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Popular Topics in The Arts
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Topics In the News
 
Transgender Woman Wins Insurance Coverage for Sex Reassignment Surgery
Posted by: Claude J. Summers on 10/09/12
Last updated on: 10/09/12
 
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Ida Hammer.

On October 3, 2012, the Transgender Legal Defense and Education Fund (TLDEF) announced that it has resolved a claim on behalf of Ida Hammer, a transgender woman who had been denied health insurance coverage for sex reassignment surgery.

Hammer, a New York City resident, applied for pre-authorization for male-to-female sex reassignment surgery in July 2011. MVP Health Care denied her claim on the grounds that the surgery was "cosmetic" and therefore not covered under her policy. MVP denied two internal appeals, even after TLDEF submitted extensive evidence in support of Ms. Hammer's claim.

Only after TLDEF threatened to file a lawsuit did MVP reverse its position and agree to cover the doctor-recommended procedure. MVP acknowledged in its letter authorizing the surgery that "the requested surgery is medically necessary."

"I have been undergoing treatment for gender dysphoria for the past five years. My doctors determined that surgery is the only adequate treatment for my condition," Hammer said when the settlement was announced.

She added: "My insurance company should not be second-guessing my doctors. I'm relieved that it is finally treating me fairly and covering the health care I need."

TLDEF executive director Michael Silverman said, "The well-established medical and legal consensus is that transgender-related health care is medically necessary care. This surgery is not designed to improve one's appearance, but rather to treat a recognized medical condition. Transgender individuals pay the same premiums and simply want the same benefits as anyone else."

The medical necessity of sex reassignment surgery has been widely recognized in medicine and law. Organizations such as the American Medical Association, the American Psychological Association, and the World Professional Association for Transgender Health recognize surgery as medically necessary and support insurance coverage for it.

TLDEF was founded in 2005 to achieve equality for transgender people through public education, test-case litigation, direct legal services, community organizing, and public policy efforts. The New York-based organization works on issues ranging from employment discrimination to health care access, from educational discrimination to housing issues.

In the video below TLDEF attorney Noah Lewis discusses discrimination against transgender people.

 
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