A D.C. transgender man says he’s in the process of filing a complaint with the city against Kaiser Permanente because it refused to provide him with health insurance coverage for his gender reassignment surgery.
Morgan Givens, 30, told the Washington Blade that although Kaiser never officially denied coverage for his needed female to male periareolar or “top” surgery, it failed to respond to his repeated requests beginning in March for information needed to arrange for the surgery.
“I spent over six months attempting to find out from Kaiser and their employees what I needed to do in order to have top surgery cleared and covered and got virtually nowhere,” he said.
“Employees would ‘lose’ my paperwork, hang up the phone when they realized what I was attempting to gather information about, say they were transferring me when they found out what I was calling about only to have the line go dead a few minutes later,” he said.
“I attempted to find information on their website about transgender health, who I needed to see, or where I should go all while trying to find someone who would be able to assist me, and there was nothing,” Givens said.
The D.C. Department of Insurance, Securities and Banking issued a bulletin in February 2014 reminding the public and the insurance industry that existing D.C. law requires all health insurance companies doing business in the city to provide full coverage for medically recognized treatments to help transgender people change their gender.
The bulletin says gender reassignment surgery is among the treatments health insurers are required to cover for people with gender dysphoria, a condition recognized by the American Medical Association and the American Psychiatric Association.
Shana Selender, public relations manager for Kaiser Permanente’s Marketing and Corporate Communications division, told the Washington Blade in an email statement on Monday that Kaiser could not comment on Givens’s specific case due to patient confidentiality requirements.
But she added, “Kaiser Permanente is deeply committed to providing equitable, compassionate and high-quality care to our transgender members. We strive to treat all members, including those considering gender transition, with dignity and compassion, and to support their decisions with an experienced team of expert physicians and specialists.”
Selender said Kaiser covers a “wide range of surgical and non-surgical services when clinically appropriate for members diagnosed with gender dysphoria.” Among them, she said, are behavioral health visits, hormone therapy and “gender confirmation” surgeries.
Her description of the transgender-related services provided by Kaiser is at odds with Givens’s account of how the company responded to his attempt to obtain coverage for his surgery.
Among the questions that Kaiser never answered during the first six months of his attempts to arrange for surgery, according to Givens, was whether Kaiser had within its network of physicians a surgeon qualified to perform gender reassignment surgery.
By late August, Givens said, he scheduled his surgery with internationally recognized plastic surgeon Beverly Fischer of Timonium, Md., who specializes in gender reassignment surgery for female-to-male transgender patients.
He said he remained hopeful that Kaiser would approve reimbursement for some if not all of the cost for the procedure. Although Fischer, who teaches at Johns Hopkins University, is not within Kaiser’s network of physicians and surgeons, Givens said a Kaiser representative gave him the name of a Kaiser doctor who had the authority to provide him with a referral to Fischer.
Such a referral would enable Givens to receive partial reimbursement for the surgery, which he said cost him over $8,600. But similar to his past interactions with Kaiser, the referring physician and his administrative support staff took weeks to get back to him, Givens said. Three weeks prior to the surgery, he said, he had to pay the cost of the surgery in full.
“Because I was getting no assistance from any Kaiser employees, I decided I would attempt to recoup some of my money after the surgery,” he said.
However, when he attempted to submit a claim for partial coverage after the surgery took place, a Kaiser representative told him that Kaiser, in fact, had a surgeon that preforms gender reassignment surgery and he could not be reimbursed for an out-of-network surgeon.
“I then asked why it was that after spending seven months trying to gather this information I was just being informed of this,” Givens said.
He said a short time later a Kaiser representative named Laura Weimer, a nurse case manager, called him, saying she had heard he was having a “bad experience” with Kaiser.
“I laid out the entirety of what had happened over the seven-month period,” he said. She apologized, “said it should not have happened, but that Kaiser would not reimburse me any portion of my surgery,” said Givens.
On Oct. 21, Givens said, he spoke with Kaiser officials E.W. Emanuel and Ayanna Wells, who told him they were in charge of Kaiser’s transgender healthcare branch.
“Both of them told me that while the behavior of their staff was unacceptable, they were new to providing transgender care, none of their staff had been trained nor knew where to point me or how to interact with me,” Givens said.
“They also said the staff at Kaiser were predominantly unaware of doctors within the network who could specialize in trans health or that there is a surgeon who performed gender reassignment surgery, but that they could still do nothing to compensate me for their staff’s mismanagement,” said Givens.
“I’m furious about the treatment that I received because I know it was directly linked to the fact that I am transgender,” Givens told the Blade. “I also worry and wonder about the people in the community who wouldn’t be able to foot the bill for their surgery if they ran into the same form of depressing discriminatory resistance I experienced.”
He said he planned to file a complaint against Kaiser this week with the D.C. Department of Insurance, Securities, and Banking.
“I can tell you the department takes this kind of complaint very seriously and we will look at the details of the particular situation, including whether the insurer effectively discouraged the insured from accessing benefits for which he is eligible,” said Philip Barlow, D.C.’s Associate Commissioner of Insurance.
“When addressing complaints we look at both the letter and the spirit of the law in determining what actions we take,” Barlow said. “In general, we have found that when presented with facts that support the insured, the insurers operating in the District have acted promptly to address the situation and have looked to modify their procedures to reduce the likelihood of future occurrences.”
Added Barlow: “We encourage any resident in the District or any person covered by an insurance policy issued in D.C., to file a complaint with DISB any time they feel they have a problem. The department will thoroughly investigate the complaint and ensure that the HMO complies with the requirements of our bulletin.”
Selender, the Kaiser spokesperson, didn’t address the specific concerns raised by Givens but said the company strives to address the needs of all of its members.
“While we cannot comment on the specifics of any case due to patient confidentiality, we are committed to working with each of our members to better understand the specifics of their case and how we can better provide the best care possible,” she said.