DOI issues new rule banning discrimination

Leo Kattari has to go to the doctor every three months for blood tests, and he takes biweekly testosterone shots. Although he has health insurance through his job, the policy covered none of the checkups, lab tests or medicines.

“I spend about $200, $300 every time I go to the doctor,” he said. “My doctor deemed these tests and shots as medically necessary, but the insurance company wouldn’t pay them.”

Kattari spent the past year transitioning from a woman to a man — and until this week, insurance companies were allowed to deny coverage for medical care related to his transgender status.

Believe it or not, he’s one of the lucky ones. His insurance company did pay for illnesses or medical care not associated with his gender identity.

“I think the most egregious case we heard was when someone was denied care for a broken arm because they are a transgender individual,” said DeDe de Percin, executive director of the Colorado Consumer Health Initiative. “That’s how broad these exclusionary policies are — not only could they deny care or coverage for issues related to sexual orientation or gender identity, they could deny coverage for anything, at any time.”

De Percin said there was a “double whammy” of discrimination — transgender people were often denied care as well as coverage.

“Even if they paid premiums, had coverage through their employer, insurance companies would deny care for nearly anything,” she said. “Care other people could get, transgender people couldn’t. For instance, if I needed hormone replacement therapy, my doctor would prescribe it and insurance would cover it. If I were transgender, not so much.”

That’s not the case any longer.

New regulation

Kattari’s insurance company — and every insurance company in the state — must now cover all medical issues, thanks to a regulation announced last week by the Division of Insurance. Essentially, the new rule mandates that transgender people be allowed the same care and treatment as anyone else. Colorado joins California, Oregon and Washington, D.C., in banning discrimination.

The regulation basically said Colorado law prohibits the “denial, cancellation, limitation or refusal to issue or renew health coverage because of a person’s sexual orientation. A carrier may not impose any differential in premium rates or charges with regard to an applicant or covered person’s sexual orientation.” The rule also says companies cannot use sexual orientation as a pre-existing condition to deny coverage, and medically necessary services also can’t be denied.

“It bars the common practice of excluding medically necessary care prescribed for the treatment of gender dysphoria and requires private health insurance to cover medically necessary care for transgender Coloradans on the same terms that they cover all care,” said Noah Lewis, staff attorney for the Transgender Legal Defense and Education Fund.

“Transgender people pay the same premiums and just want the same health care that everyone else has,” he said. “Transgender Coloradans routinely saw their medically necessary care singled out for exclusion by insurance companies even when the treatments they sought were covered for people who aren’t transgender.”

The new regulation was a necessary step to keep the state in compliance with its own laws, and those of the federal government, de Percin said. No legislative action was needed.

“Discrimination like this is banned by the Affordable Care Act, which says insurance companies have to cover everyone,” she said.

“So we asked the Division of Insurance for a clarification, and they issued this rule. It really is a great victory. You shouldn’t be denied health care based on who you are.”

Under the new rule, hormone treatments, blood tests and surgical interventions must be covered by the insurance companies — essentially anything that’s deemed medically necessary by a physician, Lewis said.

“The medical necessity of transgender health care, including hormone therapy and sex reassignment surgery, has been widely recognized in medicine and law,” he said. “Organizations such as the American Medical Association, the American Psychological Association and the World Professional Association for Transgender Health recognize these treatments as medically necessary.”

Positive effect

It’s a major victory for families, said Shawna Kemppainen, executive director of Colorado Springs Inside/Out, a nonprofit group dedicated to creating a safe place for teenagers who are gay, lesbian, bisexual or transgender.

“There’s been a lot of different government entities, changing and redefining the rules,” she said. “And having agencies like the DOI confirm patient rights and access to health care is important not only for the individual it impacts today, but because that kind of support creates a climate that will foster more LGBT people to seek the care they need. This rule change will make Colorado families healthier.”

The discrimination allowed before the rule change could keep teenagers in the closet longer, she said. And it could make families afraid to discuss medical needs with their doctor, for fear of having insurance claims rejected.

“When it comes to issues of fairness, such as health care access or relationship recognition, LGBT people simply want to have to jump the same-height hurdles as everyone else has to jump,” she said. “No more, no less.”

For Kattari, the rule change comes too late to help him through his transition year. That’s the year after gender reassignment surgery that he needed checkups every three months and biweekly shots of testosterone. Still, he said, the change is a relief and will benefit others.

“The only way I was able to afford to do this — live my life as my true self — is because I inherited money,” he said. “So it only took a year; it was a fairly smooth process. Some people can’t afford that, can’t do it all at once. I think this will help change that.”