OPINION: Navigating Health Insurance Still Proves Challenging For Trans People
Donnie TC Denome | April 20, 2018, 12:42 a.m.
My IUD cost $1,500.
The complications from my IUD cost over $7,000.
I know all of this because Aetna Student Health Insurance Plan — student insurance from the 5Cs — sent me a bill for both of them. They wouldn’t pay, they said, because the “procedure code is not consistent with the patient's gender.”
Fast forward seven months, I had a gynecologist appointment. Aetna refused to pay again.
Both times, I waited on the phone, listened to the taunting hold music, and outed myself to multiple customer service representatives who shuffled me around until I reached someone who could help me. Both times, every customer service rep I spoke to seemed intrigued and a bit confused by my plight.
It was like I was the one who had to explain and fix things for those reps, not the other way around. I spelled out what being trans was and what body parts I still had for every person I spoke to just to make sure they knew what to do.
I still have a uterus, I told Aetna.
They understood and reversed their decision, paying for the procedures, but it was still a headache — especially the first time, when I was dealing with Aetna and the hospital while lying on my side with a heating pad clutched to my cramping abdomen.
I have, in my short life, dealt with health insurance an awful lot. I saw more doctors before the age of 10 than most people will see in their entire lives. In my first two weeks of life, I racked up half a million dollars in hospital bills.
By the time I reached adulthood, I was a pro at talking to doctors. I can rattle off my medications list from memory, tick off my diagnoses on my fingers, and know exactly how tall I am and how much I weigh. I’ve been inoculated to finger pricks, blood draws, and injections. I no longer cringe at awkward questions about my sex life. It’s all become part of my life.
Most doctors and medical offices I’ve been to understand that my body doesn’t fit the “typical” model of maleness and are accommodating of that. At the very least, nobody’s denied me medical care because I am trans.
Insurance is another matter, though. For an industry that deals with paying for people’s medical issues and health problems, medical insurance really doesn’t like when patients fall outside pre-set boxes. I can have a brain injury, a developmental disorder, multiple mental illnesses, and a truly unruly uterus, but if I label myself as male and need a Pap smear, somehow that’s an issue.
I understand Aetna’s concern: Healthcare fraud is a real issue. A gynecologist billing services for a patient with a male gender marker looks like fraud at first glance. It would be a transparent, weak attempt at fraud, but fraud all the same.
It’s not fraud in my case, which is my issue. I understand their position but it’s difficult to deal with being called a fraud when I’m just trying to access health care.
Additionally, gynecological care (the only medical care that causes “gender inconsistencies”) makes me incredibly dysphoric and can cause depressive episodes that last days. Being reminded that the very care that worsens my mental health is also a burden for insurance to cover exacerbates this.
When I went through the first round of Aetna refusals, my mother told me I shouldn’t have changed my gender marker until I “fully transitioned.” Ignoring the fact that “fully transitioned” means something different to every single trans person, there are definite legal drawbacks to being “visually” male and legally female.
I have a salpingo-oophorectomy and total hysterectomy (the removal of the Fallopian tubes, ovaries, cervix, and uterus) scheduled for late May. Once it’s over, I’ll never need another Pap smear, contraceptive method, or yearly gyno exam. Aetna will no longer need to cover all the procedures they find “not consistent with [my] gender code.”
Perhaps they’ll let up after that. They’ve been surprisingly good with transition-related healthcare; the biggest problem I’ve had is that they refuse to cover more than a month’s worth of testosterone at a time.
Nevertheless, every time this happens, I have to out myself to a random stranger who, for all I know, is a vicious transphobe who might scream at me about how I’m a degenerate and a freak (not to mention, the fear and waiting until the problem is fixed).
I believe the issue here is twofold. One, healthcare in the United States is ridiculously expensive. There’s no reason that an IUD insertion should cost $1,500; it’s a piece of plastic with some hormones in it, and the insertion and observation period take an hour at most.
If healthcare wasn’t so expensive — and people weren’t therefore forced to rely on private companies with their own agendas for care — I wouldn’t be so resigned to throwing myself to the mercy of Aetna’s uncaring judgment.
Two, medical insurance coverage shouldn’t be based in morality judgments and assumptions about what bodies “should” look like and what care people “should” need. Being transgender is considered a pre-existing condition in many cases, and it’s only because of the Affordable Care Act that Aetna can’t deny me coverage altogether for being trans.
We have a ways to go, and I don’t have a perfect solution. Nationalized, universal healthcare might take care of the expense issue, but it leaves trans people and other marginalized groups at the mercy of the government for our healthcare. Insurance companies setting clear policies for how trans and gender non-conforming people can get the healthcare we need would also help, but that puts the onus on companies that may not comply.
A permanent solution isn’t likely to arise without significant government intervention and industry reform, alongside continuing pressure from patients, healthcare workers, and patient advocates. It’s a huge step forward that can’t be accomplished by any one person, least of all college students.
Still, we are not powerless. Part of allyship is listening, offering support, and commiserating when necessary. I’ve found some of my best support on this issue from venting to and with other people who have had insurance denials for necessary procedures as well — mostly cis people who were willing to listen to my experiences as a trans person.
Healthcare reform is far in the distant, and the forecast isn’t looking good given the current political climate. In the meantime, we can all be here for each other, supporting one another through medical complaints and insurance journeys.
Donnie TC Denome PZ ’20 is a public health major from Sunnyvale, CA. Their greatest achievement in college so far is either becoming a GLAAD Campus Ambassador or breaking 5’3” in height.