Appeals Committee

Yesterday, I contacted a legal organization to bring teeth and claws into my case with Select Health.

I live in Taylorsville, Utah, a community on the outskirts of Salt Lake City. My healthcare plan is Select Health Plus PPO + HSA, and it is offered through my employer. On Monday, I met with the Appeals Committee for my third-level and final internal appeal.

The case I made was based on the following bullet points:

·         Why Select Health needs to drop the exclusions against Gender Reassignment and treat my policy as if they never existed:

1.     A transgender woman was sentenced to 30 years in prison for robbing banks to be able to afford gender reassignment surgery. After she was incarcerated, she attempted to remove her penis with a knife. Attempts like this are more costly in medical treatment than actually supporting gender reassignment surgery, and are very common.

2.     A friend of mine changed her insurance company from Select Health to Blue Cross Blue Shield in January of this year. Blue Cross Blue Shield has promised to pay $19,000 dollars of her gender reassignment surgery. Given her delight, she'll probably be their customer for life.

3.     Google in California now covers Gender Reassignment Surgery in their insurance policy.

4.     So does American Express.

5.     So do 10 of the Fortune 20.

6.     The exclusions themselves have references that are over 20 years old. What are the assumptions behind those exclusions? It's quite likely that whatever they were, they are no longer valid.

7.     There has been a lot of medical advancement with regards to understanding the eschatology of Gender Identity Disorder and its treatment in the intervening 20 years, most of it in the last 10 years.

8.     The assumption that gender identity disorder can be treated effectively using reparative therapy is now no longer honored among professionals who deal with transgender people, because of the underlying eschatology. In fact, the only treatment that does work, has been found to be transitional therapy, which necessitates in some cases, gender reassignment surgery.

9.     The World Professional Association for Transgender Health, the American Medical Association, and the American Psychological Association have stated that gender reassignment, including surgery in some cases, is medically necessary treatment; and that failure to provide or cover such treatment can be considered discriminatory.

10.   The US Tax Court agrees.

11.   Select Health prides itself on being a discriminatory-free insurance company; but these exclusions are discriminatory against people who suffer from GID.

12.   Select Health, however willingly or unwillingly, made my employer a participant in that discrimination by not providing an option whereby gender reassignment would be covered.

13.   My employer, with over a 1000 employees, is currently interviewing insurance providers, to make sure that the insurance provider meets employee needs within corporate resource boundaries. I have started working with the company's human resources to let them know that these exclusions are in direct contradiction to their employment policy.

The committee also had in front of them the presentation I prepared for my prior presentation. They also had hundreds of pages to reference, including AMA Resolution 122, Tax Court vs O'Dhonobain, the WPATH standards of care as well as my documentation showing that I had followed WPATH SOC.

Monday, when I met with the three members of the trustee board, a lawyer, medical director, note taker and organizer, as well as one other person were present. One of the trustees served as facilitator and after reading my case and complimenting the presentation booklet I had prepared for the last meeting, proceeded to inform me that “it all ends here,” and that they change policy. I stated a summary of my case, and emphasized why the exclusions in their policy with regards to gender reassignment need to be dropped. In the end, I challenged them to determine the thinking behind the exclusions, treat those reasons as assumptions and to strike them from the policy if the assumptions cannot be validated.

During the meeting, the facilitator grilled me over choice, why I went to Thailand instead of having the procedure done in Colorado, why they showed no records of me pre-vetting the insurance policy ahead of time (I just did it anonymously), and if I knew I was taking a risk that the procedure would not be covered.

The trustee sitting to his left seemed to be more concerned with penny-pinching and whether coverage of the surgery had “market penetration.” In fact, his first words, before I knew what he was talking about were, “I’m wondering about the penetration.” I felt rather shocked by that particular statement until he clarified his intent later.

The remaining trustee’s frame of reference was on the public perception of Select Health. He seemed amenable and didn’t have any questions for me.

So, in summary, I feel that they are at least slightly worried about their public image; and yet, there is a hesitancy to take a risk to pay for the surgery without knowing that their competitors have already profited from the risk.

So, even though I came in trying to argue that coverage is the right thing to do, I had to digress to argue about cost. I even asked the penny-pincher, “What is the value of a human life?” I  later referred to calculations by the AMA and myself that the total cost is negligible.

At this point, I give it a 50/50 chance of going either way.

Hugs and Blessings,

Sofia