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BCBSM speaks about cutting gender reassignment coverage

LANSING – As reported last week in Between The Lines, Blue Cross Blue Shield of Michigan has announced it will eliminate coverage of gender reassignment surgery in its single payer insurance program, effective immediately. That decision has the Coalition for Gender Equality calling for a re-examination of the decision.
But BCBS spokesperson Helen Stojic said the decision was a business decision, plain and simple.
"We took a look at our product line and what other insurers were covering in other markets," Stojic said. "Most don't cover this type of surgery. So we are aligned our products."
But that explanation is not sitting well with Coalition members, which include groups like Michigan Equality, Transgender Michigan and Triangle Foundation, as well as the National Association of Social Workers Michigan chapter and the ACLU of Michigan.
"The ultimate impact of not having access to those services at all, I believe, is going to lead transgender people to have more health issues, less access to health care, and then open up the door of mental health care," said Maxine Thome from NASW of Michigan. Thome said in her private practice she is currently working with five people in the process of transitioning. "The ability to attempt to pass without surgical intervention is not only a health risk, it is a safety risk. It may lead people to access those services from the street. It is not too dissimilar from what women were doing when abortion was illegal."
"We certainly understand that people who are particularly interested in (transgender health) may not be happy with (coverage elimination)," BCBS's Stojic said about concerns. "We have to compete in the market."
Jason Moon, a spokesman for the Office of Financial and Insurance Regulation, called the change "unfortunate," but noted the law did not define gender reassignment surgery as a necessary medical care area. Moon said such areas were things like breast cancer and diabetes.
Health officials, including the American Medical Association, have declared Gender Reassignment a medically necessary treatment for gender dysphoria.
Thome listed off a series of concerns associated with lack of access to affordable gender reassignment options, including access to hormones. She said it was possible the elimination of the plan coverage could lead to transgender people seeking injectible hormones from the streets, raising the risk of HIV infection as well as other disease issues.
In addition to eliminating the coverage for gender reassignment surgeries, BCBS, the insurer of last resort which is obligated by law to insure all patients regardless of pre-existing conditions, also changed maternal health care coverage. The new coverage has a benefit maximum of $5,000 for vaginal delivery, and $7,500 for medically necessary C-sections. The insured party would be required to pay above and beyond what BCBS covers. The new plan also forces women to wait six months before they conceive, or the maternity coverage does not kick in.
Also under the new plan, unlimited hospitalization coverage has been reduced to a maximum of 120 days, and inpatient mental health and substance abuse coverage has been slashed from 45 days to 30 days.
"We are concerned that BCBSM underestimates the profound impact of these medically necessary procedures," said Andre Wilson of MCGE. "Gender reassignment surgeries can be a critical part of the transition process and these new exclusions will place many transgender individuals and their families at real risk."
Julie Nemecek, co-director of Michigan Equality, said the state's comment about the change being "unfortunate," gave her hope the policy might change again.
"It gives me a lot of encouragement they recognize how bad a decision it was on their part," said Nemecek.

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