July 28, 2015

TLDEF Challenges Discriminatory Health Insurance Coverage Denial

Colorado Transgender Woman Demands that Aetna Life Insurance Company Cover Her Medically Necessary Gender Reassignment Surgery; Aetna's Coverage Denial Violates Colorado Law

New York, NY - The Transgender Legal Defense & Education Fund (TLDEF) has demanded that Aetna Life Insurance Company reverse its decision to deny coverage for a Colorado transgender woman’s medically necessary gender reassignment surgery. The coverage denial violates Colorado law, which requires companies to cover medically necessary care for transgender policyholders on the same terms as all other policyholders.

Ashlyn Trider is a transgender woman. She began taking steps to live openly as female in 2012 after she was diagnosed with gender dysphoria, the diagnostic term used to refer to discomfort or distress caused by a difference between a person’s gender identity and their sex assigned at birth. As part of her gender transition, she began treatment for that condition, including hormone therapy. She also legally changed her name and corrected the sex designations on her Colorado driver’s license, U.S. passport, and Social Security Records.

On January 28, Ashlyn’s surgeon submitted a request for preauthorization for gender reassignment surgery on her behalf as part of Ashlyn’s prescribed treatment for gender dysphoria. One day later Aetna denied the request on the grounds that her policy excludes coverage for all transgender health care.

“Aetna’s categorical exclusion of treatment for gender dysphoria violates Colorado law, which mandates that insurance companies must cover medically necessary health care for transgender policyholders,” said TLDEF Staff Attorney Ethan Rice. “In March of 2013 the Colorado Division of Insurance issued clear guidance making it illegal for insurance companies to exclude the vital transition-related health care that Ashlyn is seeking.”

On July 20, TLDEF appealed Aetna’s coverage denial on Ashlyn’s behalf. Aetna has 30 days to respond. TLDEF also filed an official complaint with the Colorado Division of Insurance on July 23, 2015.

“Aetna denied my claims because I am transgender,” Ashlyn said. “This is the health care that I need. No one should be denied health care coverage just because of who they are.”

“Transgender women like Ashlyn need medical care, which often includes gender reassignment surgery,” added Rice. “Aetna’s discriminatory behavior highlights the significant challenges that transgender people face in getting the care that they need. Aetna must reverse this denial immediately so that Ashlyn can receive the medically necessary health care she needs. The company must also change its discriminatory policy to ensure that future claims for transgender policyholders in Colorado are handled appropriately.”

“I just want to be able to receive medical care without discrimination,” Ashlyn added. “Transgender people like me continue to struggle to get our health care needs met. My hope in speaking out about my experience is that it will shine a light on the discrimination that transgender people face and help bring it to an end.”

Health care related to gender transition is widely recognized as medically necessary by organizations such as the American Medical Association, the American Psychological Association and the World Professional Association for Transgender Health. 11 jurisdictions currently bar health insurance discrimination against transgender people including: California, Colorado, Connecticut, Illinois, Massachusetts, Nevada, New York, Oregon, Vermont, Washington, and Washington D.C.