Lee Albertorio felt like a man trapped in a woman’s body. After serving in the Air Force, he began taking hormones, which deepened his voice and made his physique more masculine.
He changed his passport to reflect that he was male, and last year he decided to have a mastectomy, known as top surgery. But his insurance company told him the operation was cosmetic and refused to cover it, he said Wednesday.
Now Gov. Andrew M. Cuomo is warning insurance companies that they will no longer be allowed to deny gender reassignment surgery or other treatment to change a person’s gender, like hormone therapy, if a doctor has deemed that treatment medically necessary.
In a letter being sent to insurance companies this week, the governor said that because state law requires insurance coverage for the diagnosis and treatment of psychological disorders, people who are found to have a mismatch between their birth sex and their internal sense of gender are entitled to insurance coverage for treatments related to that condition, called gender dysphoria.
“An issuer of a policy that includes coverage for mental health conditions may not exclude coverage for the diagnosis and treatment of gender dysphoria,” the governor’s letter says.
“That would change everything — I mean that sounds very good,” Mr. Albertorio said excitedly when told of the governor’s order.
The rule makes New York the ninth state to require the coverage, the Transgender Legal Defense and Education Fund, an advocacy group, said on Wednesday. The others are California, Colorado, Connecticut, Illinois, Massachusetts, Oregon, Vermont and Washington, according to the group. Washington, D.C., also mandates it.
The group said that most insurance policies currently exclude coverage for transgender treatment, and at best include it as a more expensive rider to a standard plan.
“This is an absolute sea change in the way that insurance for transgender people will cover their health care needs,” Michael Silverman, executive director of the fund, said. “This essentially opens up an entire world of treatment for transgender people that was closed to them previously.”
Leslie Moran, a spokeswoman for the New York Health Plan Association, the trade association for most health plans across New York State, said the industry did not object to having to cover gender dysphoria.
But she said the industry was concerned that the governor’s order could raise costs in the new year that were not contemplated during the recent round of rate-setting. And she said companies were concerned that the policy would open the door for other services that people might seek, claiming they were medically necessary for mental health reasons.
“It sets a precedent,” Ms. Moran said.
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SOURCE: The New York Times