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NJ Trans Woman Wins Health-Insurance Coverage For Mammogram

Beth Scott, a 44-year-old transgender woman from New Jersey, successfully appealed a decision by Aetna to deny her coverage for a mammogram after a doctor recommended she undergo the procedure, reports the Transgender Legal Defense & Education Fund (TLDEF).

Throughout the appeals process Aetna refused to cover the mammogram, stating Scott’s policy didn’t cover treatments “related to changing sex.”  But with the help of TLDEF, Scott was able to successfully argue that a mammogram has nothing to do with changing gender.

“I was denied access to the same health care benefits that my co-workers receive,” says Scott. “While I’m hopeful that my employer will soon eliminate the transgender health exclusion altogether, I’m relieved to know that the existing exclusion can no longer be used to unfairly deny me other needed health care like a cancer screening just because I’m transgender.”

A statement from TLDEF indicates the decision will have an impact on future trans patients:

Aetna reversed its position and paid for Ms. Scott’s mammogram in full. It agreed that the policy exclusion for transgender health care will apply only to treatments prescribed to change an individual’s sex characteristics, and not to any other medically necessary care. Additionally, Ms. Scott secured changes to the health plan ensuring that transgender people can access all necessary sex-specific care, such as prostate exams and gynecological care, regardless of whether they are categorized as male or female in insurance records. Many transgender people have claims rejected when an insurance company asserts that the procedure is not covered because it does not match the sex listed in the policyholder’s records. The plan will also allow individuals to correct the sex on their insurance records by presenting an updated ID such as a driver’s license, passport or birth certificate.

Most health-insurance carriers still refuse to cover costs relating to gender transitioning, such as for surgery or hormones.

Photo: TLDEF

By:           Dan Avery
On:           Apr 30, 2012
Tagged: , , , ,

  • 20 Comments
    • J
      J

      This is not gay news!

      Apr 30, 2012 at 11:57 am · @ReplyReply to this comment ·
    • Zach
      Zach

      @J: So?

      Apr 30, 2012 at 12:00 pm · @ReplyReply to this comment ·
    • w.e.
      w.e.

      Personally, I’d rather not hear about the details of the transexual health issues.

      Apr 30, 2012 at 1:06 pm · @ReplyReply to this comment ·
    • well now
      well now

      Well now, don’t click on the article then @J and @w.e. Some of us enjoy reading victories for equality even when it’s not directly related to us.

      some of use don’t like reading annoying comments yet we put up with it

      Apr 30, 2012 at 1:18 pm · @ReplyReply to this comment ·
    • Wesley Horace
      Wesley Horace

      can somebody explain why a transgender woman would need a mamogram? the breasts would obviousliy be fake…

      Apr 30, 2012 at 2:20 pm · @ReplyReply to this comment ·
    • Dr. Dick
      Dr. Dick

      Some of y’all are heart-breakingly ignorant.

      Apr 30, 2012 at 2:25 pm · @ReplyReply to this comment ·
    • Denise
      Denise

      Is Queerty going post stories about the war in Sudan and trends in interest rates? Because those subjects have as much to do with gay news as this story. Stop pushing the lie that gay and lesbian people are linked with people who wish to change their gender and/or alter their bodies to reflect that gender change. That is an old stereotype and Queerty spreads a lie every time it posts these trans stories here.

      Apr 30, 2012 at 3:28 pm · @ReplyReply to this comment ·
    • W.P.
      W.P.

      @Wesley Horace:

      For real?

      No, her breasts are real. When you’re taking Estrogen and a testosterone blocker it causes you to grow breasts. Personally I’ve gone from nothing to just under B’s in a little under 8 months of hormones. She needs a mammogram because just with all breasts (particularly breasts in people who have Estrogen flowing through their system), cancer develop in them.

      Apr 30, 2012 at 3:38 pm · @ReplyReply to this comment ·
    • AJ
      AJ

      You people are ignorant as hell! Go get yourself some education, or do not speak about what you know nothing about. GLBT THE T IS NOT SILENT!!! I am glad she was able to get that for her health! We all want EQUALITY!

      Apr 30, 2012 at 4:26 pm · @ReplyReply to this comment ·
    • Hyhybt
      Hyhybt

      @W.P.: Besides, men can get breast cancer too.

      Apr 30, 2012 at 5:59 pm · @ReplyReply to this comment ·
    • MKisNE
      MKisNE

      If my manboobs get any bigger I’m gonna need mamograms. But I’m not even gonna try for that one. I know what my place in health care is.

      Apr 30, 2012 at 10:19 pm · @ReplyReply to this comment ·
    • Clockwork
      Clockwork

      Mammograms for transwomen are not needed at the same frequency of naturally born women, for many obvious reasons. She may have had a family history of breast cancer.

      If you’re trans, don’t jump up for a mammogram just because you love the thought of engaging in a female procedure. Yes, I know some of you transwomen who would go there just to say you’ve had one.

      Many transgenders equate trans rights to getting other folks to pay for all medical transition related costs.

      Apr 30, 2012 at 11:01 pm · @ReplyReply to this comment ·
    • Denise
      Denise

      @AJ: There is no such thing as GLBT. Someone made it up. It doesn’t describe reality. Wake up and use language that describes the real world.

      Apr 30, 2012 at 11:51 pm · @ReplyReply to this comment ·
    • Hyhybt
      Hyhybt

      @Clockwork: Mammograms, though, are not “transition related costs.” If your doctor says you should have one, you should have one, regardless of how much or little breast you have and regardless of why you have it. (And I seriously doubt anyone gets one just for the fun of it, regardless of who’s paying.)

      May 1, 2012 at 3:26 am · @ReplyReply to this comment ·
    • Bipolar Bear
      Bipolar Bear

      Like it or not, we share a lot of the same issues. Such as being accused of vanity parenting when we want to have children: http://bipolarbear.co.nz/2012/03/13/rosemary-mcleod/

      May 1, 2012 at 5:18 am · @ReplyReply to this comment ·
    • pedro
      pedro

      Wow, the anti-trans sentiment is sickening…I’ve also noticed anti-lesbian sentiment on this sight. as well as straight up racism…Who are you people? Yes, trans women do actually develop real breast. Once they begin HRT their breast develop naturally, so this woman has breast, just like any other woman. As a gay man and an ethnic minority, I really have to ask…Is there a gay chapter of the KKK that I’m not aware of? Or are your personal lives so miserable, that you need to lash out at the world at large?

      May 1, 2012 at 7:11 am · @ReplyReply to this comment ·
    • Clockwork
      Clockwork

      @Hyhybt:
      >If your doctor says you should have one, you should have one, regardless of how much or >little breast you have and regardless of why you have it.

      I never made this inference, in fact I said they need them less frequently.

      >(And I seriously doubt anyone gets one just for the fun of it, regardless of who’s paying.)

      I am a transwoman. I know transwomen.
      Some of them (not all, not many, but some) are thrilled to get a mammogram, will ask their endo/docs for referral to get one. If you’re trans go get a colonoscopy before you go in for a mammogram.

      May 1, 2012 at 9:57 am · @ReplyReply to this comment ·
    • twiterosG
      twiterosG

      men can also get breast cancer albeit at a smaller % compared to women.

      I’ve seen women have mammograms with breasts that look like the size of eggs

      May 1, 2012 at 2:43 pm · @ReplyReply to this comment ·
    • Denise
      Denise

      @Bipolar Bear: Some issues maybe, but not “a lot.” And even if we did share “a lot” of issues, this mammogram issue isn’t one of them. So why is it posted here? The people who push LGBT aren’t just trying to form an alliance on certain issues, they want to create a new identity where gay people consider themselves fundamentally linked to transsexuals and crossdressers. That is a lie.

      May 1, 2012 at 3:45 pm · @ReplyReply to this comment ·
    • Josie McCormick
      Josie McCormick

      Some of the comments are complete absurd. Is it not about gay rights, but human rights? I think you are also forgetting that transgendered people are also gay, straight, bi, and everywhere else in between. Anyhow, one cannot be tricked by this story’s headline. If you don’t want to read it, then don’t. Have some self-control and fight real injustice.

      First they came for the communists,
      and I didn’t speak out because I wasn’t a communist.

      Then they came for the trade unionists,
      and I didn’t speak out because I wasn’t a trade unionist.

      Then they came for the Jews,
      and I didn’t speak out because I wasn’t a Jew.

      Then they came for me
      and there was no one left to speak out for me.

      —Martin Niemöller

      May 3, 2012 at 5:27 pm · @ReplyReply to this comment ·

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