Groups that represent transgender people say that those in transition face a difficult road, despite laws that say health insurance companies cannot discriminate based on gender or health history.

“The idea that you have insurance and you’re still being denied basic care is outrageous,” Human Rights Campaign (HRC) Senior Legislative Counsel Robin Maril told CNN recently.

Federal health law states that insurance companies cannot choose to not offer coverage to transgender people or people who are transitioning. It also states that transgender people cannot be denied access to sexually transmitted disease preventive services.

But sometimes-subtle, sometimes-confusing rules make that a much harder challenge than it seems.

Boxed-in Genders

The problem starts from the beginning: Those signing up for health insurance register as a certain gender, further complicating the situation for those who want to transition.

Despite federal legislation outlawing discrimination, some transgender people say they are told that being transgender is a pre-existing condition and that their insurance policy does not cover it. If the insurance company does cover reassignment surgeries and medicine, it often doesn’t cover enough of the cost.

“When health care really stresses biology, it leaves a large portion of us out,” Nell Gaither, president of the Trans Pride Initiative, told The Dallas Morning News. “Our lives depend on medical intervention. One way or another, we’ll figure out how to get the treatment we need.”

Gaither shared that some go to the internet or use other means to get help transitioning.

Then it gets tougher. “What happens is that the health insurance companies have specific codes and they put you in as female or male; you only get services that go with that code,” HRC’s Maril told CNN.

People who are transitioning may still have organs from their former gender and may still need medical procedures for that gender. The insurance coding system doesn’t allow for that.

That can create risks for sexually transmitted diseases, such as HIV. For example, World Health Organization research has found that transgender women’s HIV rate is 49 times what it is for other women.

“I think a lot of it is stigma-driven,” JoAnne Keatley of the University of California’s Center for Excellence for Transgender Health told NPR recently. “Many trans people are not able to obtain health coverage.”

Groups Speak Out, Offer Solutions

With an estimated 700,000 Americans identifying as transgender, healthcare is one issue that’s becoming tough to ignore.

It’s also an emotional issue. 41 percent of transgender people try to commit suicide, according to a Williams Institute survey.

Advocates say that additional flexibility—starting with the addition of “transgender man” and “transgender woman” boxes on health and insurance forms—is necessary. That flexibility will make doctor visits less uncomfortable and could help streamline insurance support for procedures.

Harvey Makadon, the director of the National LGBT Health Education Center, is also advocating for electronic health records that could help doctors work with transgender people.

“Whatever solutions are put forward, surely none can be more important than training health care providers to continuously look for unaddressed, unconscious biases of any kind,” he wrote in an op-ed for The Advocate.

(iStock/Thinkstock)