May. 6th, 2012

ftmichael: - at Old Sturbridge Village, 03 July 2008.  Copyright 2008-2009. (Default)
[personal profile] ftmichael
http://www.transgenderlegal.org/headline_show.php?id=382

Victory! Transgender Woman Wins Health Insurance Coverage for Mammogram

April 30 - We are thrilled to announce that we have resolved a claim on behalf of Beth Scott, a 44-year-old transgender woman in New Jersey who had been denied health insurance coverage for a mammogram. Ms. Scott underwent the mammogram in June 2010 at her doctor’s recommendation. Aetna denied coverage for the mammogram on the grounds that it fell under her policy’s exclusion for treatments “related to changing sex.” As a transgender woman, Ms. Scott was assigned male at birth and developed breasts after undergoing hormone therapy. Aetna refused to alter its position throughout the lengthy appeals process.

Beth Scott

TLDEF intervened and argued that Aetna’s interpretation of the policy exclusion was overbroad and that it should apply only to treatments prescribed to change an individual’s sex characteristics. Because a mammogram is a procedure that has nothing to do with changing sex characteristics, Ms. Scott’s mammogram should have been covered. Aetna’s interpretation could have led to the continued denial of claims for medically necessary care for transgender patients, including treatment for conditions such as breast cancer.

Aetna reversed its position and paid for Ms. Scott’s mammogram in full. Read more... )

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