health insurance options for transgender people in louisiana?
November 20, 2012 8:55 PM   Subscribe

A transgender friend of mine was denied health insurance in Louisiana because of the 'underwriting risk' of her condition: "gender identity disorder". What are her options here?

She is currently covered under her parents' insurance, but that ends when she turns 27 in January. She's trying to figure out options so that she can continue HRT and seeing her therapist after that happens. She applied for health insurance through Humana One, but was rejected (scan of rejection letter) Is there any point in trying to appeal this decision?

Would other health insurance carriers in Louisiana be likely to deny her coverage as well? Are there any carriers that would be more likely to approve her?

Are there any other options to continue health coverage?

Bonus questions:
Do any of the Obamacare (PPACA) provisions change any of this in the future? And, how viable of an option is PCIP? Would a denial be likely there?
posted by yeoz to Health & Fitness (17 answers total) 1 user marked this as a favorite
I can address only one part of this: Yes, the PPACA will absolutely address this. Namely, it will make it impossible for her to be rejected for coverage on account of that condition. Her coverage might be expensive but it cannot be outright denied.

Unfortunately, that doesn't kick in until 1 Jan 2014.
posted by Tomorrowful at 9:01 PM on November 20, 2012 [3 favorites]

Unfortunately, it doesn't look like an appeal for Humana One would be worthwhile. If nothing else works out, she could look into applying for PCIP, but it seems like you need to be without insurance for six months to qualify.
There's also Louisiana's high-risk pool or their HIPAA plan here, or at 1-800-736-0947. I don't know the specifics of whether she qualifies, of course, and can't guarantee anything, but it might be worthwhile to look into for 2013. The high risk application makes it seem like she might qualify. However, there's a six month waiting period. I would call them and ask both about the pre-existing plan and the (very similar, but with no waiting period) HIPAA plan, with the basis of her having health insurance coverage terminated for a reason other than non-payment. Again, I am definitely not an expert in Louisiana state-run insurance plans, but give them a call and see what they can do for you.
posted by mismatched at 9:31 PM on November 20, 2012

Can she purchase coverage through the company she's currently covered with? (Or was that Humana?) knowing her treatment history, they might be willing to write her a policy, but it will be pricey. Does she have any options through her job? Sometimes part time employees can buy the insurance offered through work but the company pays none of the premiums. Might be worth asking about.

Is she planning on reassignment surgery? That may be what's scaring off the insurance companies so she might ask if she qualifies for a policy the specifically denies coverage for the surgery. Be really careful on how that is worded though.
posted by MultiFaceted at 9:42 PM on November 20, 2012

Is she not eligible for COBRA coverage via her existing plan?
posted by pecanpies at 10:10 PM on November 20, 2012

I didn't consider COBRA because I didn't think it would apply given that it wasn't a loss-of-employment event, but, I guess a child ceasing to be dependant *is* (or can be?) a qualifiying event under COBRA. Thanks for the suggestion! We will look into that as well.
posted by yeoz at 10:25 PM on November 20, 2012

This is all evolving pretty fast, of course. It was only a few years ago that the AMA released a statement that it was unethical for insurers to discriminate against trans patients, and some insurers are still calling trans health care (not just surgeries, but anything gender-related) "cosmetic," "elective," etc.

If there's a break in her coverage: I know I've heard of organizations that help with HRT costs for uninsured patients, and the trick may be finding one that either serves LA or helps remotely. I'd suggest she ask for advice from one of the large organizations (googling for "trans health" turns up several) -- there's definitely help out there for her.
posted by kalapierson at 3:32 AM on November 21, 2012

Contact TLDEF. Also, appeal the decision. The scan of the letter says you can request reconsideration. Do it. Memail me if you want to discuss this route further.
posted by prefpara at 4:11 AM on November 21, 2012 [1 favorite]

Hell, post about it on Tumblr and in 72 hours the Humana One offices will be a trampled waste.
posted by Benjy at 5:07 AM on November 21, 2012 [2 favorites]

Yes, aging off an employer plan is a qualifying event.
posted by FergieBelle at 5:26 AM on November 21, 2012 [1 favorite]

Letter to National Center for Lesbian Rights about discrimination against trans* folks from HHS. I would contact NCLR. The Transgender Law Center would also be a good place to contact for recommendations.
posted by anya32 at 6:31 AM on November 21, 2012 [1 favorite]

"HIPAA gives individuals who are losing group health coverage and who have at least 18 months of creditable coverage without a break in coverage of 63 days or more the right to buy individual health insurance coverage that does not impose a preexisting condition exclusion period..."

Even assuming they're allowed to consider being trans a pre-existing condition, if she's been on her parents's plan for years, isn't HIPPA supposed to prevent this kind of thing from happening? She shouldn't need to wait for 2014 and the full sound and fury of the PPACA to kick in in this case, right?
posted by Corinth at 8:06 AM on November 21, 2012

Speaking from experience of several family members who have been denied for (stable, non-threatening) pre-existing conditions, HIPPA doesn't stop insurance from denying you for pre-existing conditions, unfortunately. I think it stops group plans from imposing a waiting period, but unfortunately individual health insurance is a pretty ruthless application process heavily weighted in favor of the insurance industry. It's horrific. It sucks. (At least until 2014.)

I'll second the recommendation to look into the High Risk pool of your state for insurance, most states offer this. Usually the requirement for qualifying is just being denied for regular insurance, so your friend would qualify pretty easily. It sometimes is only catastrophic coverage, but it's better than nothing.
posted by ninjakins at 8:35 AM on November 21, 2012

She needs to find a job that has group coverage that doesn't deny individuals.
posted by radioamy at 9:32 AM on November 21, 2012

Tomorrowful: "I can address only one part of this: Yes, the PPACA will absolutely address this. Namely, it will make it impossible for her to be rejected for coverage on account of that condition. Her coverage might be expensive but it cannot be outright denied."

I'd like to see a cite for this. I've been trying to get solid information on what's in the law since it passed and no one has been able to show me for sure one way or the other. (While I understand that the PPACA disallows discrimination on the basis of preexisting conditions, most insurance plans still have specific clauses disallowing treatment for gender identity disorder or related issues, and it's not at all clear that the PPACA will address that specific topic.)

It's little wonder that many trans people self-medicate; the system usually does its best to kick us out the door.
posted by jiawen at 3:53 PM on November 21, 2012

It seems like most trans people don't expect insurance to cover any trans-related care at this point (which is obviously sad in and of itself), and it's my understanding that the PPACA won't change that. But hopefully the pre-existing condition thing will at least allow trans people to get insurance that covers everything else, or at least that's what it sounds like Tomorrowful was saying.
posted by Corinth at 7:10 PM on November 21, 2012

There have been many examples of trans people being turned away entirely by doctors because the doctors can't figure out what 'conditions related to gender dysphoria' (or whatever) means. I certainly have my hopes that the PPACA will improve things, but in the history of trans rights, until things get explicitly spelled out in our favor, they usually get interpreted against us.
posted by jiawen at 7:59 PM on November 21, 2012

You might also try contacting the folks who run the Philly Trans Health Conference, they may have some good resources and leads on those who have been through this before.
posted by manicure12 at 2:07 AM on November 23, 2012

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