Aetna is expanding coverage for gender-affirming surgeries for transgender women.
The insurer will now cover gender-affirming breast augmentation in most of its commercial plans, the CVS Health subsidiary announced this week. The change came as a result of a collaboration between Aetna, the Transgender Legal Defense & Education Fund (TLDEF), Cohen Milstein Sellers & Toll law firm and several transgender Aetna members.
The update aligns coverage for breast augmentation with coverage policies for other surgical procedures for transgender patients such as breast removal or gender-reassignment surgery. Breast augmentation procedures will be covered with a referral from a doctor, documentation of the patient's gender dysphoria and the completion of at least one year of hormone therapy, Aetna said.
After being denied coverage for breast augmentation under their plans, two transgender women contacted TLDEF and Cohen Milstein, who worked with Aetna to update the policy.
“My hope is that being part of this groundbreaking collaboration helps other transgender and non-binary people have access to the health care we deserve,” Nancy Menusan, one of the women, said in a statement. “By dropping exclusions for medically-necessary care like top surgery, Aetna is paving the way and setting an example for other health insurance providers, and I hope others will take note.”
Transgender patients experience significant hurdles to accessing care. A 2018 study found that 70% experience some kind of discrimination when seeking care, leading nearly half to avoid visits to the emergency department for acute care needs.
Some insurers have been bringing more transgender voices into the discussion on how they can improve; Blue Cross Blue Shield of Minnesota, for instance, has hired a gender services consultant who can assist in navigating care needs.
Startups like Plume are aiming to target transgender and other LGBTQ patients directly and are getting into the benefits space to provide a service that better fits them.
Aetna has worked previously in collaboration with TLDEF and Cohen Milstein to update its coverage options for transgender members, according to the announcement.
“Our decision to update our clinical policy bulletin is consistent with many changes we have made over the years to better serve the needs of the LGBTQ community,” said Jordan Pritzker, senior director of clinical solutions for Aetna, in a statement. “We appreciate the collaborative nature of this process, which allowed us to make an evidence-based change to our coverage policies regarding important care for members of the LGBTQ community.”