North Carolina’s largest private insurer, Blue Cross and Blue Shield of North Carolina, has announced it will cover gender-affirming facial surgery and voice therapy for transgender individuals who challenged its past denial of coverage for those procedures.
Transgender advocates with the Transgender Legal Defense & Education Fund challenged the existing insurance exclusion after two transgender policyholders were denied coverage for facial surgery and voice therapy. Following negotiations with those advocates, Blue Cross and Blue Shield updated its policy to allow coverage for those treatments if they are allowed under a patient’s health benefit plan.
“Knowing that care may be within reach has me hopeful that my life might finally move past transitioning. I might finally be able to exist fully as myself,” Kathryn Vandegrift, one of two transgender women insured by Blue Cross NC who were denied pre-service authorization for gender-affirming facial surgery, said in a statement following the release of the updated policy. “Transgender health care is health care, and health care is a human right. No one should be denied the medical treatment they need.”
Blue Cross Blue Shield of North Carolina said in a statement that it has long recognized gender dysphoria as a medical condition and has covered treatments for it, adding that the update “expanded coverage on treatments that are medically necessary as part of the overall treatment plan for gender dysphoria,” reports The Herald-Sun.
With the change, Blue Cross NC becomes the latest private health insurer to update its policies covering gender-affirming care for transgender people. In January, Aetna announced that it had expanded coverage of gender-affirming procedures, such as breast augmentation for transfeminine policyholders, in most of its plans. In May, Anthem updated its coverage to include procedures like breast augmentation, facial surgeries, and voice surgery.
Last year, the Connecticut Commission on Human Rights and Opportunities found that the health insurer Cigna’s policy of excluding coverage for facial reassignment surgeries was a form of unlawful discrimination. Similarly, that same year, a county in Oregon and Regence BlueCross BlueShield of Oregon settled a lawsuit challenging an exclusion on facial surgeries in the Clatsop County employee health plan.
“Across the country, health insurance companies are increasingly recognizing the need to end systemic denials of lifesaving gender-affirming health care for transgender people,” Noah Lewis, the director of the Trans Health Project at TLDEF, said in a statement. “We are pleased that Blue Cross Blue Shield of North Carolina has revised its medical policy to acknowledge that facial surgery is medically necessary when used to alleviate gender dysphoria in transgender people.”
In addition to the two transgender plaintiffs, TLDEF is also representing Equality North Carolina and the LGBTQ Center of Durham, both organizations that advocate for transgender rights and employers seeking to provide their employees with insurance that will cover gender-affirming care.
“At a time where transgender youth are under attack all across this country, Equality NC is thrilled to see Blue Cross Blue Shield take this proactive step towards offering gender-affirming care to its clients,” Kendra Johnson, the executive director of Equality NC, said in a statement. “Access to equitable health care is a lifesaving resource for trans and gender-nonconforming individuals, particularly Black and Brown trans women who’ve already faced a long history of hostility in North Carolina. We hope that this standard of gender-affirming care becomes industry-wide as the healthcare system catches up with the lived realities of the transgender community.”
“Gender-affirming health care as enormous impacts on a person’s happiness, joy, and longevity,” J. Clapp, the executive director of the LGBTQ Center of Durham, said in a statement. “As an agency, I want to make sure that everyone on my team can thrive. That is why we needed to be sure to provide all of our staff members with access to the health care they need, including our transgender and non-binary employees.”
TLDEF, along with Lambda Legal, is currently suing the state of North Carolina for insurance exclusions in the North Carolina State Health Plan that deny gender-affirming health care to employees. The organization is representing several current and former state employees and their dependents who were denied coverage for medically necessary health care in that case.
TLDEF is also challenging an insurance exclusion in Georgia on behalf of a sheriff’s deputy who was denied coverage through her employer-based plan.
According to the 2015 U.S. Transgender Survey, one of the largest surveys of transgender people in the nation, one in four transgender individuals have experienced a health insurance problem in the past year, such as being denied coverage for transition-related procedures or routine care. The survey also found that more than half of transgender individuals have been denied coverage for transition-related surgery.
When such care is denied, policyholders are often forced to pay out of pocket, often taking on debt or cashing out their retirement in order to foot the bill. In addition to the financial burden imposed on them when insurance coverage is denied, any transgender advocates also argue that, without undergoing facial surgery or voice therapy, transgender people may be at higher risk of discrimination, harassment, or even violence because their appearance doesn’t match their gender identity.
“Not being able to have the surgery I need has affected every aspect of my life — from my mental and physical health to my professional life, everything has suffered,” Lauren, a transgender woman who, like Vandegrift, was also denied coverage for gender-affirming surgery, said in a statement. “Without this coverage, which I am already paying for, I would not be able to afford the surgery that I need. I am so happy to know that I can finally start making plans for a brighter future for myself.”
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