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Debate continues whether insurers comply with ACA's transgender-coverage mandate

Transgender advocates say insurers don't follow the rules; AHIP says they do

The Affordable Care Act mandates that health insurance companies cannot deny coverage to transgender individuals or those who are going through the reassignment process, but recently there's been debate whether insurers actually comply with this provision.

While certain transgender advocates believe insurers continue to deny care to this population, America's Health Insurance Plans (AHIP) says insurers are following the rules, reports Kaiser Health News.

The issue at hand for many transgender consumers is that they must check a single gender box when signing up for coverage on either the individual or small group markets. When processing applications, insurers have specific codes and classify an individual as either female or male. That means an individual can only get services that go with that code.

Insurers argue doctors can clarify if the patient is transgender by submitting notes in the claims. However, that doesn't always work since claims are processed automatically through the coding process, notes the article.

This past spring, the Obama administration issued guidelines that state insurers cannot deny coverage of sex-specific preventive services to transgender people--and AHIP says insurers have complied.

"Health plans want to make sure patients have access to the care they need, and this latest guidance was aligned with those efforts. Plans do cover medically necessary care and preventive services for transgender individuals," AHIP's Clare Krusing tells KHN.

UnitedHealthcare and Cigna did not respond to requests to comment, notes KHN. Elsewhere, insurers have made moves to include transgender reassignment procedures in their coverage. For instance, Aetna became the first major health insurer to add gender reassignment surgery as a benefit for its employees and any contracted companies choosing to add it to their benefits package, FierceHealthPayer previously reported.

For more:
- here's the KHN article

Related Articles:
Industry moves against transgender discrimination
More insurers cover gender reassignment surgeries
Should insurers cover sex-reassignment surgery?