TLDEF Applauds Guidance Requiring Insurers to Provide Transgender People with Access to Sex-Specific Care Under Affordable Care Act

DOHHS Logo May 12, 2015 - TLDEF commends the U.S. Departments of Labor, Treasury, and Health and Human Services for issuing guidance yesterday stating that health insurance companies must cover sex-specific preventive care, including mammograms and pap smears, for transgender people. That care must be provided without regard to sex assigned at birth, gender identity, or recorded sex. Transgender people are routinely denied coverage when insurance companies arbitrarily determine that their care does not align with the sex listed in the insurer’s records. The guidance states that insurance companies must cover the medically necessary care transgender people need:

Where an attending provider determines that a recommended preventive service is medically appropriate for the individual – such as, for example, providing a mammogram or pap smear for a transgender man who has residual breast tissue or an intact cervix –... the plan or issuer must provide coverage for the recommended preventive service... regardless of sex assigned at birth, gender identity, or gender of the individual otherwise recorded by the plan or issuer.

Statement from TLDEF Executive Director Michael Silverman

“Transgender people face tremendous challenges in getting the sex-specific health care they need. Insurance companies regularly deny claims from transgender people, stating that the care they have received does not match the sex listed in the insurance company’s records.

“We commend the federal government for stating that transgender people are entitled to the same sex-specific care as everyone else, without discrimination. For transgender men, routine care often includes preventive gynecological care. Many already forego care because of concerns about discrimination related to revealing that they are transgender. That fear should not be compounded by insurance companies’ baseless claim denials.

“No one should be denied health care coverage just because of who they are. This guidance is an important warning to all insurance providers that they are prohibited from discriminating against transgender people. It is also a reminder to transgender people who may experience discriminatory coverage denials that those denials are illegal and may be challenged.”