Insurance Companies Starting to Get Penalized for Not Covering Transgender Surgeries

Insurance Companies Starting to Get Penalized for Not Covering Transgender Surgeries Insurance companies are coming under fire for refusing to pay for cosmetic procedures and other services related to transitioning and feminization. In fact, Health Net, an insurance provider located in California, was recently fined $200,000 for their failure to cover this type of service. Does this mean that all insurance providers may be forced to offer procedures and services for transitioning individuals?

What Happened to Health Net? The California State Department of Managed Health Care notified Health Net of their intended administrative action after its investigation into its practices surrounding gender reassignment procedures. The report stated that between the months of December 2013 and February 2015, Health Net denied seven transgender individuals services related to their transitions with the claim that they were not covered under their Health Net policies. Per the department, this violates the Insurance Gender Nondiscrimination Act of 2006.

Which Services Were Denied?

Per the report that carefully studied each of the seven patients who were reportedly denied medical treatment, a variety of services were denied. These include everything from simple consultations with gender reassignment surgeries to testosterone injections, and even gender reassignment surgeries. In three cases, Health Net made the claim that the procedures were denied because they were cosmetic and not considered medically necessary. Per Health Net’s policies, procedures that change one’s physical characteristics to resemble the opposite gender are strictly prohibited.

What Happens Now? Lawmakers and regulators have decided that this prohibition is against state law. As a result, Health Net must now pay fines in excess of $200,000 and provide written confirmation that it has reviewed and changed its policies to be in accordance with the law – meaning, they must remove any form of discrimination from their coverage. For the seven individuals who were denied, Health Net is being forced to either pay for the requested care or reimburse those patients for any out-of-pocket costs they incurred as a result of seeking their treatments.

What Transgender Patients in California Can Expect in the Future This ruling brings relief to many transgender Californians, but the truth is that most states don’t have similar laws in place. In fact, in most places across the United States, gender reassignment is considered cosmetic in nature and insurance companies are allowed to deny patients coverage for any of the related procedures – including simple consultations, hormones, and therapy. It is hoped that lawmakers in other states will follow in California’s footsteps and change the way discrimination is defined in the medical field, thus requiring all insurers to provide coverage for services and procedures intended for transgender patients.

Though Health Net has complied with the state’s request to pay the fines, revamp their policies, and take care of the seven patients it initially denied, it is unknown how many other patients in this state have been denied treatment by other insurance companies. Perhaps the state will continue to look into denials and complaints, thus ensuring that more people get the procedures and services they need.