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.