Transgender Health Coverage: California & Oregon Direct Insurance Companies To Provide It


 Regulators in Oregon and California have quietly directed some health insurance companies to stop denying coverage for transgender patients because of their gender identity.
The states aren't requiring coverage of specific medical treatments. But they told some private insurance companies they must pay for a transgender person's hormone therapy, breast reduction, cancer screening or any other procedure deemed medically necessary if they cover it for patients who aren't transgender.
The changes apply to companies insuring about a third of Oregonians and about 7 percent of Californians, but not to people on Medicare and Medicaid or to the majority of Californians who are insured through a health management organization, or HMO.
Advocacy groups said the action is a major step forward in their long battle to win better health care coverage for transgender Americans.
"It's just a matter of fairness," said Ray Crider, a 28-year-old transgender man from Portland. "I just never felt that I was like anybody else. I see everybody else being taken care of without having to fight the system."
Officials in both states said the new regulations aren't new policies but merely a clarification of anti-discrimination laws passed in California in 2005 and in Oregon two years later.
Many health insurance policies broadly exclude coverage of gender identity disorder or classify it as a pre-existing condition. Transgender patients are often denied coverage for medical procedures unrelated to a gender transition, advocacy groups said, because insurance companies deem the condition to be related to their sex reassignment.
Some transgender patients also have trouble getting access to gender-specific care. A person who identifies as a man might be denied coverage for ovarian cancer screening or a hysterectomy. A transgender woman might be denied a prostate screening.
The state insurance regulators said those procedures, if covered for anybody, must be covered for all patients regardless of their gender. Masen Davis, director of the Transgender Law Center in San Francisco, said he's unaware of insurance regulators in any other state taking similar action.
The California regulations took effect in September and apply only to insurance products regulated by the California Department of Insurance. The agency primarily regulates preferred provider plans, or PPOs, that covered about 7 percent of the population in 2010, according to data from the California Health Care Foundation.
The agency that regulates California HMOs has discussed transgender care with consumer groups and health plans, "but no regulations have yet been proposed or adopted," said Marta Bortner Green, a spokeswoman for the Department of Managed Health Care.
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Re: How to tell the doctor I'm transsexual. Any tips?

Here are a couple messages that I received in an email...
Many are apprehensive in telling their doctor, but doctors already know about transgenderism although many do not have a lot of experience. 


ARTICLE: Isn't it cool when we find out we were putting ourselves thru a hell because we were afraid to tell someone about us and when we do we find out it's really no big deal..Its called self torture, lack of confidence in other people to understand, especially our Doctors..I personally want my doctor to know everything, if I'm screwed up or not, it gives them a better perspective of you as a patient and makes asking for help a lot easier...
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> I know exactly what you are going through. I was self medicating on and off for 4 years and full regime since last April. I have developed pretty fairly considering that I have been taking hormones for 5 years but almost a third of that time I was off of HRT and only full time for 9 months. I was very nervous about coming out to my doctor but I just couldn't pretend I was a male any longer and decided that I would tell my doctor as well as my employer I was trans. I was very surprised that my employer was so understanding and supportive and my doctor wasn't upset at all. My doctor took lab tests and suggested I get involved with a support group and counseling. She (my doctor) wants to see me again in 3 months to do another set of labs and adjust my hormones if necessary.

> I was so scared to come out to her that I started crying when telling her and she comforted me. What was supposed to be a 15 minute office visit lasted almost 2 hours because she was so supportive and listened to me for a long time. I am happy that I decided to inform her of my HRT and that I was transsexual and wish I had done it earlier. Perhaps I wouldn't have stopped taking the hormones on and off so often because my medical insurance will pay for all of the hormones. I quite several times because I was faced with food and housing or hormones, not a good choice. Now i can have both without worry.