Aetna reimburses transgender member for mammogram


Aetna has reimbursed a transgender female for a doctor-recommended mammogram she underwent two years ago, reversing a previous decision to deny coverage.

Beth Scott had a mammogram in 2010, and Aetna refused to pay for the service, claiming that the mammogram fell under an exclusion treatment policy "related to changing sex," reported ABC News.

Such exclusionary clauses are common among insurers and often are used to deny people coverage for medical procedures needed to change genders, as well as ordinary care, such as gynecological visits and medically necessary surgeries, if they can be linked to their transgender status, New York Daily News reported.

However, the Transgender Legal Defense and Education Fund, which intervened on Scott's behalf, argued Aetna's interpretation of its own exclusion policy was "overbroad" and should apply only to medical treatments that change sex characteristics.

"Transgender people should have their healthcare needs covered by insurance just like everyone else," TLDEF staff attorney Noah Lewis said in the article, adding that insurers denying coverage for transgender members is a "widespread problem and not an isolated incident."

Scott appealed the claims denial, a process that took almost two years, but Aetna again refused coverage for the mammogram. When Scott threatened to file a lawsuit, Aetna agreed to reimburse her for mammogram cost, the Star-Ledger reported.

"If transgender people are being singled out for denial of care that is provided to other individuals, this makes it clear transgender people have to be treated equally under the plan," Lewis said. "Hopefully this will send a message to other insurance companies they can't keep making these kinds of denials."

Aetna's spokeswoman Cynthia Michener said the insurer erred in denying Scott's claim and has covered previous mammograms for transgender patients. "Any denial would have been an error corrected by Aetna in administering the claims in the appeals process," she told the Star-Ledger.

To learn more:
- read the ABC News article
- see the New York Daily News article
- check out the Star-Ledger article

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