Transgender surgery: should your company pay for it?

Transgender employee Gina Duncan works at Wells Fargo where her sex reassignment surgery was covered by health insurance.

/ AP Photo/Roberto Gonzalez

(CBS/AP) SAN FRANCISCO - While millions of Americans are grappling with employer-provided health insurance that covers less and costs more, one surprising group is benefiting as of late - transgendered people.

That's according to an Associated Press report which found that big name companies like Coca-Cola, Campbell Soup and Walt Disney have expanded their insurance coverage to meet the needs of transgender workers.

All told, there are 85 large businesses and law firms that cover the cost of at least one surgery, according to a 2010 survey by the Human Rights Campaign, the nation's largest gay rights group.

The trend follows a concerted push by transgender rights advocates to get employers and insurers to see sex reassignment the way the American Medical Association does - as a medically indicated rather than an optional procedure for people diagnosed with gender identity disorder.

In order to transition from one gender to another, patients may need some combination of hormone treatments, breast augmentation, plastic surgery to remove or reconstruct genitals and facial reconstruction. People suffering from gender identity disorder are at a very high risk for suicide.

Some businesses see covering the cost of transgender surgery as not only an important human resources statement, but good business sense. They want to retain valuable employees and are keen to keep a 100 percent rating on the Corporate Equality Index, a measure graded by the Human Rights Campaign.

The next index comes out in fall and in order to keep a pristine rank, companies will have to offer at least one insurance plan that covers at least $75,000 worth of surgery and other treatments recommended by a patient's doctor.

Find out more about gender identity disorder here. Find out about the HRC's corporate equality index here.

WHAT DO YOU THINK?
Should companies pay for sex reassignment surgery and other treatments or is it asking too much?

[ripley816]

This is absolutely a waste of money. This condition is bogus and also a waste of strength in people. Another way to weaken the community and the people in it. A person is conflicted about body parts is more likely to get insurance to pay for a swap rather than a cancer patient receive radiation treatment. Does this sound right? Its not about bigotry, it is about community perspective and initiating priorities.

[ZoeBrain]

I understand that that's your opinion. Everyone's entitled to those. They're not entitled to their own facts though, and here's the facts:

From Sexual Hormones and the Brain: An Essential Alliance for Sexual Identity and Sexual Orientation Garcia-Falgueras A, Swaab DF Endocr Dev. 2010;17:22-35

The fetal brain develops during the intrauterine period in the male direction through a direct action of testosterone on the developing nerve cells, or in the female direction through the absence of this hormone surge. In this way, our gender identity (the conviction of belonging to the male or female gender) and sexual orientation are programmed or organized into our brain structures when we are still in the womb. However, since sexual differentiation of the genitals takes place in the first two months of pregnancy and sexual differentiation of the brain starts in the second half of pregnancy, these two processes can be influenced independently, which may result in extreme cases in trans-sexuality. This also means that in the event of ambiguous sex at birth, the degree of masculinization of the genitals may not reflect the degree of masculinization of the brain. There is no indication that social environment after birth has an effect on gender identity or sexual orientation.

It's a congenital medical condition, mixed anatomy, visible on PET and MRI scans. Like cancer in that respect, and almost as distressing.

[WestonJames]

As someone who has this "bogus condition," I can tell you it's anything BUT a fabrication. Take the time to educate yourself rather than bask in your own ignorance.

[hp440lisa]

As a Transsexual I find it offensive that your article would try to rename sex reassignment surgery with an offensive and inaccurate term Transgender. Someone please do their homework and research the history of the word Transgender its very problematic. Also as a heterosexual identified Transsexual I neither want to be labelled the word Transgender or associated falsely with the LGBT. The LGBT does not represent me or my best interest and forcing that association on people that do not wish it is at best unethical but most likely illegal.

[Chromodoris]

Holy crap! I need to work for Disney! :D

[BellaMaddo]

Ground Breaking Film with an ALL Transgender Cast- www.bellamaddo.com

[tsigili]

Absolutely not. Period.

[ZoeBrain]

You are of course entitled to your own opinion. May I ask why you come to that conclusion though? It might help others explore the issue. Saying either "The Earth is flat, period" or "The Earth is round, period" without giving reasons for those beliefs doesn't really help a lot. I assume you came to that conclusion on the basis of some evidence, rather than, say, tossing a coin? Could you please tell us what that evidence is.

[T-Girl-Nicole]

To the people above concerning Gender being a choice.

Your gender is not your choose, you do not choose to be female or male. You are completely born with your gender it can differ that can differ from that of your own sex. However gender is not just Black and white there is a gray area, for people who feel they aren't either or maybe even both.

As far as SRS is concerned in America it is only for people who have been diagnosed with Gender Identity disorder aka Transsexuals. Transsexuals are created at birth, in the womb everyone originally starts out as being female and then the chromosomes/DNA tell the body what sex that they should be developing to become. However there is abnormalities the brain could be developed to becoming female while the Genitalia and the rest of the outside body is developing to become male. This is thus how gender is created through the brain it is what you see yourself as. Transsexuals should have the right to get SRS(sexual-reassignment-surgery) that is covered by health insurance. You say that the national suicide rate is 1.4% do you realize that it is about 31% for the transgender community.

It should be covered it is much needed in our community, it is very hard to pay for it out of pocket it is quite expensive. There are many transgendered people today who don't have surgery quite frankly because they can't afford it.

Kudos to private health care insurances for doing something right for once.

[kc629]

I support the gay community 100% but, with that being said, we need to focus on getting NECESSARY treatments covered and insurance reform implemented, there are too many actually ill people struggling. 75,000 worth of coverage would be a godsend to someone with an actuall illness.

This honestly (no offense guys) is a waste of time, resources, and money. Gender is not a life or death situation. If these kinds of surgerys are covered, any cosmetic operation should be fully covered as well! I know many girls who'd like to upgrade to a C and sit home and recover on the companies dime! And, once this word gets around the workplace I dont see many happy co-workers either.

[ZoeBrain]

Kc629

Did you see the bit in a previous comment about // is medically indicated and medically necessary. Sex reassignment is not "experimental," "investigational," "elective," "cosmetic," or optional in any meaningful sense.//

This has nothing to do with the "gay community". Gays don't want or need treatmemt like this; in fact, give them cross-sexed hormones (as used to happen), and they'll likely suicide.

This is a life-threatening condition. In the most severe cases, few live to age 25 without treatment. Many more live lives of utter misery for decades. A recent survey showed that 41% had attempted suicide because of this condition, though obviously those who completed, being dead, were not surveyed. Many more die of stress-related illness, a "merciful release" for them.

kc629 - tell me - if you were in a car accident, and had your genitalia removed - would you consider re-attachment to be a mere cosmetic procedure, or would you quite literally trade your right arm for full restoration?

[bekahdawn]

You know what i don't understand. You have no idea what it's like to be transgender never had to live with your body not the way it should be. Never had to fight to be the gender you are. to say that insurance companies shouldn't cover these is on the verge of ignorance. People get physical deformities fixed all the time but because it's genitalia people can't seem to handle it. Because in their mind nothing is wrong, I just wish others could experience for a week what we have had to deal with our whole life. Especially societies ignorance.

[Paula_Audette]

I wish that my employer had covered the surgery and all of the preparation (hormone, electrolysis, counseling, etc.). Along with all of the other devastating financial costs to transitioning, it probably cost me another $30k, and that was several years ago. I went to Thailand for my surgery because it was all that I could not even consider a US doctor due to cost. I was, and continue to be, an excellent employee, but I looked around for a different job, even considering working for the state government or moving to another state in order to be covered. Companies will lose some good employees if they don't wish to compete in this benefit, just as they can lose out on employees on affordable health care, vision and other benefits. I think that it is great that more and more companies are covering the medical expenses associated with transition.

[ZoeBrain]

Here's what the Best Practices, the Standards of Care say about the issue:

"In persons diagnosed with transsexualism or profound GID, sex reassignment surgery, along with hormone therapy and real-life experience, is a treatment that has proven to be effective. Such a therapeutic regimen, when prescribed or recommended by qualified practitioners, is medically indicated and medically necessary. Sex reassignment is not "experimental," "investigational," "elective," "cosmetic," or optional in any meaningful sense. "

Not "cosmetic". Not "experimental". Not "optional". NECESSARY.

They had to make this totally, completely, unequivocally and unambiguously clear, but *still* there are people who know nothing about the issues claiming it's "experimental" etc.

[barbaram99]

I have read yer posts when ye talked about this in the Bangor paper. I have a transgender roommate..The poor can't get this necessary medical care..I am a Mainer now in Seattle.

[valarissa]

These surgeries are a personal choice in as much as a cisgendered (non-transgendered) individual makes a choice to live as their assigned gender. We live in a society that does not condone abnormality, so the idea of being a man with breasts, or a woman with a ***** is typically anathema to a person's ability to live a "normal" life. We have such narrow definitions of allowable gender that people tend to fall through the cracks.

I understand that people believe this is a choice, or trans individuals should just live as they were born. However, staggeringly large percentages of attempted suicide rates have been reported in the demographic, to a point that is beyond the ken of most individuals. In a recent study, 41% of respondents reported having attempted suicide. (http://www.thetaskforce.org/downloads/reports/reports/ntds_full.pdf) If you take into account the number who successfully ended their lives, the number would go well over 50%.

Take a minute to contemplate that. 50% of a demographic population attempt to, or succeed in, committing suicide. Let that sink in for a moment. 50%. A coin toss. Heads, your life is bearable enough to just go through life, tails, the situation of your life is such that you actively attempt to end your own life. Flip a coin, and if that coin doesn't land as you predict it to, then you would have attempted to take your own life, and perhaps would have succeeded.

To put this into perspective, the national average rate for suicide, across all demographics, is 1.4%

The amount of money saved through surgery, as opposed to hospitalization, therapy, anti-depressants, court and legal expenses and more is astounding. Lasik and weight loss surgery do not cost upwards of $20,000 dollars. Through insurance negotiation alone, thousands come off that price tag. A procedure that normally costs $20,000 would most likely be negotiated by insurance companies down to $10,000 or less.

Gender Identity Disorder not a choice. Cancer is not a choice. Appendicitis is not a choice. Lasik is a choice, weight loss surgery is a choice. There are alternatives to fixing the problems corrected by Lasik and weight loss surgery. This is why they are not covered. There is no alternative to this procedure.

If you ever seriously considered suicide as a feasible alternative to living without Lasik or weight loss surgeries then perhaps this becomes a more relevant discussion. If those problems ever bothered you enough to hold a knife to your throat or a gun to your head, perhaps then we can discuss the importance of Lasik and weight loss surgery as being medically necessary. I would then request that you get even 30% of a population that has had that surgery and then ask them if they attempted, actually attempted to commit suicide due to not having that surgery or the discrimination faced by having glasses.