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Growing Number of Insurance Plans Cover Gender Reassignment

Andre Wilson, an inclusive health advocate and transgender man, will speak at Washington University in St. Louis on Nov. 13 and 14.
Durrie Bouscaren
St. Louis Public Radio

Andre Wilson lived as a woman for the first 43 years of his life. It was excruciating, he said.

“I lived a life of depression, suicidality. I couldn’t even explain to myself, let alone others, what the barriers were,” Wilson said. “One lives a life of never having access to the core self.”

When Wilson began hormone therapy to transition into becoming a man, everything changed.

“The third day on testosterone for me was the first un-depressed day of my life,” Wilson said. “So, while life suddenly became more difficult, and access to care became more difficult--I could face that because I suddenly had a self.

That feeling of severe discomfort with one’s biological sex is called "gender dysphoria" by physicians. The treatment is often gender reassignment therapies or surgeries. But in many cases, the treatments are not considered medically necessary by health insurance plans and are therefore not covered, leaving people to pay the bills out-of-pocket.

Today, Wilson is a consultant and lobbyist for transgender-inclusive health insurance based in Ann Arbor, Mich.

Although plans that cover gender reassignment are not overly plentiful, advocates have had some victories in recent months, including the repeal of a 1981 rule forbidding Medicare to cover the surgeries.

However, for plans that do not include gender reassignment, Wilson said the definition of what is covered is sometimes broadly interpreted. As a result, they deny reimbursement to transgendered individuals for care that is completely unrelated to their gender transition.

“Blood transfusions, broken wrists … the list is really quite endless. Routine health exams that are denied because the person is transgender, and transgender related care is excluded under the plan,” Wilson said.

Some large employers in St. Louis do offer transgender-inclusive health insurance, including Monsanto and Boeing. Washington University added gender reassignment surgery coverage to employee plans this year, and is holding a series of seminars on transgender-inclusive care on Nov. 13 and 14.

Seminar organizer Peter Jones said it took a year of dialogue with Washington University officials before a group of employees were able to secure the inclusion for the 2015 health plans. A cost-benefit analysis showed the change to plan prices would be minimal.

“One of the reasons Washington University is able to do this, is that they’re self-insured. They’re able to sit down with an insurance company and say, 'We want these things covered,' and they pay the cost directly to the insurance company,” Jones said.

“There are lots of employers that are like Washington University and are about the same size. I don’t think anything stands in their way to making their care trans-inclusive.” 

Follow Durrie on Twitter: @DurrieB