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New York Says Health Insurers Must Cover Transgender Individuals

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Health insurers in New York may not discriminate or deny coverage for transgender and gender-nonconforming individuals, the Cuomo administration reminded insurers yesterday.

According to a letter sent to health insurers Wednesday from the state’s Department of Financial Services, it had “come to the attention” of Superintendent Maria Vullo that some health insurers may be denying claims of transgender individuals “because the gender with which the individual identifies does not match the gender of someone to whom those services are typically provided.”

(Related: Transgender Clients and Disability Insurance)

For example, the letter written to insurers by Lisette Johnson—the health bureau chief at the DFS—said a female who identifies as male may be denied coverage for gynecological services because the insured is anatomically male. “Similarly, a male who identifies as a female may be denied a claim for prostate cancer screening because the issuer’s information indicates that the insured is anatomically a female,” Johnson wrote.

The letter reminded insurers that although a health insurer may request additional information regarding a medical service, the insurer may not deny a claim because it does not have sufficient information to pay the claim.

“An issuer should not deny a claim for a health service provided to an individual because the individual is seemingly not of the gender to whom the service is typically or exclusively provided without seeking additional information to determine whether the service was appropriately provided to the individual,” the letter said.

In a statement, Vullo said, “Transgender persons should not be discriminated against and denied health insurance coverage because of their transgender status nor denied treatment simply due to insurance coding issues.”

The New York Health Plan Association, a trade group that represents 29 managed care health plans across the state, said it was not aware of any issues with transgender people being denied care or discriminated against.

(Related: ‘Disability Insurance Is Too Expensive… and I’m Invincible’)

“The examples given—a female who identifies as a man seeking gynecological services or a male who identifies as a female requesting prostate cancer screening—do, however, present challenges to claims systems. This is true for the Medicaid program, where plans rely on rosters from the state of enrollees [members] with gender identification, and the state employees’ health insurance plan as well. It is our belief that the number of cases where any problems might be identified is small and are quickly corrected through plans’ normal appeals processes,” the Health Plan Association said in an email.

A spokesman for the regulatory agency said the DFS had received a “handful of complaints” and met with consumer groups who raised claims that transgender individuals were being denied coverage. The spokesman declined to say who the complaints were filed against.

The trade group, which represents health plans that provide coverage to more than 7 million people, raised a concern that the action by the Cuomo administration may lead to “some sort of labeling that would not be welcome to transgender people.”

A request for comment from the Lesbian, Gay, Bisexual & Transgender Community Center of New York received no response Thursday.

— Read How Supreme Court’s Same-Sex Marriage Ruling Changed These 6 Areas on ThinkAdvisor.


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