The Other Hand

Posted by – June 20, 2008

The AMA passed a resolution attempting to make home births illegal, and yet in the same session, they also passed Resolution 114 (MS Word .doc):

Whereas, Gender Identity Disorder (GID) is a serious medical condition recognized as such in both the Diagnostic and Statistical Manual of Mental Disorders and the International Classification of Diseases; and

Whereas, GID, if left untreated, can result in clinically significant psychological distress, dysfunction, debilitating depression, and, for some patients without access to appropriate medical care and treatment, suicidality and death; and

Whereas, The medical literature has established the effectiveness and medical necessity of mental health care, hormone therapy, and sex reassignment surgery in the treatment of patients diagnosed with GID; and

Whereas, Many health insurance plans categorically exclude coverage of mental health, medical, and surgical treatments for GID, even though many of these same treatments, such as psychotherapy, hormone therapy, breast augmentation and removal, hysterectomy, oophorectomy, orchiectomy, and salpingectomy, are covered for other medical conditions; and

Whereas, The denial of otherwise covered benefits for patients diagnosed with GID represents discrimination based solely on a patient’s gender identity; and

Whereas, Our AMA opposes discrimination (AMA Policies H-65.983, H-65.992) and the denial of health insurance (H-180.980) on the basis of gender identity; and

Whereas, Our AMA opposes limitations placed on patient care by third-party payers when such care is based upon sound scientific evidence and sound medical opinion (H-120.988); therefore be it

RESOLVED, That our American Medical Association support public and private health insurance coverage for treatment of gender identity disorder in adolescents and adults (New HOD Policy); and be it further

RESOLVED, That our AMA oppose categorical exclusions of coverage for treatment of gender identity disorder in adolescents and adults when prescribed by a physician. (New HOD Policy)

Which doesn’t do the job entirely, but it’s certainly a good weapon in a trans person’s arsenal when arguing for why their transition related costs should be funded.

(thanks to Veronica for the news)

4 Comments on The Other Hand

  1. Sara says:

    Once the AMA has stated (and insurance companies accepted) that this is a medically treated problem with accepted treatments, how credible will conversion therapy remain? If something is a sanctioned medically treatable condition (and therefore it follows that the treated problem was medically *caused*), should it still be treated as a psychological pathology? The timing is certainly interesting. Wouldn’t it be nice if this is the first step in transsexualism getting delisted from the DSM?

  2. Catrina says:

    Well, its about time. Yet, every insurance policy is a contract. So it is doubtful the insurance company’s will move to strike their waiver clauses any time soon.

    It will probably require one hell of a huge litigation success against an insurer, involving a tragedy like suicide directly related to GID for there to be movement…. and the judgment will have to be for hundreds of millions, including a significant award for damages, and perhaps negligence against the Insurer in order for it to have impact.

    For a good case, the criterion will probably be this:

    1. A very well heeled TS will seek that treatment be paid for GID by means of a group insurance plan that now waives GID. There will probably be a need for persistent requests by the insured for assistance.

    2. A record of declining psychological health by the insured, well documented with the insured undergoing long term and persistent psychological treatment for GID as the primary diagnosis, including second opinions.

    3. An indication that the insured did everything possible to heal or resolve the GID without the denied treatment.

    4. Tragedy:Perhaps a 220 grain 0.45 ACP bullet into the head. (Very affective way to end it.) The act should be accompanied by a note expressing how GID led the person to end it.

    5. Distinct proof, in legal terms, that GID was the primary cause of suicide and that the insurance waiver aggravated the condition because of lack of treatment. This needs to be well documented.

    5. A family willing to pursue litigation.

    6. A damned good plaintiff lawyer.

    7. A good solid judgment, preferably in Federal Court where it has stronger regional teeth, in the seven figure minimum range ($100 million plus)

    Only then will the cost benefit valuations used by insurers indicate that it is cheaper to pay for the treatment than continue the waivers or defend them in court. After all, money is more important to insurers than human life, especially someone as unimportant as a GID sufferer. (Commented with caustic a plume)

    If I was that well healed I would volunteer. Most of this criteria is in my medical history. But if I did it, the estimated payout wouldn’t be big enough, probably about $3.00.

  3. Sara says:

    Catrina, the picture isn’t that bleak at all!

    When San Francisco announced that they were going to fully (including SRS) cover trans-related healthcare, initially there was an extra premium added. By the end of 2006, it became clear that costs had actually gone down and the “trans premium” was removed.
    see: http://www.outandequal.org/sum.....nefits.pdf
    for a powerpoint-style pdf (poke around the URL for more…).
    It’s clear that we do not incur additional costs to insurers or employers, leaving only ignorance and religious bigotry to conquer…but I repeat myself.

  4. Catrina says:

    Hi Sara:

    Thanks for the update and info. It is appreciated.

    Yet, from a perspective from the middle of the country, please be aware most people from “fly over country” take their Passports when traveling to San Francisco because they assume it is a foreign country…. different culture, values…food etc. Most everyone assumes they have to go through Customs to get to any of the downtown hotels. Its been that way since Haight Ashbury hippie days. :)

    “Oh look, its a gay couple! (Visualize snapshots and multiple flashes from the cameras in the tour group) See a trans couple? They’d ask them for autographs and have their pictures taken with them to show “da folks back home…”

    In my opinion, this will take awhile, Sara dear. Insurance contract templates are constructed under the licensee of States. They differ from State to State. Even Illinois, as Democratic as it is, won’t consider to lift the waiver in the template “until hell freezes over” or the pols get sufficient bribes that neutralize the bribes they get from the insurance companies. But “dats da Chicagah way”… and “Chicagah runs Illinois.

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