“Transition-related care” can be divided into two parts, Keisling said: the costs directly related to gender reassignment surgery, and the other treatments and services that are related, things like checking hormone levels, lab tests, and mental health services associated with the transition process.In a car crash and break your leg? That's not covered, as the bones could be weakened from HRT therapy. Or if you don't take hormones, they could be weakened because you don't. In either case, "transition-related" according to some Insurance company's rules. And of course, since the evidence is it's congenital, it's a "pre-existing condition".
“Even someone who has fully transitioned probably still needs to get her hormone levels checked on a regular basis. And insurance companies will deny those claims by saying they are ‘transition-related,’” Keisling said.
This is also the issue of sex-specific care, she continued. After transitioning, a trans woman will qualify for regular mammograms, but not for regular prostate exams — which she still needs, too.
And a lot of trans men face similar difficulties, Keisling said. “A trans man might need a pap smear or some other kind of gynecological care, and they are often told no, insurance won’t cover that,” she said.
She described another case in which a trans man was told by his doctors that he was facing serious gynecological problems and needed to have a hysterectomy. Because he was trans, however, insurance wouldn’t pay.
“Insurance said, ‘No. We don’t pay for sex-change operations. The doctors said this is transition surgery. This is a medically-necessary procedure.’ But they wouldn’t pay,” she said.
But in some cases, the discrimination is even more blatant.
“The insurance for federal government employees specifically excludes coverage for the costs of [gender reassignment surgery], but there have been a number of cases where that was used to exclude coverage of any type for transgenders,” Keisling said.
“I know of a federal employee who was told insurance wouldn’t pay for care for her son’s broken arm because she was transgender. Another trans woman who was anemic and needed transfusions was told insurance wouldn’t cover the treatments because she had ‘transsexual blood,’” she said.
“The list goes on and on. I know another trans woman who was playing for a woman’s softball team and broke her arm during a game,” Keisling continued. “She went to the hospital, had the X-rays and got her arm set. Then the insurance company turned around and denied the claim. They said if she weren’t transsexual, she wouldn’t have been out there playing for a women’s team and she wouldn’t have broken her arm.”
When it comes to these “really egregious stories” that are “so clearly wrong,” Keisling said, the victims can hire lawyers and get remedies through the courts. Still, she said, “You have to know what to do, how to get things fixed.” And court cases aren’t cheap, either.
That's in the USA. Here in Australia, Medicare just changes the patient's records from M to F and back again as necessary when it comes to Intersexed and Trans people. Yes, it's silly, makes a mockery of the whole system - but a humane work-around to prevent inhuman treatment.