Transgender Man Wins Health Insurance Coverage for Gender Transition

Melanie Nathan | Oblogdeeoblogda |  December 22, 2015.

New York, NY – The Transgender Legal Defense & Education Fund (TLDEF) has secured insurance coverage for a transgender man’s medically necessary care after his union-sponsored health insurance plan refused to cover it.  Adrian Sealy works in a Rochester, NY hospital as a cleaning and sanitation specialist. He is a member of 1199 SEIU United Healthcare Workers East, the nation’s largest union for health care workers. The union is self-insured for its workers’ health care.

Screen Shot 2015-12-21 at 9.42.50 AMTwo years ago, Adrian began transitioning to live openly as male, changing his name and correcting legal documents. He began medical treatment, which included hormone therapy and a prescription for a hysterectomy. Earlier this year, Adrian’s doctor filed a pre-authorization request for his hysterectomy. Almost immediately, Adrian was informed that his health care would not be covered because “in the opinion of the 1199 SEIU National Benefit Fund… gender re-assignment surgery is not a covered benefit.”

But nowhere in the union’s health plan did it actually state that transition-related care would not be covered on the same terms as any other medically necessary care. On November 2, TLDEF challenged the union’s decision, demanding that 1199 SEIU overturn Adrian’s claim denial and ensure that “medically necessary treatments for gender dysphoria, including surgical interventions, will be covered for 1199 SEIU members in the future.”

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