Under the direction of Insurance Commissioner Mike Kreidler, Kaiser Foundation Health Plan of Washington and Kaiser Foundation Health Plan of Washington Options, Inc. have reversed their practice of denying breast augmentation, or chest reconstruction, for transgender women. View the agreement.
Kreidler started an investigation into the companies earlier this year when three consumers sought help from his office. The companies specifically excluded breast augmentation as a treatment for gender dysphoria, the clinical diagnosis for transgender men and women. The companies did not consider individual cases, but instead issued blanket denials based on exclusions in their policies.
As a result of Kreidler’s investigation, the companies will now cover chest reconstruction for transgender women. A physician must write a prescription for the treatment.
In addition, both companies will review all denials of this treatment since January 2016, and will complete the assessments by Oct. 28.
“People who are transgender should not be barred from medical treatments because of their gender identity,” Kreidler said. “I’m glad the companies ultimately did the right thing to ensure they are treating their transgender enrollees fairly.”
Kreidler’s investigation found that the companies treated transgender women differently than they treated transgender men and cisgender women. The companies pay for chest reconstruction for transgender men and for cisgender women who have had a mastectomy. The Affordable Care Act requires insurers to cover services for transgender individuals if they cover the services for cisgender individuals.
In addition, Washington state’s mental health parity laws don’t allow insurers to categorically deny a treatment that is medically necessary to treat a mental health condition.
If you have been denied insurance or treatment based on your gender or gender identity, you should file a complaint with Kreidler’s office.
Consumers in Washington state can get help with their health, property, life and other types of insurance from Kreidler’s office. Help is available online or by phone at 1-800-562-6900.