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to Section One | to Arts & Entertainment
posted Friday, June 27 2014 - Volume 42 Issue 26
Don't discriminate against Trans patients, Insurance Commissioner tells industry
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Don't discriminate against Trans patients, Insurance Commissioner tells industry

by Mike Andrew - SGN Staff Writer

In a June 25 letter, Washington Insurance Commissioner Mike Kreidler warned insurance companies that exclusions and denial of coverage based on gender identity is a violation of state and federal law.

'Transgender people are entitled to the same access to health care as everyone else,' Kreidler said in a statement. 'Whether specific services are considered medically necessary should be up to the provider to decide on behalf of their patient.'

Currently, some insurers have exclusions for all Transgender services. Today's announcement makes it clear that disparate access to these and other medical services is not allowed.

Kreidler's office is currently reviewing all 2015 individual and small employer health plans to determine if they contain any discriminatory exclusions, and to make sure they cover medically necessary services equally for cisgender and Transgender enrollees.

'Health insurance policies that discriminate against any group of people cause significant harm by preventing people from receiving basic health care,' Kreidler said. 'I expect the health insurers doing business in our state to meet a high standard of equity and fairness. All policyholders deserve to get the medical services they need and have paid a premium for.'

According to Kreidler, Washington's Law Against Discrimination (RCW 49.60) and the federal Affordable Care Act (Section 1557) both prohibit discrimination against Transgender individuals who seek insurance coverage.

'Reading the provisions of state law in conjunction with the definitions contained in Washington state's Law Against Discrimination, and the requirements of the federal Affordable Care Act, it is clear that exclusions, prohibitions, and other forms of discrimination by issuers against policy holders who identify as transgender is prohibited,' Kreidler concludes in his letter to insurance companies.

Consequently, Kreidler says, 'Health insurers are required to cover procedures that are part of a gender transition process if they're covered for other policyholders for different reasons. Examples of such services include: hormone therapy, counseling services, gender transition process, mastectomy, breast augmentation and reconstruction.'

In other words, Kreidler told insurance companies, if you pay for a procedure for one reason for a cisgender patient, you must pay for it for a Transgender patient seeking to change his or her gender.

The only catch is sex reassignment surgery. Because such surgery is essentially a Trans-only procedure - it is not prescribed for cisgender patients for some reason other than gender transition - it is not covered by these rules.

Kreidler says that even though insurance companies cannot be forced to cover surgery, they are not prohibited from paying for it either.

'While Washington state insurance law doesn't require insurance companies to cover sexual reassignment surgery, it also doesn't prevent insurers from adding this coverage if they chose to do so,' his office said in a statement.

Many large employers in Washington state, including Boeing, Amazon, Microsoft, Nordstrom, and the city of Seattle have already taken action to prevent discrimination against Transgender employees in their health coverage.

Medicare recently lifted the ban on coverage for sex reassignment surgery and Washington's Health Care Authority is looking into what steps it can take to ensure coverage for medically necessary services.

Insurance Commission spokesperson Kara Klotz told SGN that enforcement of Kreidler's instruction could take several tracks.

'The first thing is to look at the plans, to see if anyone is out of compliance,' she said. 'We have relationships with the insurers and we have established processes for appeals.'

If Kreidler's office finds any holdouts, 'we may go to rule-making, or the legislature may decide to do something,' Klotz explained.

She urged anyone who feels they have been targets of discrimination to file a complaint with the Commissioner's office or call the insurance consumer hotline at 1-800-562-6900.

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