How important is gender when signing up for healthcare?
December 6, 2017 12:16 PM   Subscribe

My transgender daughter, who is aging off of our family medical plan when she turns twenty-six in a few months, has just signed up for the medical benefits provided through her workplace. There was no way to change her gender from "female" to "male" on the form; it was automatically filled in based on her gender presentation at work. The trouble is, legally she is still male. Will this cause problems?

She works as a cashier in a large grocery store. The medical benefits are provided through her union, the UFCW (South Central UFCW Unions and Employers Health & Welfare Trust). Her employers do know that she is transgender, from the time she got the job, almost two years ago. We live in Texas, whose government is far more anti-trans than its people are.

My only worry is that she had no option to specify her gender. It was automatically entered as "female", since that is her presentation and how she is known at work. But she is legally male, according to her driver's license and the social security administration. Will the insurance company use this as an excuse not to pay? What should we do?

She has a few months' overlap. She can make changes only by redoing the whole thing, which can be done only during open enrollment or when there is a special enrollment event. She will have a special enrollment event when she turns twenty-six and loses our family coverage, though, I think. Open enrollment ends December 15.

Throwaway email:
posted by anonymous to Health & Fitness (12 answers total) 1 user marked this as a favorite
The Transgender Education Network of Texas might be able to help.
posted by Mr.Know-it-some at 12:27 PM on December 6, 2017 [1 favorite]

I would recommend that she contact the insurance company and/or the union and see what they say. I know insurance companies have a reputation for being evil but not all of them are actively trying to screw people over, especially customers who are members of big valuable group plans. Still best to clear as much up as possible as early as possible, because even if the insurance company isn't being deliberately shitty, if they're a large organization that automates stuff your daughter could end up in a situation where if she is marked as "female" on her health insurance documentation, she might have trouble getting them to pay for, say, testicular cancer screening or something.

The benefits coordinator at her workplace can probably change the checkbox to "male" for insurance purposes but that wouldn't necessarily be correct for the insurance company either, so best to ask them directly.
posted by mskyle at 12:36 PM on December 6, 2017 [3 favorites]

It's BS that she can only do this during open enrollment. I changed my legal gender after open enrollment and just gave my HR department a heads up. (No one cares about SS by the way.) HR will probably ask for a copy of her drivers license or other govt ID showing correct gender. I don't remember if they asked for a doctor's letter. I don't think so. It took a few weeks to percolate through the system but I had no problems with insurance. Make sure she tells all her doctors offices though because the problem starts when there's a mismatch between what the doctor submits and what the insurance company has on file. (They will just reject the claim and your doctor will have to re-file, it's no big deal, just a hassle to figure out.)
posted by AFABulous at 1:12 PM on December 6, 2017 [5 favorites]

Still best to clear as much up as possible as early as possible, because even if the insurance company isn't being deliberately shitty, if they're a large organization that automates stuff your daughter could end up in a situation where if she is marked as "female" on her health insurance documentation, she might have trouble getting them to pay for, say, testicular cancer screening or something.

This specifically violates ACA rules, but HHS may or may not enforce it under the current administration. If they offer a service to one gender they have to offer it to the other. That's how I got my "bilateral mastectomy" (commonly called "top surgery" among trans men). Cis women get mastectomies for various reasons; as long as its determined to be medically necessary, so can I. Testicular exams are obviously medically necessary. They may reflexively reject it depending on what's in the database but that's when you call and invoke HHS rule 1557 and imply you have a lawyer on standby. They will fold really quickly.
posted by AFABulous at 1:16 PM on December 6, 2017 [2 favorites]

Yeah, I was thinking more in the "they might reflexively reject this" way than the "they will have a legal basis for denying you coverage" way.
posted by mskyle at 1:22 PM on December 6, 2017

I would urge your daughter to solve this in a different way, which is for her to get her legal gender changed to match her presentation and identity. It is currently fairly straightforward for transfolx to get passports that affirm their gender identity, but with this administration that may change rapidly. Rather than making her insurance match her legal documents, why not make her legal documents match her insurance?
posted by amelioration at 1:49 PM on December 6, 2017 [5 favorites]

Yes, it will be a problem, but not that big of a problem, potentially. If you are legally one gender on your insurance, they will fight you if you get treatments that the insurance thinks is only for the other gender. For example, I have to get a pap test once in a while. I am legally male, so my insurance denies the claim and bills me a crazy amount. I have to get my doctor to send a letter explaining the situation and using the magic words "medically necessary." Sometimes they have to go a few rounds. It's best to find a doctor that has done this before.

It is also likely that insurance will send bills, statements, and so forth to Mr. Legal Name, and that she will have to fill out forms as Mr. Legal Name (if you appear as the wrong name on a form, insurance will deny the claim as "for someone else." This takes multiple phone calls and a doctor's note to fix, usually.) This is tedious and unpleasant, to say the least, and can be a safety issue if your neighbor sees your mail, for example.

If she legally changes her name or gender, she can make them change it at any time. It's not any different from a name change due to getting married. My understanding is that because health care is tied to taxes/Social Security, it has to be under the legal identity (name and gender) at all times, but I could be wrong.

Amelioration, getting a legal gender change is an expensive hassle. In Texas you have to get a court order after surgery, and even then, some judges won't do it. There are good reasons why she may not want to change her gender yet or ever.
posted by blnkfrnk at 1:53 PM on December 6, 2017 [3 favorites]

I misread the post and thought she'd changed her legal gender already. You can get info about the name/gender process here and financial help here.

I defer to blnkfrnk's answer.

I would have her talk to her HR department and the insurance company and ask what they need. It could really be as simple as needing a doctor's note to affirm that she is female. Companies will vary on how much they hassle you. In my case the squeaky wheel got the grease - I talked to about 5 people before they agreed to cover my surgery.
posted by AFABulous at 2:04 PM on December 6, 2017 [1 favorite]

Okay, so there's two situations here:

1) Person needs care that is considered stereotypically "male," person has an F on their insurance policy
2) Person has an M on their driver's license and an F on their insurance policy

I've been in situation #2 for a few years now — M on my passport and driver's license, F on my insurance — and it's been fine. Like, not even an issue, never came up, definitely has never been used to deny me care. I wouldn't necessarily recommend doing it on purpose, because there's probably some risk associated with it. So don't take this as an endorsement or anything. But... yeah, my experience has been that it's fine.

Situation #1 is messier according to everyone I know who's dealt with it, but I can't speak to it from personal experience.

(FWIW, if she does want to "fix" situation #2, the best approach might be for her to approach the insurance company and say "Look, I know it's not open enrollment, but there was an outright error on the paperwork my employer sent you. Can we get this fixed?" The analogy would be a situation where someone in some office typed her name wrong and now her insurance card says Anne Ominous instead of Anne Onymous. Like, surely they have some process for fixing that if it happens, and I'm willing to bet if she gets the right person on the phone they can take care of it right quick. Frankly I've viewed situation #2 as a feature rather than a bug, since it reduces the number of times I need to read mail addressing me as Mr. Windphone, but if it does turn out to be a bug in your daughter's case this is what I'd do.)
posted by nebulawindphone at 2:46 PM on December 6, 2017

I live in Texas in Austin. I had M legally and F on insurance for a couple of years and it wasn’t an issue unless the billing doctor or pharmacy used “M” as the designator. I would have them re-run it as “F” and then it would go through.

As far as changing gender in Texas you don’t have to have surgery. I had my gender marker changed 1.5 years before I had GRS.

Dallas, Houston and Austin are pretty cool about changing gender markers. I believe San Antonio and El Paso are okay as well.

Look up the name Claire Bow and the UT pro bono name and gender marker change program.
posted by Annika Cicada at 2:57 PM on December 6, 2017 [5 favorites]

Good to know about Texas. I was looking at the birth certificate form, which may not have been updated to reflect that (California’s still says “surgery” too, even though that is definitely not required.)

It sounds like she could just let it ride and go “whoops my bad here’s my ID” if there is an issue. I would urge you to have a consistent gender marker across all your documents if you can— I have had major issues getting agencies to recognize my gender as male if they see even one piece of paper with an F on it, but it’s possible I’m just unlucky.
posted by blnkfrnk at 4:51 PM on December 6, 2017 [1 favorite]

In my experience, the gender marker on your insurance is less important than / can be overcome by a doctor's office who knows how to code things so that your insurance company will pay the claims. I am trans and have had very good luck with my local Planned Parenthood affiliate, recently featured in an NPR story about transgender health care. Maybe check to see if your local Planned Parenthood affiliate is providing services (not even necessarily hormones, but just primary care) for trans people? You can just call 'em up and they should be able to tell you.
posted by zebra at 7:42 PM on December 6, 2017 [2 favorites]

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