U.S. Government says health plans must not deny preventive services based on gender

Health Care

Very good news for trans folks – the U.S. government says that under the Affordable Care Act, health insurance plans cannot code procedures by gender and then deny paying for preventive procedures if the persons seeking care doesn’t “match” the gender coding for that procedure. This has long been an issue for trans men and women who need reproductive health care. Trans men have been denied cervical cancer screenings and trans women denied mammograms, for example.

via National Center for Transgender Equality – US Gov: Health plans may not restrict preventive services for transgender people:

Positive guidance issued yesterday by the US Department of Health and Human Services (HHS) told insurers that health insurance plans must cover preventive services for all consumers without co-pays or other out-of-pocket costs—regardless of gender. This means that preventive care can no longer be denied because someone is not the “right” gender for a service such as screening for breast or cervical cancer or sexually transmitted infections or contraception. This guidance will help many transgender consumers who have faced arbitrary barriers to needed preventive care—however, it does not address the larger, urgent problem of blanket transgender exclusions for transition-related surgeries in health plans.

Insurance companies have traditionally coded certain tests and procedures as being for either men or women, based on assumptions about body parts and gender. Insurance claims for services not deemed to “match” a person’s recorded gender are automatically denied, on the assumption that they represent an erroneous or fraudulent claim. While some plans have systems for health care providers to override these automatic rules, many patients have had to fight through the appeals process to get basic preventive care covered.

Yesterday’s guidance, in the form of Frequently Asked Questions, made clear that this is not allowed under the Affordable Care Act.

Read more about the clarification on the National Center for Transgender Equality site.

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