Vt. officials clarify gender-affirmation insurance coverage rules

BURLINGTON, Vt. (WCAX) Vermont is clarifying rules for insurance companies about covering gender-affirmation surgery.

The Department of Financial Regulation says it got several complaints, including a few recently that insurance companies were putting age restrictions on some types of surgery for transgender people, particularly youth.

The department says that's discrimination. Department of Financial Regulation Commissioner Michael Pieciak spoke with our Cat Viglienzoni. He says they're clarifying for insurers that the surgery is determined by medical necessity and not other factors like age or gender.

Cat Viglienzoni: Why is that significant?

Michael Pieciak : It has come to our attention with a few consumer complaints that youth who are transgender in Vermont were having some inability to access gender affirmation care. In particular gender affirmation surgery. The reason for this was that some companies had a strict age restriction on certain types of gender affirmation care. Again, particularly relating to gender affirmation surgery. So, Vermont law is pretty clear on this point -- that there cannot be discrimination based on gender identity. So if similar surgeries were to occur for someone who is not transgender, for example, to be covered by an insurance company, they cannot be denied for someone seeking that same care who is transgender. And in this instance it was clear to us that we had to refine a previous policy that we put out to clarify that there could not be a hard and fast age restriction when it comes to these critical services -- this critical care. It has to be determined by medical necessity and that has to be what drives the decision.

Cat Viglienzoni: How many cases do you know of where this has happened?
Michael Pieciak: Yeah, so we've received a handful just this year. And every year there seems to be questions and calls to our consumer services department about access to care. But just in the last six months we've received a couple of different complaints, so this is what really brought the issue to our attention and why we really thought we needed to go out and make this important clarification.

Cat Viglienzoni: So what's next for people who might have run into a barrier already? Can they now pursue it further?
Michael Pieciak : Yeah, so our bulletin clarifies the law. But it is our opinion that this was the law since it was passed in 2007. So if individuals have had difficulty accessing that care, they should contact our department, our consumer services division, and make a complaint with us. We will receive those complaints. We also handle external appeals from the insurance company as well, that will come to us through the normal appeals process. So we certainly encourage Vermonters who have run into issues or who have questions to reach out to our department and get those questions answered.

Cat Viglienzoni: Is the issue of transgender surgery the only time this has come up, or does this apply to other medical procedures as well?
Michael Pieciak : It applies to really any medical procedure that relates to gender affirmation care. Certainly in preparation for surgery, in post-surgery as well. So it's a pretty broad application in terms of the nondiscriminatory impact. So people who have had difficulty in the community should reach out to our department.

Vermont's revision comes as the federal government considers rolling back some similar gender identity protections.

More Resources:

Click here to read the DFR bulletin

Click here for information on how to contact the department to file a complaint.