Aetna has long been supportive of the lesbian, gay, bisexual, transgender community, the company said in a written statement.
“Moving to include gender reassignment procedures in our plans is consistent with other changes we have made to better serve the needs of the LGBT community,” Aetna said in a written response to The Denver Post. “In 2015, Aetna started covering gender reassignment surgeries for our 33 Aetna plans offered to federal employees. … Aetna also is expanding coverage of gender reassignment surgery in many of our fully insured commercial plans … and will continue to roll (such plans) out over the next couple of years as we refile our plans with the states. We will be introducing the product in West Virginia, Utah, Idaho, Missouri, Wyoming, Nebraska, Iowa, Louisiana, South Carolina (for our fully insured plans) this year.”
Trider took steps to begin living openly as a female in 2012 after she was diagnosed with gender dysphoria — the discomfort and distress caused by conflict with one’s gender at birth and his or her own gender identity. She began treatment, including hormone therapy, and legally changed her name and gender designations on her driver’s license, passport and Social Security records.
On Jan. 28, Trider’s surgeon submitted a request for preauthorization for gender reassignment surgery. One day later Aetna denied the request on the grounds that her policy excludes coverage for all transgender health care.
TLDEF appealed Aetna’s coverage denial July 20. Aetna has 30 days to respond. TLDEF also filed an official complaint with the Colorado Division of Insurance on July 23, but DOI officials did not return the Post’s calls about the complaint as of deadline Monday.
“Aetna denied my claims because I am transgender,” Ashlyn said. “No one should be denied health care coverage just because of who they are.”
Health care related to gender transition is recognized as medically necessary by organizations such as the American Medical Association, the American Psychological Association and the World Professional Association for Transgender Health. The 11 jurisdictions currently barring health insurance discrimination against transgender people include California, Colorado, Connecticut, Illinois, Massachusetts, Nevada, New York, Oregon, Vermont, Washington and Washington D.C.
Electa Draper: 303-954-1276, edraper@denverpost.com or twitter.com/electadraper
