image

health as it happens

LGBTQ inclusive insurance protections expand in Blue Cross NC case - Citizen Times

play

Correction: The exclusion to medical care related to gender dysphoria in North Carolina's State Health Plan was temporarily suspended for a year in 2016 and has not been approved for permanent removal. This story has been updated.

BlueCross BlueShield of North Carolina (Blue Cross NC) announced in July that it is expanding its coverage for gender-affirming medical procedures, marking an important win for the transgender community.

The policy change came after two transgender women challenged the company to change its policy after being denied coverage for facial feminization surgery.

Kathryn Vandegrift, 28, one of the women who brought forward her complaint in April 2020, fought for over a year for expanded coverage.

“The way I describe to people, the lack of treatment makes my body hard to live in, and it makes the world uncomfortable and very frequently unsafe to exist within,” she said.

While the change applies only to BlueCross NC members, advocates say the announcement is a significant win for a community that has been the target of a wave of proposed legislation limiting access to healthcare this year. Of the proposed bills, Arkansas was the only state to pass a law restricting access to gender-affirming care for people under 18. The law is now being challenged in court.

While there has been a widespread push in some states to restrict health care access for this community, a growing number of private health insurers are changing policies to increase access to a wider range of gender-affirming procedures that are considered standard medical practice.

Transgender care in the South: Transgender kids in the South face multiple obstacles to affirming care

'Doctors are so uninformed': For transgender Americans, the doctor's office experience often a difficult one

Family support: A father's love for transgender daughter puts Alabama family in the spotlight

Health insurers expand coverage for transgender care 

In January, Aetna announced the expansion of coverage of gender-affirming surgery to include breast augmentation for transgender women in most of its commercial plans.

In May, Anthem announced it was adding facial surgery, and chest and genital surgery to its list of covered procedures for gender dysphoria. This is the psychological condition that results in mental distress when someone’s sex assigned at birth does not match the gender they identify with, according to the American Psychiatric Association.

As of July 1, BlueCross NC expanded coverage of procedures to include facial surgery, voice therapy, and chest and genital surgery said company spokesperson Jami Sowers. BlueCross plans in other states like Oregon and New Mexico also offer coverage for medical procedures related to gender dysphoria.

“We are seeing a lot of these announcements in recent years—where companies are taking a hard look at their harmful restrictions. They are increasingly removing them voluntarily without having to go through litigation,” said David Brown, the legal director for the Transgender Legal Defense and Education Fund (TLDEF), which helped Vandegrift with her complaint.

But while some private insurers are expanding policies, Brown said that several states still allow exclusions to transition-related care in their state health plans.

States where transition-related coverage is banned

Only 18 states provide transition-related care coverage in their state-employee health benefits, according to the Movement Advancement Project, a Colorado-based think tank that tracks LGBTQ rights issues. Twelve states have explicit bans on transition-related healthcare in their state plans, including North Carolina, Mississippi, Louisiana, Arkansas, and Tennessee.

The American Psychiatric Association states that medically available treatments for gender dysphoria are standard and offer the best long-term outcomes for patients. 

North Carolina’s exclusion of medical procedures connected to a diagnosis of gender dysphoria has been in effect since the 1990s. It was temporarily suspended for a year in 2016, but the suspension expired at the end of 2017 and the board that oversees the plan has not approved the removal of the exclusion to this date. 

The plan is under the jurisdiction of State Treasurer Dale Folwell's office who in October 2018 said that the “legal and medical uncertainty of this elective, non-emergency procedure has never been greater. Until the court system, a legislative body or voters tell us that we “have to,” “when to,” and “how-to” spend taxpayers’ money on sex-change operations, I will not make a decision that has the potential to discriminate against those who desire other currently uncovered elective, non-emergency procedures.”

He added that while the state “empathized with all members’ health conditions” they could not provide coverage for every “elective, non-emergency procedure they want.”

It’s a stance many insurers have previously taken to justify these exclusions by classifying the care as cosmetic or medically unnecessary despite substantial evidence to the contrary, according to the Transgender Law Center.

Discrimination lawsuits filed 

TLDEF has filed lawsuits along with Lambda Legal on behalf of state employees in North Carolina and a separate case in Georgia challenging these exclusions. 

In both cases, state employees say their employers discriminated against them by excluding medical care for procedures tied to gender dysphoria from their health plans.

The lawsuit filed on behalf of state employees in North Carolina alleges that the state violated Title VII of the Civil Rights Act by discriminating against transgender employees. The state’s health plan includes a sweeping exclusion to all types of gender-affirming procedures, from mental health care to hormone therapy. The North Carolina State Health Plan covers over 700,000 people.

'Hopeless feeling'

Julia McKeown, 45, an assistant professor in the College of Education at North Carolina State University, is one of the plaintiffs in the case. She began hormone replacement therapy in 2013 as part of her initial medical transition. She has since paid over $14,000 out of her savings to continue her medical transition even though as a state employee she is enrolled in the state health plan.

McKeown said the plan could cover many of the same types of services if it weren’t associated with gender dysphoria, including mental health services and even hormone treatment.

“If you need to seek mental health care—depending on how it’s coded, you can be denied reimbursement. If they can even tie it to transition-related care, then it can be excluded. That’s one of the big keys here. You feel very targeted,” she said.

A similar case out of Georgia involving Anna Lange, a sergeant with the Houston County Sheriff’s Department, also aims at removing the exclusion in her employer’s health plan.

Lange has worked with the sheriff’s department since 2006 and began her medical transition in 2017, which she has mostly paid out of pocket.

When she came out as transgender, she examined her insurance policy to see what was covered. 

“It was trial by error. I would submit things and hope they would get pushed through,” Lange said.

When Lange decided to move forward with gender confirmation surgery, her surgeon initially said she was covered. But a week before the scheduled surgery in November 2018, she was informed that her insurance denied her coverage. 

“It took me so long to admit to myself that I was trans," she said. "The door had been shut in my face, and I was devastated."

In February 2019  Lange petitioned the Houston County Board of Commissioners to have the exception removed but was denied. 

“The Board is not considering any changes to the plan at this time,” said Houston County Attorney Tom Hall in response to her request according to the lawsuit.

Three years later, Lange is still waiting for answers. 

Houston County officials did not respond to a request for comment and the case is still pending.

“It’s frustrating knowing that people who haven’t taken the time to research the issue have so much power over your life. It’s a hopeless feeling because this has been going on for years,” she said.  

Maria Clark is a general assignment reporter with The American South. Story ideas, tips, questions? Email her at [email protected] or follow her on Twitter @MariaPClark1. Sign up for The American South newsletter. Follow us on Instagram, Facebook and Twitter.