Transgendered man wins insurance coverage

The legal victory is also being viewed as a societal one for a community still struggling to win what it sees as equal footing in insurance coverage

Transgendered man wins insurance coverage

Insurance News

By Lyle Adriano

After a union-sponsored health insurance plan refused to cover his medical needs, transgender man Adrian Sealy found insurance coverage through the help of the Transgender Legal Defense & Education Fund (TLDEF).

Sealy works in a hospital located at Rochester, NY as a cleaning and sanitation specialist. Additionally, he is a member of 1199 SEIU United Healthcare Workers East; the union is self-insured for its workers’ health care needs.

Two years ago, Sealy began to identify himself as male, correcting legal documents to reflect his gender, and even underwent medical treatment. When Sealy’s doctor filed a pre-authorization request for a hysterectomy, Sealy was informed that his health care claim would not be covered.

“[In] the opinion of the 1199 SEIU National Benefit Fund… gender re-assignment surgery is not a covered benefit,” according to a statement by the union.

Despite the statement, the union’s health plan does not actually have any clause that prohibits gender transition-related care. The TLDEF challenged the union’s decision on these grounds on November 2, demanding that the union overturn Sealy’s claim denial and make sure that “medically necessary treatments for gender dysphoria, including surgical interventions, will be covered for 1199 SEIU members in the future.”

Afterward, the union reversed its decision and informed both the TLDEF and Sealy that his care would be covered. A representative of the union stated that it is “not the policy of any our health funds to exclude coverage for gender reassignment.”

TLDEF Staff Attorney Ethan Rice expressed his enthusiasm for the victory the TLDEF has scored for Sealy.

“We are thrilled by this tremendous victory for Adrian and the 400,000 workers affiliated with 1199 SEIU and thank the union for its prompt and positive response.”

In a recent interview with The New York Times, Michael Silverman, executive director of the TLDEF, said that “Many people still don’t think of [transition medical procedures] as medically necessary care, so they reflexively deny claims because that’s what they’ve always done.”

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