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California Transgender Health Insurance Survey

Kevin Knauss
California transgender health insurance survey.

California transgender health insurance survey.

With the passage of the Insurance Gender Nondiscrimination Act (IGNA), also known as AB 1586, all California health insurance plans must cover medically necessary transgender health care services. Unfortunately, many health plan customer service representatives and many health care providers are not aware of the law and have erroneously denied or delayed coverage and treatment for transgender health care services to address gender dysphoria conditions. The transgender health insurance survey seeks to gather information about health insurance plans and how they are administering the coverage of transgender health benefits.

Measuring access to transgender health benefits

The transgender health insurance survey is completely anonymous. It is not a scientific poll or survey but rather an attempt to provide additional information on the different health insurance carriers and how well they support the transgender communities’ to access necessary health care services. Information on how a health plan performs and supports their members is one of the most important resources a consumer can have when making an enrollment decision with a carrier. Honest information about health plan performance is also one of the scarcest resources for consumers.

Anonymous participation

Results of the health insurance survey will  be posted approximately every two weeks depending on the number of responses. Every attempt will be made to cull out fake responses. Comments by respondents to specific questions may be published if the comment adds pertinent information to the topic. The names of providers such as specific doctors, clinics or hospitals will not be included in any published comments. You can review the questions below before taking the survey.

California Transgender Health Insurance Survey

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Survey responses

As of April 19th, there were only 19 responses to the survey. Even though that is too small a sampling or population to draw any meaningful results, I present the overall responses and pertinent comments.

1. How did you enroll in your California health plan?

Of the survey respondents, 26% received their insurance through Covered California, 5% off the exchange, 32% from an employer plan, 26% were on Medi-Cal and 10% through Medicare.

2. Who is or was your health insurance carrier if you received transgender specific health care services?

The top five health insurance carriers represented were Anthem Blue Cross at 33%, Kaiser at 27%, Med-Cal at 20%, Blue Shield at 13% and Aetna at 7%.

3. Were you ever told by your health plan that transgender health care services were not covered?

35% of the survey respondents said they had been told that transgender health care services were not covered.

4. How easy or difficult was it to obtain prior authorization from your health plan for related transgender healthcare services?

38% of the respondents said it was very difficult to get prior authorization for related transgender health care services. Only 8% said it was easy to get the prior authorization. Comments included – “Initially turned down but Dr. intervened by phone and approval was granted” and “IEHP flat out said they did not cover grs, proving medical neccessity was impossible because they would not listen.”

5. How easy or difficult was it to find an In-Network doctor with the indicated health plan to help you with your transition health care services?

Most respondents, 46%, said it was very difficult to find an in-network provider to help with transition related care.

6. Do you feel your health plan treated you with respect and were willing to help you access the necessary transgender medical services?

A minority, 15%, said they didn’t feel their health plan treated them with respect while 38% felt they were respected and were offered help in accessing necessary transgender services. One respondent commented: “[W]as referred to an endocrinologist that would not see transgender patients (complaint filed, resolution unfound)”

7. Have you had any of the following prescriptions or procedures covered under the health plan you indicated at the beginning of the survey?

75% of the respondents listed Hormone Replacement Therapy as a transgender health care service they received through their insurance. Other services and procedures included counseling (16%), hysterectomy (8%), mastectomy (16%), orchiectomy (8%), and salpingo-oophrectomy (8%).

8. Were you denied any transgender health care services because they were deemed to be cosmetic or not medically necessary?

45% said they were denied transgender procedures because it was considered cosmetic.

9. Were prior authorized claims for any transgender health care surgeries paid promptly and without issues?

36% said their transgender health care surgery claims were paid promptly without issues while 27% indicated they had problems, and another 36% weren’t sure.

10. Overall, how would you rate your health insurance that has covered any transgender medical services indicated in this survey?

45% of the respondents felt like they had to fight to receive the transgender health care services that are included in their health plans. 27% felt the overall service from the health plan wasn’t too bad and 18% said everything went as planned.

Transgender health plan questions

Below are the questions included in the survey. The access and delivery of transgender health care services can be complicated and multi-faceted as there are a number of procedures and providers involved. The survey questions are focused on how easy or difficult the health plans make it for Below are the questions included in the survey. The access and delivery of transgender health care services can be complicated and multi-faceted as there are a number of procedures and providers involved. The survey questions are focused on how easy or difficult the health plans make it for transgender individuals to access and receive the medically necessary health care services they deserve. Each question in the survey has a place for comments for additional information.

1. How did you enroll in your health plan?

2. Who is your California health insurance carrier?

*If you are either Medi-Cal or Medicare, indicate which managed health care plan you are a member in the Other field. For individuals who don’t participate in a Medicare Advantage plan, put Original Medicare in the Other field.

3. Were you ever told by your health plan that transgender health care services were not covered?

4. How easy or difficult was it to obtain prior authorization from your health plan for related transgender health care services.

5. How easy or difficult has it been to find an in-network doctor with the indicated health insurance to help you with your transition to your identified gender?

6. Do you feel your health plan treated you with respect and were willing to help you access the necessary transgender medical services?

7. Have you had any of the following prescriptions or procedures performed that were also covered by the health plan you indicated at the beginning of the survey?

8. Were prior authorized claims for any transgender health care surgeries paid promptly and without issues?

9. Were you denied any transgender health care services because they were deemed to be cosmetic and not medically necessary?

10. Overall, how would you rate your health insurance plan that has covered any transgender medical services indicated in this survey?

Thank you for participating in the survey or adding your comments.

 

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