As more trans Coloradans land health coverage, insurers work to deliver better care
One of the challenges facing the health industry in the Obamacare-era is to deliver more, and more enlightened, care providers to serve a more diverse population.
Some Colorado insurers are trying to promote compassion and inclusion in the way doctors and other medical professionals treat the influx of transgender patients seeking health care after years without coverage.
“There are some disconnects between the way insurance is done, the way primary care is provided, and the way patients who have unique needs may experience it,” said Dr. Jack Westfall, chief medical officer at Colorado HealthOP, the state’s non-profit health care cooperative. “One of the big challenges is that transgender patients may not feel safe accessing primary care.”
Insurers traditionally diagnosed applicants whose identities or expressions differ from their birth gender with what they called “gender dysphoria.” The “pre-existing condition” label served as a way to refuse coverage, or at least deny treatment, for transgender patients with unique healthcare needs.
“The best you could get for health insurance [before Obamacare] for a trans person was a don’t-ask-don’t-tell policy,” said Jessica Crowe, whose insurance plan in 2011 through her then-oil-and-gas employer didn’t cover any trans-related medical care. “It was a huge hole in my health care – specifically anything I needed. Medication and doctors’ visits I was paying out of pocket.”
Colorado occupies a unique place in transgender history. For a period between the 1970s and 1990s, the southern Colorado town of Trinidad became a destination for people seeking changes in their gender identities. Stanley Biber was one of the first surgeons to offer gender confirmation surgeries – prolonged, multi-step procedures that tempted patients to take up residency in the old coal-mining town. Locals welcomed the influx of business that came with being the so-called “sex change capital of the world.”
Such tolerance, though, didn’t extend beyond Trinidad’s city limits. Transphobia and discrimination toward LGBT patients has long been and continues to be a problem almost everywhere else in Colorado and nationally.
Things changed last March when the state Division of Insurance issued a bulletin prohibiting insurance companies from discriminating based on sexual orientation and gender identity. Although the bulletin isn’t legally binding, it prompted two insurers, Kaiser Permanente and Anthem, to announce last fall that they would begin to include transgender care in Colorado.
Under its founding principle of non-discrimination, the one-year-old Colorado HealthOP never excluded trans patients. And now it seems to be pioneering the next step in inclusiveness for the LGBT community. Westfall said HealthOP is working on ways to help providers serve the lesbian, gay, bisexual and transgender community with greater comfort and understanding, to make friendly offices.
“If I have a cough, I don’t want to be told it’s because I’m trans,” said Leo Kattari, a social worker in Denver. “What’s really lacking is training and building capacity of providers in being more inclusive and more knowledgeable around their trans patients.
“The number one thing carriers can do is training.”
Kattari goes to providers that are trans-knowledgeable – meaning the entire staff knows to use a patient’s preferred name and to acknowledge his or her preferred gender identity. Many in the community talk enough to one another to figure out which doctors are more trans friendly.
A 2011 report and survey about healthcare by One Colorado, a gay- bisexual- and transgender-rights advocacy organization, showed many LGBT Coloradans had problems accessing informed and compassionate care, while others in the community hid their sexual or gender identities to make sure they’d be treated with respect. One-fifth of those surveyed reported having been turned away by health-care providers.
“There are far too many cases of LGBT Coloradans – particularly transgender Coloradans – who are simply trying to get the health care they need and are forced to deal with powerful barriers that others don’t have to face,” said Dave Montez, One Colorado’s executive director. “It’s time for all Coloradans to be visible and for our systems to reflect that.”
A 2013 report by One Colorado looked at how physicians interact with their LGBT patients. It found that while doctors often felt they treated all their patients equally, that “is not exactly the right approach in the eyes of the LGBT community – one-third of whom are not confident that physicians are actually comfortable addressing their needs.”
“Certainly, there is a gap,” said Sheri Proctor, a trans woman in Boulder. “We’re working really hard [as a community] to close that gap.”
Westfall aims for reform not just by his employer, Colorado HealthOP, but among all insurers in a state in which only three specifically cover trans healthcare.
“This is not just about the Colorado HealthOP. This is about what can we do about moving the industry to be more supportive of the common and unique needs of the LGBTQQI community,” he said.
Crowe, who’s now covered under HealthOP, is taking full advantage of her new benefits by planning a gender confirmation surgery later this year. Reform will mean finally feeling comfortable in her own skin.
“Maybe I’m one of the few, maybe I’m one of the only — but I’m so glad for Obamacare because I would have never had the health care I’m getting today,” she said. “I’ve never ever been able to call and say: This is what I need, this is why I need it.”
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