Insurance victory for Ohio transsexual

By Rachel Charman • May 18, 2007 - 20:30

When she submitted the bills for the surgery to company Highmark Blue Shield, she was refused.

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An Ohio transsexual has won a court battle with her insurance company over the cost of her gender reassignment surgery.

Jan Stacy, and electronics engineer, was told when she began gender realignment in 2006 that her self insured plan covered the surgery.

When she submitted the bills for the surgery to company Highmark Blue Shield, she was refused, despite confirmation from the company's human resources officer that the plan included gender reassignment.

Stacy took her complaint to Pennsylvania LGBT legal organisation Equality Advocates.

After an initial refusal to pay for the surgery, Highmark agreed to enter an arbitration process with Equality Advocates.

Highmark eventually conceded that the plan covered Stacy's surgery, but then refused to reimburse her, claiming that the surgery took place "out of network", and that the surgeon charged more than a "reasonable and necessary" fee.

After Equality Advocates and Stacy's employer persisted, however, Highmark was forced to award Stacy $14,097, which covered most of her medical costs.

Katie Eyer, Employment rights Project Attorney at Equality Advocates, said: "It is appalling how badly Highmark Blue Shield mishandled Ms. Stacy's claim."

"Their repeated refusal to pay this claim was clearly the result of bias against the transgender community, and demonstrated a willful ignorance of the medical necessity of procedures such as SRS."

Eyer said that many members of the transgender community encounter "systematic" problems when dealing with insurance claims.

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