Over the last year and a half, the Coalition of Graduate Employees at Oregon State University became aware that transgender graduate students under PacificSource’s health care plan were being denied care, and that this denial was very much determined among gender lines.
Even though there was specific language in the PacificSource health care guidelines covering “Treatment for Gender Dysphoria,” students were having great difficulty receiving covered care.
Despite multiple attempts by the CGE to work with PacificSource and OSU to clarify the health care plan language, the 2017-2018 Graduate Employee Healthcare plan language was even more vague and less inclusive for transgender graduate students.
Emory Colvin, Secretary Treasurer of the CGE, explained that the majority of the complaints they’ve received are for denial of coverage of what is commonly referred to as “top surgery,” or breast augmentation surgery. For transgender men, the surgery has been consistently covered, but for transgender women, it has often been denied as being cosmetic.
PacificSource has been unclear about what is covered, making it difficult for students to receive pre-approvals for surgery. Colvin said that PacificSource’s own case managers often don’t know what items will and will not be covered by insurance.
In a statement, OSU Vice President of University Relations and Marketing Steve Clark said, “In an email sent in the second week of November to all CGE members, OSU leaders reported that this matter promptly would be addressed by PacificSource.”
“As I understand, PacificSource has now completed an amendment to the insurance plan regarding this matter. As well, PacificSource will provide additional training of its staff; have one case manager to support individuals seeking such coverage; and affirmed that the firm will follow the national guidelines.”
In a press release from earlier this month, CGE asks for “an immediate timeline towards OSU working with PacificSource to provide transgender healthcare which is covered, comprehensive, and inclusive.” Despite the changes, the new language does not fulfill the CGE’s request.
“The amendment is an improvement, but doesn’t entirely capture what the problem was,” Colvin said. “It now states that it covers ‘hormone therapy, gender affirmation surgery, and certain non-medically necessary services.’ The problem that was happening is that PacificSource was denying services listed as medically necessary by the World Professional Association for Transgender Health’s (WPATH) standards. We want language that requires PacificSource to conform to WPATH’s definitions of medical necessity.”
More inclusive language in the plan guidelines would mean transgender students would not have to question whether their care would be covered. The new language may be an improvement, but without more specific guidelines, students are still left in the dark.
By Ashley Rammelsberg