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Insurance giant expands coverage in a win for transgender population

Photo by SaytaPrem of Pixabay

In a win for LGBTQ healthcare rights, insurance giant Aetna is expanding gender-affirming surgery coverage for transgender women. Aetna, which is owned by CVS Health, will now include breast augmentation for transwomen in most of its commercial plans, following appeals from members of their transgender customers and civil rights organizations.

“Our decision to update our clinical policy bulletin is consistent with many changes we have made over the years to better serve the needs of the LGBTQ community,” Jordan Pritzker, MD, senior director of clinical solutions for Aetna, said in a statement.

Just days before the change to Aetna’s policy, President Biden signed an executive order mandating all persons, irrespective of their gender identity, should receive equal treatment under the law. These protections extend to healthcare access.

The change to Aetna’s policy comes after several transgender women customers were denied coverage for their breast augmentation surgery as part of their gender affirming treatment. Aetna’s clinical policy assigned breast augmentation for transgender women as a cosmetic procedure rather than a medical necessity, prior to the coverage expansion.

After partnering with Transgender Legal Defense & Education Fund, a civil rights organization for the transgender population, and law firm Cohen Milstein Sellers & Toll, the transwomen worked with Aetna to update the insurance company’s policy to cover breast augmentation for transgender women as a medical necessity.

“We appreciate the collaborative nature of this process, which allowed us to make an evidence-based change to our coverage policies regarding important care for members of the LGBTQ community,” Pritzker said in the same statement.

A referral from a mental health professional and a year of feminizing hormone therapy treatment, among other clinical requirements, must be met to be eligible for coverage.

Aetna’s policy expansion is undoubtedly progress for the LGBTQ community, though transgender individuals are still facing discrimination at alarming rates.

A survey published by the Center for American Progress and NORC at the University of Chicago found that 43% of transgendered people said their health insurance company denied them surgery for their transition and 38% said their insurance company denied them hormone therapy for their transition. Another 34% said their insurance company would not change their records reflecting their changed name or gender.

“My hope is that being part of this groundbreaking collaboration helps other transgender and non-binary people have access to the health care we deserve,” said Nancy Menusan, an Aetna-insured patient who appealed for expanded coverage. “By dropping exclusions for medically-necessary care like top surgery, Aetna is paving the way and setting an example for other health insurance providers, and I hope others will take note.”

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