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Two trans teens win top surgery coverage

 

We recently helped a pair of transgender teens who, coincidentally, have top surgery scheduled this summer with the same surgeon, on the same date, using the same insurance.

Unfortunately, they also received the same denial letters.

Oxford denied both young men preauthorization for their surgeries simply because they were not yet 18. One is 15 and cannot wait another two and a half years for surgery. The other will be just six weeks shy of turning 18, but he has good reason not to wait—he needs time to recover before starting college in the fall.

Oxford continued to deny the surgery during the internal appeals. So we turned to the external appeal process where an independent review body reviewed the company’s decision. The appeals went to two different external review agencies, but both came back with the same decision to overturn Oxford’s denial. When viewed by objective experts, this was medically necessary care that must be covered.

Oxford’s denials were out of step with the World Professional Association for Transgender Health's Standards of Care, which specifically state that top surgery can be performed for people who are under 18. We will be pursuing advocacy with Oxford to update their policy to ensure that no other trans youth are unfairly denied care.

 

Trans-health provider now provides equitable coverage

 
Angelina Bouros
 

Angelina Bouros had been running Building Services at the Institute for Family Health for nearly a decade when she contacted us. Although the Institute provides transgender-related health care to its patients, it ironically had an explicit “sex change” exclusion in its employee health plan.

Angelina had done her best to confirm coverage, and Aetna had assured her her surgery would be covered. But after arranging for time off, her surgery was cancelled at the last minute once she learned it would not be covered. That’s when Angelina contacted us.

After we contacted the Institute, it decided to eliminate the exclusion. Angelina was able to get her surgery just three months after it had initially been denied, and she couldn't be more thrilled!

 

How $75 became $13,000

 

The mother of a transgender woman contacted us for a $75 consultation because her daughter was having trouble being reimbursed for her surgery.

When our client had initially learned her student insurance plan would cover her surgery, she was thrilled. After paying out of pocket, she submitted the claim under her student health plan. UnitedHealthcare Student Resources denied her coverage because the surgeon’s office would not provide a more detailed bill than it already had. Our client was stuck.

That’s when Transcend Legal came into the picture. We wrote to the insurance company and explained that the bill they wanted was not required under the terms of the plan, and they had no basis to deny payment. UnitedHealthcare reversed course and paid the claim, sending her a check for over $13,000.

Transgender people should not have to contact an attorney to simply get the coverage they are owed, but until we have equitable health care, we’ll keep helping trans people get the coverage they need and deserve.

 

Name change victory for incarcerated trans woman

 
Clinton County Correctional Facility
 

Co-counseling with Milo Primeaux at Empire Justice Center, we helped a transgender woman incarcerated in Clinton County, New York to get her legal name change. This was over the objections of the judge presiding in her criminal prosecution and the Department of Corrections and Community Supervision (DOCCS).

New York law makes it harder for people who are incarcerated to get a legal name change. The criminal court judge and the District Attorney must be notified so that they can have an opportunity to object to the name change.

Our client had experienced repeated harassment, and eventually she decided to defend herself and fought back. But as often happens to LGBTQ survivors of violence, she’s the one who ended up being convicted of assault.

The judge who objected here referred to our client using female pronouns in quotation marks. DOCCS used male pronouns and asserted that the name change would “primarily serve illegitimate purposes,” such as preventing crime victims from maintaining awareness of her whereabouts.

The judge ultimately acknowledged that our client had a legitimate purpose—changing a male name to a female one—and granted the name change. As the case set positive precedent for transgender inmates, the New York Law Journal published the decision, Matter of A.H.M.

Our client is still housed in a men’s facility. In contrast, New York City just announced that transgender inmates in its jails will be housed according to gender identity or wherever the person feels safest.

We’re confident that small victories like this one will help lead to greater victories for justice in the longer term.

 

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