An unexpected gift to my professional and personal life this past year of 2014 has been the numerous transgender men, women and families I became acquainted with as a health insurance agent. Through numerous conversations and correspondence I realized we had more in common with the transgender community than I previously thought. In reality, most of us have life and career experiences that have small threads of resemblance to the challenges faced by the transgender community.
In the face of overwhelming societal skepticism and hostility toward the transgender human condition I was in awe at the level of professionalism, modesty and humility that so many of the trans men and women I spoke with exhibited. This was juxtaposed to interactions I had with fellow insurance agents who harbored irrational anger and hatred of the Affordable Care Act because it somehow threatened their revenue stream. My transgender clients actually gave me strength and inspired me to let go of the petty annoyances produced by inept bureaucracies and illogical human behavior and focus on clearing the brush from the chosen path of life.
It was only after I posted on my website the gender dysphoria sex reassignment medical policies of Anthem Blue Cross and Blue Shield that I started having conversations with transgender folks. The medical policies, which are internal guides on how the health plans authorize various sex reassignment surgeries, were developed to comply with California’s Insurance Gender Non-Discrimination Act. The IGNDA outlines that health plans can’t restrict health care coverage for sexual identity conditions among other LGBT concerns.
Health insurance medical policies
The medical term for individuals who identity as the sex opposite of which they born is called gender dysphoria or gender identity disorder. When gender dysphoria has been diagnosed and confirmed by different health care professionals the individual can then seek authorization for sex reassignment surgery from their health plan to transform their body into the gender they identify with. Of course, as the medical policies delineate, there are many letters of recommendations and other conditions that must be met before the health plan will cover the surgeries.
Does health insurance cover sex reassignment?
There is nothing simple or straight forward when it comes to health insurance covering the treatment of gender dysphoria. Shortly after I posted some of the transgender information I started receiving calls from transgender men and women with questions about the coverage.
- Which health plans offered sex reassignment surgery?
- Could they be denied for pre-existing conditions?
- Which doctors were covered?
- What documents needed to be produced for authorization?
- How do you start the authorization process?
- Are out of network surgeons covered?
- What about coverage for hormone replacement therapy, hair removal and voice training?
The transgender folks who contacted me were calm, cool and collected. They had been living in their identified gender for years. There was a notable lack of desperation for immediate treatment and more of a methodical approach to collecting as much information to make the best decision for treatment. As I had conversation after conversation with numerous transgender people I realized these folks had the same dream as me and so many other friends…just to be accepted for who we are.
Day to day life
The focal points of everyday life for trans men and women are no different than the rest of us. They focus on their friends and family, career, and trying to lead healthy and productive lives. Underneath, which is the case for most of us, are the issues of aligning their body with the sexual identity they are leading. While the stress of gender dysphoria is far higher than the anxiety for any number of social identities we all wish we could change, there is a common thread of discomfort we all feel.
A new hair cut, a new you
It was reading Rizi Timane’s book, An Unspoken Compromise, which showed me the emotional and psychological highs and lows that transgender people can have. Who hasn’t wanted to alter their appearance or just be a completely different person with a different identity? But whereas most of us can change our hair style, buy new clothes or get a different job and have a modicum amount of satisfaction that we are moving toward self-actualization those are only the first steps for a transgender individual. They are psychologically burden with having a body that doesn’t conform to their true identity.
Family support and acceptance
I’ve also been impressed, amazed and humbled by the support network for the transgender community. There was the father who contacted to me to arrange health insurance for his trans son who would be graduating college at the end of the year. The mother and father of this young man, born female, understood that for their son to succeed in life he had to fully transition to his true gender. The parental support for this young man was a mixture of love and practicality. I think it helped that these immigrant parents had first-hand knowledge about the importance of assimilating for there to be any hope of future success.
Mental health melt down
Of course, assimilation and conformity are both sought after and repelled by all of us. We want to be seen as part of the mainstream of society and yet we want to retain our individual identities. This can be a recipe for a mental health melt down. Depression is a true partner for men and women trying to come out and transition. Not all transgender people have had the good fortunate to navigate this psychological mine field successfully. Gender dysphoria has and can rip a person apart.
The transgender men, women, and families I’ve dealt with this past year have been successful in traversing their chosen path of life. Many have had sex reassignment surgery to complete their lives. They are healthy, happy and productive. They are patient, calm and intelligent. They have responded with correspondence of support and encouragement to my some of my other transgender clients facing tough situations. They have been my teacher, my guides and my inspiration. They have been a gift in 2014.
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