A Colorado woman is challenging her insurance provider, Aetna, after they refused to cover her gender reassignment surgery even though she and her doctor say it is medically necessary.
The Transgender Legal Defense Fund & Education Fund is siding with transgender woman Ashlyn Trider saying Aetna's refusal to cover Trider's surgery as prescribed by her doctor directly violates Colorado law.
Colorado's Department of Regulatory Agencies bulletin B-B.49 supports Trider's and TLDEF's claims stating that health insurers may not deny coverage of treatments for transgender policyholders if the same treatments are covered across the board for other policyholders.
HIPAA law prevents Aetna from discussing Trider's information, but a denial letter Trider received and shared with the public says her “plan has a specific exclusion for the requested service or treatment.” However, Aetna claims it supports the greater LGBT community and those seeking gender reassignment surgery in a statement addressed to The Denver Post:
“Moving to include gender reassignment procedures in our plans is consistent with other changes we have made to better serve the needs of the LGBT community. In 2015, Aetna started covering gender reassignment surgeries for our 33 Aetna plans offered to federal employees … Aetna also is expanding coverage of gender reassignment surgery in many of our fully insured commercial plans … and will continue to roll (such plans) out over the next couple of years as we re-file our plans with the states. We will be introducing the product in West Virginia, Utah, Idaho, Missouri, Wyoming, Nebraska, Iowa, Louisiana, South Carolina (for our fully-insured plans) this year.”
Although Trider's surgeon submitted a preauthorization request for gender reassignment surgery on Jan. 28, Aetna denied the request the following day citing her policy excludes coverage for all transgender healthcare. TLDEF appealed the denial of coverage on behalf of Trider on July 20. Aetna has 30 days to officially respond.
