Despite a Division of Insurance edict prohibiting health care discrimination based on transgender status, the problem still persists in the state.
Kelly Costello was denied coverage for surgery that allowed him to transition from a woman to a man, just as the state was saying those denials are no longer allowed. And Nicole Garcia has hormone replacement therapy covered, but prostate screenings are not.
“Preventive care is preventive care,” said Ashley Wheeland, health policy director at One Colorado, a gay-rights advocacy nonprofit. “And this is very clearly a case of discrimination for transgender individuals. It’s time to change this in Colorado.”
Garcia and Costello are not alone. A study showed that 60 percent of transgender people in the United States experience some form of harassment or violence and 37 percent have experienced economic discrimination.
“Health related research, policies and materials do not mention or deal with the actual lives of transgender persons,” said Dr. Emilia Lomardi in a research paper, “Enhancing Transgender Health Care.” “Simply adding transgender materials to existing materials is not enough, nor is using materials or programs originally created for other populations.”
That’s something Garcia knows about firsthand. A man-to-woman transgender, she is able to list “female” on all her insurance paperwork. But not all her internal organs are female, and therefore, she still needs routine screening for prostate cancer.
“But women don’t need PSA checks,” she said. “And I’ve checked that block on the forms. It’s not covered.”
That level of discrimination — and the one Costello experienced — isn’t allowed in Colorado anymore. In March, the Division of Insurance issued a regulation that said companies could not deny coverage based on transgender issues for any reason. The move was heralded as a step in the right direction for equal access to health care.
But it still happens.
The Human Rights Campaign said that the discrimination experienced by Garcia and Costello is common. Denial of coverage for claims for gender-specific care based on the person’s gender marker on insurance forms is common.
For example, a male-to-female person who develops prostate cancer or a female-to-male person who develops ovarian cancer — either can be denied by insurance companies.
Costello says many transgender people no longer expect adequate care from doctors nor complete coverage for health insurance — even though they pay the premiums.
“The expectation is just really low,” he said. “Transgender people no longer expect to have access that is friendly, competent and understanding of our needs — not from doctors, pharmacists or insurance companies. So many people are not getting services they need because they just don’t expect to be treated fairly.”
That’s something One Colorado is fighting. The group seems to have help from one of the state’s insurance companies. Last month, Kaiser Permanente committed to working with the Colorado Civil Rights Commission to lead a discussion about transgender health.
“It is our hope that this collaboration will be an important first step in bringing all the interested parties and stakeholders together to better understand the issues and explore possible solutions to better serve the community,” said Dr. Jandel Allen-Davis, Kaiser Permanente vice president of government and external relations in a statement about the agreement.
And it’s just an agreement to discuss the issues, said Steve Chavez, director of the Colorado Civil Rights Division. There aren’t any parameters set for the meetings.
“If it sounds vague, that’s because it’s still vague,” he said. “We agreed to sit down with Kaiser Permanente to bring parties to the table and get some understanding. That’s the extent of the conversation — what coverage is available for sexual reassignment procedures and transgender health.”
According to One Colorado, Kaiser has been a leader in providing health care for lesbian, gay, bisexual and transgender populations, “but many of Kaiser’s plans have long excluded coverage of health care services and procedures for transgender Coloradans.”
Employees of One Colorado and Colorado Consumer Health Initiative report they have been denied coverage by Kaiser.
“In response, our organizations began a discussion with Kaiser in September 2012 about ending barriers to health care for transgender Coloradans,” the organizations said in a joint statement. “Today more than ever, we look forward to continuing that conversation.”
The conversation is necessary because there are still varying levels of coverage, in spite of the DOI’s ruling.
“Some insurance companies cover everything, some of them cover nothing,” Chavez said. “In Colorado, we’re trying to figure out what will work.”
The discussion comes months after the insurance division’s mandate on prohibiting discrimination for transgender people.
But the discrimination persists, they say.
“As we know too well for far too many transgender Coloradans, refusal of care and coverage for medically necessary health care has long been the rule and not the exception,” Allen-Davis’ statement said. “Three out of four transgender Coloradans reported a lack of or limited insurance to be a problem for them in getting the health care they need. And 85 percent reported health care expenses to be a barrier to seeking services. Incredibly, 53 percent reported being refused care from a provider.”
The groups call on Kaiser, specifically, to end its discrimination.
“We also look forward to Kaiser’s full implementation of the state anti-discrimination statute and the elimination of exclusions,” they said.
Kaiser is the only insurance company promising to discuss the issues, Chavez said. Other insurers might join the group, along with officials from the civil rights division, people from the transgender community and their advocates.
“Kaiser has committed to bringing other interested parties to the table,” he said. “We’re not sure yet if it will be a trade organization or not. Basically, we’re just going to sit down and talk.”
Garcia is hoping the move will allow coverage of some preventive tests. As for Costello, he’s filed complaints with the Colorado Civil Rights Commission and the Division of Insurance. Because of the timing, it’s unclear if they can help her recoup the money she paid out of pocket for the surgery.
“I’m not sure if they’ll be able to help me specifically or not,” he said. “But it’s important to let people know this is continuing; that this is a problem. So many people have just stopped trying to find care, because of their past experiences.”