TLDEF Secures Policy Change in Aetna Health Care Coverage for Transgender People

This week, the Transgender Legal Defense and Education Fund (TLDEF) announced a victory for a case brought by a transgender woman against Aetna, her private health insurance company. Aetna denied health insurance coverage to Beth Scott, a 44-year-old transgender woman from New Jersey, for a mammogram she underwent in June 2010 at her doctor’s recommendation. The company claimed that the procedure was “related to changing sex” and therefore excluded from coverage under Ms. Scott’s policy. TLDEF refuted this interpretation, arguing that the mammogram was not a procedure to change sex characteristics and asserting that Aetna’s claim could lead to other forms of medically necessary care being denied to transgender patients. Ultimately Aetna sided with TLDEF and reversed its position.

In addition to covering Ms. Scott’s mammogram in full, Aetna also changed the terms of its health insurance policy to ensure that exclusions for transgender health care apply only to procedures and treatments related to changing sex characteristics, and that necessary sex-specific care will be accessible regardless of the gender listed on one’s policy. Furthermore, Aetna will allow individual policyholders to correct the gender-marker listed on their records by presenting an updated ID.

While this policy change opens many doors for transgender people ensured by Aetna, it continues the practice of most insurance companies by denying coverage for other aspects of transgender health care like hormones and surgery. Transgender people often pay out-of-pocket to access this medically necessary care, much of which is required for ‘proof’ of gender in updating identification records.

Noah Lewis of TLDEF noted, “Transgender people should have their health care needs covered by insurance just like everyone else…But as long as exclusions [“related to changing sex”] remain in place, Ms. Scott's case makes clear that they cannot be used to deny other medically necessary care simply because someone is transgender."

GLAAD congratulates Ms. Scott and thanks TLDEF for challenging policies that unfairly deny health care coverage to transgender people.