“Are you male or female?”
It’s a simple question, but it can be a matter of life or death.
In the transgender community, signing up for insurance means answering this question, and it’s not just a matter of respect. Choosing the wrong one could mean an insurance company will deny a procedure that could be lifesaving.
This week, the National Center for Transgender Equality released the 2015 U.S. Transgender Survey Report, an anonymous survey that attempts to capture the broadest-possible statistics of how transgender individuals survive in this country. With 27,715 respondents total, the report found among other things that “one in four (25%) of respondents experienced a problem in the last year with their insurance related to being transgender.” In many cases, the denied care was even considered routine and was unrelated to the health costs of transitioning.
Despite years of push from legal organizations such as the World Professional Association for Transgender Health (WPATH), these statistics have largely remained unchanged since the previous studies.
Atticus Ranck, the former Director of Transgender Services at SunServe, spoke to SFGN about the confusion for dealing with insurance to avoid denial of care, even as a trained consultant.
“When clients had questions about what insurance, I said it's like a Venn diagram. There's not one answer for the best insurance,” said Ranck. “It's between where you live, the surgeon you pick, what you can afford for the premium, and any other medical conditions, as well as what the insurance itself will cover for trans-related care. Good luck finding the insurance that meets all your criteria.”
As it shows in the case of Robert Eads, a 53-year-old transgender man who died back in 1999 after more than a dozen doctors denied him treatment for ovarian cancer, discrimination from doctors is also a serious problem in the health industry for anyone who is gender non-conforming.
According to the U.S. Transgender Survey Report, “one-third (33%) of those who saw a health care provider had at least one negative experience related to being transgender. Additionally, nearly one-quarter (23%) of respondents reported that they did not seek the health care they needed in the year prior to completing the survey due to fear of being mistreated.”
With both doctors and insurers pitted against them, transgender patients may put off a trip to the doctor for something as common as an infection or the flu in fear of poor treatment.
Lucas Hameister, a transgender male, said that during a trip to CareSpot for a sore throat, “I was in the room and the nurse was going through everything, but then she looks at my file, looks back at me… and asks, ‘why do you need testosterone?’” Eventually the nurse began to question him about lower surgery, at which point, Hameister intervened and said, “’I’m not gonna lie to you, I’m here because of my sore throat. I don’t want to discuss my genitalia.’”
The need to educate medical professionals prior to basic treatment is a common story, even when there isn’t red tape or outright discrimination involved.
Yet for a trans person who is in need of care for the body parts specific to their gender assignment at birth, the likelihood of finding a physician who is knowledgeable in the treatment of a prostate exam or PAP smear, for example, becomes even more difficult.
For one, the information out there that states which doctors are inclusive is incredibly limited. Joshua Brewer, a local trans man, stated that even a doctor listed on the transgender-friendly website LBTHealth.org denied him care when he reached out to them.
“The first gyno I called said that they ‘don’t do the trans,’” he said to SFGN, emphasizing the receptionist’s tone. “Even though they were on a website that was specifically geared towards trans.”
For a community that, according to the same survey, sees a rate of 40% attempting suicide, there is a frantic need for readily available healthcare providers that will be there for them in a time of crisis, both physically and mentally.
While it’s less likely that doctors haven’t heard about their transgender patients, the possibility that they’re educated enough to treat a transgender patient — whether or not the care is related to transition — is still far from guaranteed, even if the provider lists themselves as trans inclusive.
“No one vets these places,” said Ranck, speaking on physicians or websites endorsing doctors. “If you say you’re trans-competent, then ok, you must be. There’s no trans-competent certificate to show as proof.”
WPATH is a 501(c) non-profit that consists of over 600 physicians, psychologists, social scientists, and legal professional members, all of whom continue to push for a more widely-utilized standard of care for healthcare providers. They have developed the WPATH Standards of Care (SOC) for its endorsed practitioners to abide by. The WPATH SOC is a list of “internationally accepted guidelines that are designed to promote the health and welfare of persons with gender identity” that varies from what patients were assigned at birth. They state, “a physician, exercising prudent clinical judgment, would provide to a patient for the purpose of preventing, evaluating, diagnosing or treating an illness, injury, disease, or its symptoms”.
Yet as far as the organization’s power over insurers and individual practitioners who believe they have no need in educating themselves toward the needs of gender variance, there are obvious limitations.
Ultimately, there needs to be an increase of lawmakers and politicians who believe that trans-related care is an issue worth standing up for. With laws such as HB 2 in North Carolina — a law that at least has hope of being rescinded now that newly-elected Gov. Roy Cooper (D-NC) has announced his plans to repeal it — there is evidence of how even an unconstitutional breach of basic rights can be pushed into law with enough public dissent. States with politicians that are unsupportive of LGBT rights are far more likely to push trans-related healthcare needs from their priority list, if not fight against them entirely.
And the less politicians or insurers acknowledge the need for respect toward transgender patients, the less there will be competent practitioners who push to educate themselves.
On Dec. 7, the state of New York expanded its Medicaid services to include transition-related care for trans youth. This move is just one of many signs of hope in the last year for trans people seeking unbiased healthcare.
Nonetheless, after the recent election, which saw a large flux of conservatives elected, there is more need than ever to pressure lawmakers into believing that transgender healthcare is a necessity. Until then, the U.S. is bound to see discrimination against transgender patients continue — whether it’s for hormones, surgery, psychological care or a sore throat.
If you or someone you know feels that you’ve been a target of discrimination regarding insurance or healthcare, or if you wish to learn more as a practitioner, there are resources out there.
Visit WPATH.org for more information on the proper treatment of transgender patients and resources for finding available care.
If you believe you have faced discrimination or violence, visit TransgenderLegal.org to be connected with a legal representative.