Out of Reach: Sex Reassignment Surgery Not ‘Medically Necessary’?

Pamela Merritt

Sex reassignment surgery and other related medical interventions cost thousands of dollars and are not optional for many transgender people. But many insurance companies don't consider these procedures medically necessary.

Cuba has approved
free sex change operations for transgender citizens
. What a stark contrast to the reality here in the United States.

June is LGBT Pride Month and,
along with the festivals and parades, we have an opportunity to
learn about the diversity within our community and the issues that
impact the lives of LGBT people. For many transgender people, the process
of transitioning is a long and expensive journey delayed due to the lack
of health insurance coverage for medically necessary procedures.

First, a quick primer. "Transgender" describes the state
of a person’s gender identity, which may match their
assigned at birth. Other words transgender people may use are female
to male (FTM), male to female (MTF), and genderqueer. After coming out, transgender
people may undergo psychological counseling for diagnosis, hormone
replacement therapy (HRT) to adjust their body to their new gender, medical visits to support that therapy, and sex reassignment
surgery (SRS) to change their genitals to match their new gender role.
Through sex reassignment surgery, transgender women may undergo a penectomy
and vaginaplasty. Transgender men may undergo bilateral mastectomy
and hysterectomy and, in some cases, they may also elect phalloplasty
(construction of a penis).

These procedures cost thousands
of dollars and they are not optional for many transgender people.
Most states require medical procedures before personal documentation,
like drivers licenses and birth certificates, can be updated to reflect
a person’s new gender. But, despite those requirements, many
insurance policies do not cover sex reassignment surgery, which is often considered cosmetic or not medically necessary.
Thus transgender people must pay thousands of dollars out of pocket
even if they have health insurance coverage that would cover the surgical
procedure for a medically recognized condition.

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Transgender people may also
consider cosmetic surgery in order to adjust their appearance to their
new sex role. Cosmetic surgery procedures may include breast augmentation or
facial or torso surgery, and transgender women may require electrolysis
to remove hair. Many insurance companies do not cover these procedures
for any participant in their plan because they are considered elective
or not medically required.

Why would a health insurance
plan not cover a surgical procedure for a transgender person?
The American Psychological Association’s current classification of
gender identity disorder (the diagnosis given some transgender people
that may allow them to qualify for sex reassignment surgery) as a psychological
disorder does not clearly support medical treatment through sex reassignment
surgery. As a result of the
current lack of clarity, many insurance companies discriminate against
transgender people seeking coverage for the cost of surgery even if
the company through which they are insured approves coverage.

Transgender activists have been working to get an official
diagnosis and classification for Gender Identity Disorder from the American
Psychological Association to address the need for medical care and appropriate
mental health care for transgender people. In 2005, the American Psychological Association formed a task force
to study gender identity and they have been reviewing the scientific
research and American Psychological Association’s policies with the
goal of developing recommendations for education, training, practice
and additional research. The completed report is scheduled for
presentation to the American Psychological Association’s governing
Council of Representatives in August 2008.

Transgender activists
are divided
whether the classification of gender identity disorder from the American
Psychological Association as a mental disorder is positive or negative,
with some feeling that the classification stigmatizes transgender people
and others arguing that the classification is necessary to secure appropriate
health care and treatment. What is not in dispute is the need
to address lack of access to treatment options and the discrimination
many transgender people face within society and the medical community.

In 2007, the American Medical
Association amended their nondiscrimination policies to include transgender
. As
reported by the Windy City Times, the policy change "affects all aspects
of the functioning of the AMA, including relations with patients, employment
issues and insurance coverage." The report also noted that transgender
people face discrimination within the health care system and barriers
that prevent access to health care. In one section of the new policy
the American Medical Association clearly states its opposition to "the
denial of health insurance on the basis of sexual orientation or gender

As companies, health care insurers
and municipalities examine and revise their policies to ensure that
transgender people are not discriminated against or denied access to
medically necessary treatment, the cost of sex reassignment surgery
remains an obstacle for many transgender people seeking transition into
the sex role that better reflects their identity. As our community celebrates LGBT Pride Month
this June, we can celebrate the progress made within the medical and
psychological communities. But we must also note the progress
yet to be made and the impact of that lack of progress on the lives
of transgender people.

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