Blue Cross NC extends coverage to transgender people


The state’s largest private insurer will now cover gender-affirming facial surgery and other services, after advocates challenged its denial of coverage for two transgender women.

Blue Cross and Blue Shield of North Carolina updated their gender-affirming surgery and hormone therapy policy on July 1 to state that facial surgeries for feminization or masculation, singing lessons and others services are medically necessary. The change now covers these procedures and services if they are permitted under the patient’s health insurance plan.

“Healthcare for transgender people is medical healthcare,” said Kathryn Vandegrift, a 28-year-old Blue Cross client who was initially denied coverage for facial surgery. “And health care is a human right, no one should be denied. “

Vandergrift, who lives in western North Carolina, another woman and two North Carolina nonprofits, Equality North Carolina and the LGBTQ Center of Durham, have called for the change to Blue Cross, which serves near of 4 million customers.

The procedures outlined in Blue Cross policy help treat gender dysphoria, which the American Psychiatric Association defines as psychological distress resulting from “an incongruity between sex at birth and gender identity.”

Gender-affirming surgery, which involves multiple medical, psychiatric and surgical procedures and services, is a treatment for gender dysphoria, the policy says.

Blue Cross has long recognized gender dysphoria as a medical condition and has covered related treatments, the insurance company said in a statement.

The July 1 update “expanded coverage of medically necessary treatments as part of the comprehensive gender dysphoria treatment plan,” according to the statements.

The change follows an ongoing process of review of the policy by practicing physicians, the statement said.

“While the Transgender Legal Defense & Education Fund (TLDEF) has drawn our attention to this issue, the review was conducted independently of these discussions,” the statement said.

One in four transgender people had experienced a health insurance problem in the past year, including being denied coverage for transition procedures and routine care, according to the 2015 US Transgender Survey, l one of the largest surveys of transgender people in the United States.

More than half had been denied coverage for transition-related surgery.

“A security problem”

Noah Lewis, director of the Trans Health project for TLDEF, said gender-affirming health care is essential for the health and safety of transgender people.

Like most major medical procedures, facial surgery is expensive. A small percentage of people may be able to pay out of pocket, but others may incur large debt or cash in on retirement.

Without facial surgery or singing lessons, some people live in limbo, are often misgendered, and live in fear of being recognized as transgender, Lewis said.

“It poses a safety concern to be visually transgender, especially in the South,” he said.

“They are afraid to leave their homes. They’re scared of going to the gym, of applying for jobs, of going to school, ”Lewis said. “They are just being held back in all areas of their lives because they are not able to get this form of basic medical treatment, and the only reason this is ruled out is because it has to do with be transgender. “

Blue Cross is the latest in a series of health insurance companies updating their policies, Lewis said.

Aetna and Antham have also extended their coverage.

In May, the Biden administration rolled back a Trump-era policy that excluded transgender people from protection against gender discrimination in health care.

“It’s important for people to know that these types of denials and exclusions are illegal and that there are legal remedies,” Lewis said.

In general, transgender people face multiple healthcare challenges, including costs and providers who lack knowledge, reported The Charlotte Observer.

The TLDEF is also part of an ongoing 2019 lawsuit filed by state officials who are transgender or have transgender children who claim the state’s health plan discriminates against them, The News & Observer reported. .

The health plan, which insures more than 700,000 state employees, does not cover costs related to gender dysphoria.

“A devastating experience”

Vandegrift said she accepted her need for a gender transition in 2018 and started working on a plan.

Over a year ago, she started reviewing her insurance plan, which she had with a private employer. She realized that there was a categorical exclusion for facial surgeries.

Vandegrift reached out to TLDEF, which helped her navigate the process of finding complaints, filing appeals when they were denied, and other actions.

The process has been devastating, she said.

“It’s just the repeated bureaucratic denial in this harsh language to assert that who I am and what I need is not medically necessary,” she said.

Not receiving gender-affirming treatment makes life in her body and the lives of others difficult, she said. It also makes the world uncomfortable and often dangerous, she said, as she doesn’t know how people will react if they realize she is a transgender woman.

After the policy change, Vandegrift was due to have facial surgery this week.

She is excited about the change and is moving forward.

“Maybe I could get past that and live fully as myself,” she said.

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