Five graduate students | Penn students and employees deserve better health care coverage for transgender people

If Laura * worked as a barista at Starbucks or as a delivery driver for Amazon, she would have excellent health care coverage for transgender people. She would see doctors specializing in gender-affirming care and she would pursue procedures that allow her to live like herself. Gender transition, while never easy, would be possible with the support of her employer.

Laura is currently working as a graduate student at the University of Pennsylvania. For the past two years, she has been seeking gender-affirming care through Aetna Student Health. Why isn’t her employer – a university that prides itself on inclusive and equitable policies – not providing adequate transgender health care coverage?

Beginning in 2017, the University announced its transgender healthcare under the Aetna Penn Student Insurance Plan (PSIP). The Student Health Service’s 2016-17 annual report boasts:

“The Student Health Insurance Advisory Committee (SHIAC) worked with Aetna Student Health to develop a plan that is both affordable and comprehensive for students. One of the changes to the FY18 plan included coverage of electrolysis and tracheal shaving related to gender transition, which is another step forward for the transgender community.

When Laura first arrived at Penn, she asked another trans woman who worked for her department how to use these perks. Her friend laughed. These benefits, she learned, are not real. You can’t use them unless you have what Aetna calls “gender reassignment (sex reassignment) treatment”. She was shocked. Requiring trans women to undergo surgery before they can access basic benefits seemed backward and inhumane. Why were transgender students and employees restricted from using these benefits while at Penn?

After months of emails with Aetna and LGBT Center staff, she learned that one of the advertised procedures – a tracheal shave – would count as the aforementioned ‘sex reassignment (sex reassignment) treatment’. . None of the trans students she had spoken to knew this procedure fulfilled Aetna’s requirement.

She was ecstatic. A tracheal shave is a crucial part of a woman’s transition, as it allows her to appear as a less visibly assigned man at birth. This procedure would cost over $ 7,000 if she paid out of pocket. Without this coverage, she would not be able to afford this procedure.

So, she scheduled a consultation with a nearby surgeon, waited several months for an appointment, asked a therapist to assess her gender dysphoria and write a letter verifying the medical necessity of the procedure, and asked his surgeon’s admission coordinator to send a pre-clearance to Etna. Throughout this process, she was classified as having a “Gender Identity Disorder” according to Aetna’s Clinical Policy Bulletin on Gender Affirmation Surgery. Her ICD-10 diagnostic code was F64.9, or “Gender Identity Disorder, Unspecified”.

Its prior authorization was immediately refused by Aetna with the following justification:

“We have reviewed the information received on your condition and circumstances. We used the Clinical Policy Bulletin (CPB): Gender Affirming Surgery and your plan documents. Based on the criteria of the CPB and the information available to us, we refuse to cover the requested procedure to be carried out as part of your gender transition. This procedure is considered cosmetic by our CPB and your plan because it is aimed at improving the appearance, not correcting a physical problem that is affecting your daily activities.

She was surprised. She chose to come to Penn because the University announced her commitment to the well-being of transgender students and employees. The message she received from Aetna contradicted the University’s dedication to inclusion.

Peer institutions, such as Princeton University, provide extensive transgender health care coverage through Aetna Student Health. The University of Michigan recently revamped its gender-affirming healthcare plan.

Penn must provide comparable transgender health care coverage. To begin with, the University must provide the gender-affirming care it has advertised since 2017. In order to make this care accessible, the University must provide an attorney who is familiar with both Aetna’s policies and Aetna’s standards. World Professional Association for Transgender Health. of care.

Penn’s transgender healthcare is determined by how Aetna’s representatives interpret claims. Many of these representatives are unfamiliar with gender affirmation procedures and many have never worked with trans people. Students and employees are forced to defend themselves in a system that is overwhelming, unfamiliar and often damaging.

Penn can do better for his students and trans employees. The experience of gender dysphoria is debilitating and unbearable. The suicide attempt rate among trans and non-binary adults is over 50%. Strong transgender health care is necessary and is life-saving.

Students and employees at Penn need better gender-affirming care now.

* The name has been changed for confidentiality reasons.

AVA KIM, DAVY KNITTLE, AYLIN MALCOLM, NAT RIVKIN, and SAM SAMORE all hold a doctorate. candidates for the English department.