Navigating the trans-exclusive insurance labyrinth

A few weeks ago I received an orientation packet for the graduate program I’m starting this Fall, which referred to the availability of a subsidized insurance plan for graduate students. We were sent a link to the Student Health Insurance Policy brochure for review and told to let them know if we want the health insurance coverage. If so, they “simply put you on the tuition waiver list and check yes or no for coverage.”

As a student who’s well aware of the fact that many transgender people are denied health insurance coverage altogether solely because we are transgender, I knew it probably wouldn’t be that easy. While it's really great news that the Affordable Care Act (ACA) now bans discrimination that has prevented many transgender people from having health insurance coverage (Section 1557), there are still many problems - most notably, interpreting what is and isn’t discrimination has been left to the states. For instance, insurers have, "used the exclusion to justify denying transgender policyholders coverage of not only hormone replacement therapy and transition-related surgery, but also mental health services and treatment for physical injuries that have nothing to do with gender at all, such as a broken arm."

Overall, navigating the labyrinth that is health insurance is no easy task. For anyone, I'm sure - but as a person of transgender experience it's ridiculous. Even after reading articles galore, attending three workshops related to navigating health insurance at the Philly Trans-Health Conference, and doing my best to read the subsidized insurance policy available to me as an incoming graduate student, I'm extremely confused.

I started by reading the health insurance policy, which does exclude transgender service. But the policy is also outdated (2013-14) and may have changed with some of the changes that are applying gradually with the ACA.

With the help of the adorable presenter I met at the conference, we came up with the following game plan on how to proceed:

1. Call up the insurance provider and ask about their "sexual reassignment surgery" protocol, as most insurers have them. The policy is usually an insurance wide document.
2. When I call, ask them about what I would need to change the university's coverage, i.e. requiring a supplemental rider. Also, ask them if there are other plans offered at the university that would provide the coverage I am seeking.  Not all plans are accessible to students, but may help bolster my argument to get the school to change their coverage.
3. Ask my benefits administrator (or head of insurance enrollment) about the other plans available.  I could say that I need access to services that are not covered on the plan and is there any other way that I can get the specific coverage I need.
4. If my program has a place that provides LGBT services, they may be able to provide help as to how prior students have dealt with the insurance exclusion in the past.  

I confessed that I was nervous about calling the insurance provider, as I don’t want to be flagged as a “trans patient” and denied service across the board. But, I decided this morning that I’d proceed and called the insurance provider.

s.c.a.r.y.

The conversation was extremely brief and uneventful. When I asked for a copy of the 2014-15 policy brochure, I was told that it is not available yet. When I asked about their “sexual reassignment surgery” protocol, I was told that this is excluded and explicitly decided upon between the school and insurance company. And when I asked if there was anything I could do to change the coverage available to me as a graduate student - such as potentially getting a supplemental rider or opting for another plan - I was told that there’s nothing I can do and there are no other plans available to students.

So then I proceeded to steps #3 and #4. I first wrote to the individual who’s signing us up for insurance, as I'm not sure who the head of insurance enrollment is:

Hi, ____ - 

I have been investigating the ______ subsidized graduate plan and it looks like transgender services are excluded in the 2013-14 policy. Given that the policy may have changed with some of the non-discrimination changes that are applying gradually with the ACA, I called to request a copy of the 2014-15 policy and was told that they do not have this yet.  

As a transgender student, I will not be able to get the specific coverage I need from the present graduate plan. Would you be able to point me to the benefits administrator or head of insurance enrollment at the ______? I would like to speak with them to see if there's any way I can get specific coverage I need. 

Thank you,
Dexter

And I also wrote to the on-campus LGBT resource center:

Hi, ____ - 

My name is Dexter Thomas and I am an incoming M.S./Ph.D student in the ______ department. We received some orientation materials, part of which refer to having the option to opt into the ____ subsidized graduate plan. Unfortunately, it looks like transgender services are excluded in the 2013-14 policy. Given that the policy may have changed with some of the non-discrimination changes that are applying gradually with the ACA, I called ____ to request a copy of the 2014-15 policy. I was told that they do not have this yet, and that there's no way to opt for anything else (e.g. other plans, a rider, etc.).  

Do you know of any other transgender graduate students who have tried to navigate the health insurance labyrinth? Or do you have any resources/suggestions? 

Thank you,
Dexter 

To my surprise, I received a swift response from the LGBT Resource Center, which cc'd the director. And they expressed interest in looking into this. Promising!

In the meantime, I'm planning to also reach out to students elsewhere who have successfully gotten their plans changed at their universities. And I am also looking into potentially purchasing a plan through the exchange instead, which may provide inclusive coverage. Which I'm reluctant to do, as I have the same right to subsidized insurance that my cisgender peers have.