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Health insurance a maze of problems for transgender people

DALLAS – After nearly 50 years living as a man, Leslie McMurray was reborn – but then lost nearly everything: her home, her marriage of 33 years and her job as a radio program director in Dallas.

McMurray also began her long, complicated battle with health insurance. She and many other transgender people face difficulties with health insurance providers that will not cover certain procedures or medications.

An estimated 700,000 transgender people live in the U.S. As public awareness of this population grows, spurred by such high-profile stories as Bruce Jenner’s transition to Caitlyn, it’s become clear that health insurance coverage for transgender-related procedures and wellness is a complicated maze of terminology and technicalities, experts say.

Leslie McMurray, right, sits next to Katie Sprinkle in Carrollton, Texas, in May. “I am one of those people who falls through the [health insurance] cracks,” McMurray said. (Vernon Bryant/Dallas Morning News/TNS)

Leslie McMurray, right, sits next to Katie Sprinkle in Carrollton, Texas, in May. “I am one of those people who falls through the [health insurance] cracks,” McMurray said. (Vernon Bryant/Dallas Morning News/TNS)

Some insurance providers cover surgical procedures like gender reassignment surgery, but not feminization of the face for transwomen (someone born male, but who identifies as female) or mastectomies for transmen (an individual born female who identifies as male). Other providers do not cover surgeries related to gender reassignment, but will cover certain hormonal treatments and mental health therapy.

“When health care really stresses biology, it leaves a large portion of us out,” said Nell Gaither, president of the Trans Pride Initiative, a Dallas advocacy group. “Our lives depend on medical intervention. One way or another, we’ll figure out how to get the treatment we need. (But) when insurance doesn’t work, a lot of people turn to the Internet, and that’s extremely dangerous.”

Insurance company representatives say their plans abide by industry standards, including meeting Affordable Care Act regulations, which include a clause that insurance providers cannot discriminate on the basis of gender identity or stereotypes.

And some insurance providers, like Aetna and Cigna, have broadened their policies to include more access for transgender-related coverage.

But many transgender patients who don’t have ACA plans say they have had components of their coverage denied or have been denied insurance altogether because the provider considers gender dysphoria a pre-existing condition, which they do not cover.

Jody Herman, scholar of public policy at the Williams Institute at the University of California, Los Angeles, said insurance policies vary by state. For example, California law requires that insurers cover gender reassignment and hormone therapy, but Texas doesn’t. Some Texas legislators have tried unsuccessfully to end insurance discrimination.

After McMurray lost a six-figure salary, her financial situation shifted dramatically, making it difficult for her to afford insurance. The complicated life she suddenly found herself living brought her to the brink of suicide.

A 2014 study found that 46 percent of transmen and 42 percent of transwomen attempt suicide in their lifetimes, according to the National Transgender Discrimination Survey, a report published by the Williams Institute and the American Foundation for Suicide Prevention.

“For me, it was life or death,” she said. She couldn’t go on living in a body she felt she didn’t belong in and didn’t see any other way out.

ACA plans include deductibles of up to thousands of dollars and high monthly payments – and gender reassignment surgery may not even be covered. So McMurray saw no sense in trying to get insurance.

In 2014, nearly 35 percent of transgender people living below the poverty level were uninsured, according to the Center for American Progress.

She began tapping into her retirement fund to pay for her procedures, which turned out to be more expensive than her surgeries because she had to pay taxes and penalties. She’s continued to take from her retirement in order to make ends meet.

“The way health care is set up, I’m one of those people who slips through the cracks,” McMurray said.

Federal employees can now undergo gender reassignment surgery through Aetna insurance plans because of a policy change that began in January. Aetna will be adding gender reassignment surgery to many other commercial plans over the next few years.

But breast augmentation, hair removal and forms of facial reconstruction are considered cosmetic, and will not be covered. The World Professional Association for Transgender Health considers both necessary for the transgender patient.

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