Insurer Agrees to Cover Transgender Health Services

News Release: 
Monday, November 23, 2015

ACLU Challenge Led to Policy Changes

A private health plan has agreed to drop an exclusion that prevented transgender people from getting medically necessary health care, the ACLU of Washington announced today. The action came after a Seattle man represented by the ACLU challenged as discriminatory the plan’s denial of coverage for routine laboratory tests.

In an October 21 letter to Anthony Bopp, Sound Health & Wellness Trust said it will no longer exclude services related to gender dysphoria, the medical diagnosis for when a person’s gender identity does not correspond to his or her assigned sex at birth. Without the necessary treatment, gender dysphoria can cause severe psychological distress, including anxiety and suicide. Treatment for gender dysphoria may include mental health care, hormone therapy, and gender confirmation surgery.

“Health plans that exclude medically necessary care for transgender people violate anti-discrimination laws,” said ACLU-WA Staff Attorney Margaret Chen. “Sound Health & Wellness Trust’s decision is an important step in the right direction and will lead the way for other insurance carriers as well.”

Bopp takes testosterone prescribed to him by his doctor. To ensure the safety and effectiveness of the testosterone, Bopp regularly receives blood tests that measure his testosterone, hematocrit and liver enzyme levels.

On September 30, 2014, Bopp received a letter from his health plan denying coverage for a testosterone blood test he had received. Group Health Options, which administers the plan for Sound Health & Wellness, said the test wasn’t covered because of the health plan’s exclusion for sex reassignment surgery.

The ACLU appealed on Bopp’s behalf, asserting that the plan’s exclusion clause for sex reassignment surgery violates Title VII of the Civil Rights Act, which prohibits discrimination based on sex in employment; Bopp is insured through his employer. The ACLU also pointed out that the plan’s exclusion clause did not apply to a routine blood test that is otherwise covered by the plan for other individuals. The ACLU successfully urged removal of the exclusion clause so that Bopp and other transgender enrollees of the plan can access benefits consistently without discrimination.

Bopp said Sound Health & Wellness Trust’s decision to stop excluding gender dysphoria from coverage affirms that no one should be denied access to health care because of who they are.

“For too long, the health care needs of transgender people have been denied or marginalized,” Bopp said. “I am happy that Sound Health & Wellness Trust has recognized that I should not be treated differently because of who I am.”