HHS panel finds insurance must cover sex reassignment

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Charlene Lauderdale was denied coverage for the procedures by her private insurance firm, which is funded through Medicare. But for the first time this month, a U.S. Department of Health and Human Services panel found that the insurance provider must cover the procedures.

The council finds that the vaginoplasty surgery requested in this case is covered and is the responsibility of the plan.

--Medicare Appeals Council

A disabled Air Force veteran, Lauderdale, 55, was covered by United Healthcare through Medicare Advantage, a government-run program that compensates private insurers for patients who qualify for subsidized health care. Lauderdale was denied coverage for the procedures in 2014, leading to a series of appeals resulting in this month’s decision in her favor. She declined an interview Friday.

Full disclosure: This writer has the same insurance, provided through AARP.

In making its decision, HHS relied on the World Professional Association of Transgender Health (WPATH) Standards of Care, long considered the highest standard by transgender healthcare experts.

[This decision is the] first resounding affirmation from a government entity that transition care should be treated like other care. This decision specifically calls for, and identifies, genital surgery as being covered.

This potentially affects all Medicare enrollees and will likely influence private insurers as well.

--Ezra Young, attorney for Lauderdale

HHS lifted the categorical ban on transition-related coverage in May, 2014.

Young said that a handful of procedures have been approved in the following years, but no request for genital surgery had reached the HHS appeals council until this case, brought by Charlene Lauderdale.

This decision reveals that genital surgery is not a shameful thing to request or to need, and the federal government has their back.

--Young

This decision reaffirms that Medicare beneficiaries deserve care based on real medicine, not knee-jerk biases. We hope it sends a clear message that insurance companies need to follow the established standards of care — and that patients can fight companies who don’t.

--Mara Keisling, National Center for Transgender Equality

a tremendously important step towards helping ensure that transgender people who rely on Medicare are no longer denied access to the basic, yet crucial, medical care they need.

--Sarah Warbelow, Human Rights Campaign

Jamison Green, president of the World Professional Association for Transgender Health (WPATH), said the decision reflects guidance set by WPATH.

This welcome decision is a testament to the dedication of those healthcare providers who have persisted in researching and treating transgender, transsexual, and gender non-conforming people.

--Green

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...of course, about other conditions which are not being covered. I’d like to remind everyone that that is not the fault of transgender people.

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enhydra lutris's picture

not being covered that, in their opinion, should be, need to raise a fuss about that, not decry that what is covered is covered. When you want to get a movement started you don't say "This is broke, so break everything else too" you say "This is broke, so fix it".

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