Trans students grapple with insurance

The U’s plan is one of few that cover gender dysphoria treatment.

by Anne Millerbernd

It took Alena Neumann more than three years and a lawsuit against the University of Minnesota to get the medical care she wanted.

For years, she struggled with the University’s Student Health Benefit Plan because it didn’t cover the cost of her sex change. She’s still in the process of getting the procedure done, even after suing the University in a sexual orientation discrimination case.

Neumann is one of a handful of transgender students at the University and nationwide who are seeking gender confirmation surgery, and student health plans are just beginning to provide coverage.

Last academic year was the first time that the University offered coverage for the treatment. Today, the Student Health Benefit Plan covers up to $35,000 for treatment — a cap the University may increase.

Neumann said she’s suffered from severe mental anguish stemming largely from encountering roadblocks trying to get treatment related to gender dysphoria, a condition in which people feel their biological sex and gender identity don’t match.

In 2010, Neumann began to pursue a sex change through her Student Health Benefit Plan. At the time, she was the Transgender Commission’s representative to the Student Health Advisory Committee. She spent a year working with the committee to get the treatment covered.

“I tried to work with them for a year to see if it could be addressed and changed diplomatically,” she said. “And it was obvious there was no interest in going anywhere.”

After repeated rejections from the University, Neumann threatened Student Health Benefits Director Sue Jackson with a lawsuit.

“Basically, she said go for it,” Neumann said.

The disconnect

Like many transgender people, Neumann said, not receiving the treatment brought on other problems, like depression, eating disorders, anxiety and numerous suicide attempts.

Gilbert Gonzales, a University Ph.D. candidate and research assistant in the State Health Access Data Assistance Center, said insurance companies are beginning to recognize the need for trans-related health coverage.

But there’s still a disconnect between what insurance companies and the trans community see as necessary treatment, he said.

“That’s where we have these issues where trans people might not be getting the care that they need,” Gonzales said.

Transgender people would have to be diagnosed with a mental health condition before the treatment would be considered medically necessary, he said.

Gwen Carlson, president of the University student group Tranarchy, is familiar with this disconnect.

In the coming months, Carlson will travel to San Mateo, Calif., to pursue gender confirmation surgery, which is partly paid for by the University’s health plan.

After overcoming insurance roadblocks, finding a surgeon who will perform the procedure and take insurance can prove just as challenging, she said.

“Their practice is sufficiently funded by people who pay out of pocket,” she said. “And there are enough insurance companies that just don’t cover it nationwide that it’s not practical for them to take insurance.”

Boynton Chief Operating Officer Carl Anderson estimated the costs for gender confirmation surgery can range from $20,000 to $90,000, but there isn’t a set price tag.

Further research regarding cost and usage of the surgery must be done, he said, but the University health plan will likely extend the coverage cap to about $50,000.

“The cost [of treatment] is a little higher than we thought it might be,” he said. “So we’re going to proceed a little more cautiously with raising the limits.”

Four or five transgender students have used trans-related benefits at the University since they became available last year, Anderson said.

University officials had discussed adding gender dysphoria treatment to the student health plan since 2008, he said, noting Neumann’s lawsuit had nothing to do with the change.

Where the University stands

Gonzales said the University is on the progressive side of insurance coverage — many policies still don’t cover gender confirmation procedures, or are only just considering it.

“I think this is the direction that a lot of employers and schools and even government employers are heading,” he said.

Of the 12 Big Ten schools, less than half have insurance plans that cover surgical procedures related to gender dysphoria.

This year, the University of Wisconsin-Madison added gender dysphoria surgical procedures to its Student Health Insurance Plan, said the plan’s manager, Richard Simpson.

Because Madison’s student insurance plan is in good shape financially, he said, they felt comfortable adding the coverage.

“We want to be recognized as one of the best student plans, and we thought this was important,” he said.

Both Neumann and Carlson said they think if an insurance company doesn’t cover trans-related procedures, it’s engaging in a discriminatory act.

Before Neumann filed a complaint for her case, she asked the Minnesota Department of Human Rights to investigate the situation.

The department said Neumann had probable cause to prove that the University’s insurance policy violated the Human Rights Act, but it found that any discrimination was unintentional and the department itself did not sue the University.

The University argued that the exclusion of coverage was a cost-based decision, not a discriminatory act.

The health plan tries to achieve a balance between what it covers and how much students are charged. When benefits are added, the deductible can rise.

University Deputy General Counsel Tracy Smith oversaw the University’s side of the case and said the Student Health Benefit Plan has a number of exclusions.

“The exclusion of these services [does] not discriminate among people based on their gender or based on their sexual orientation,” she said.

The case never saw the inside of a courtroom. The University agreed to a $30,000 settlement, half of which went to Neumann.

“It was a disappointment, I guess,” she said. “My initial request in the suit was to make enough available so that I could get my health taken care of, and that’s not what happened.”