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Those clauses give insurers the ability to reject all kinds of claims, Davis says: “Many years ago when I first started my transition, I couldn't even get care for my bronchitis.” Finding providers who would work with him was tough, but getting even ordinary claims accepted can be tougher: a friend of Davis' was asked to pay out-of-pocket to set a stress fracture in his leg, after the insurer argued that hormone therapy must have increased the likelihood that the bone would break.

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Prior to that, she notes, there wasn't a complaint code.

Activists have argued for trans-inclusive care from a couple of perspectives.

How well things are working in those states is difficult to ascertain.

Cheryl Martinis, public information officer for the Oregon Insurance Division, said her office has received five formal complaints—the details of which are confidential—relating to transgender care since Oregon clarified its non-discrimination policy in January.

“There's been a revolution in the understanding of what medically necessary care means for transgender people in the last 10 years,” says Masen Davis, executive director of the Transgender Law Center in San Francisco. Public bodies like the cities of Portland and San Francisco, and Multnomah County (where Portland is located), have also offered trans-inclusive care to their employees in the last few years.

More employers have started offering benefits to work around the fact that most private insurers either provide limited access to transition care (hormones, but not surgery) or issue policies with clauses explicitly refusing to cover any medical care related to gender transitioning.(Medicaid plans are administered by the state.) But everyone Newberry has spoken to has been “nice,” she says, and the providers she's worked with at Kaiser—though she had surgery at an outpatient clinic in Lake Oswego, a suburb of Portland—have been professional and kind.“It's just this frustrating refusal to grapple with the real issue.”THE CURRENT FIGHT TO get insurers to cover gender transitioning is a far cry from the days when trans people in the U. sought “sexual reassignment surgery” (a term still used in medical circles, if less frequently by activists) either overseas—the first documented gender confirming surgery was performed in Germany at the Institute for Sexual Sciences in 1931—or at clinics found through a kind of whisper system.First, they point out that transition care is relatively cheap in the larger scheme of things—often less expensive than employers or insurers assume.The city of San Francisco charged individuals an additional

More employers have started offering benefits to work around the fact that most private insurers either provide limited access to transition care (hormones, but not surgery) or issue policies with clauses explicitly refusing to cover any medical care related to gender transitioning.(Medicaid plans are administered by the state.) But everyone Newberry has spoken to has been “nice,” she says, and the providers she's worked with at Kaiser—though she had surgery at an outpatient clinic in Lake Oswego, a suburb of Portland—have been professional and kind.“It's just this frustrating refusal to grapple with the real issue.”THE CURRENT FIGHT TO get insurers to cover gender transitioning is a far cry from the days when trans people in the U. sought “sexual reassignment surgery” (a term still used in medical circles, if less frequently by activists) either overseas—the first documented gender confirming surgery was performed in Germany at the Institute for Sexual Sciences in 1931—or at clinics found through a kind of whisper system.First, they point out that transition care is relatively cheap in the larger scheme of things—often less expensive than employers or insurers assume.The city of San Francisco charged individuals an additional $1.70 a month after adding trans-inclusive care for all of its employees in 2001, only to find itself with a surplus of over $4.1 million three years later.Gender confirming surgery can be expensive for individuals—Newberry paid $17,500—but that's pocket change compared to more commonly performed procedures (open-heart surgeries can cost anywhere from $20,000 to $100,000, tracheostomies are about $200,000, and organ transplants start there and spiral upwards) and not all transgender people want it.

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More employers have started offering benefits to work around the fact that most private insurers either provide limited access to transition care (hormones, but not surgery) or issue policies with clauses explicitly refusing to cover any medical care related to gender transitioning.

(Medicaid plans are administered by the state.) But everyone Newberry has spoken to has been “nice,” she says, and the providers she's worked with at Kaiser—though she had surgery at an outpatient clinic in Lake Oswego, a suburb of Portland—have been professional and kind.

“It's just this frustrating refusal to grapple with the real issue.”THE CURRENT FIGHT TO get insurers to cover gender transitioning is a far cry from the days when trans people in the U. sought “sexual reassignment surgery” (a term still used in medical circles, if less frequently by activists) either overseas—the first documented gender confirming surgery was performed in Germany at the Institute for Sexual Sciences in 1931—or at clinics found through a kind of whisper system.

First, they point out that transition care is relatively cheap in the larger scheme of things—often less expensive than employers or insurers assume.

The city of San Francisco charged individuals an additional $1.70 a month after adding trans-inclusive care for all of its employees in 2001, only to find itself with a surplus of over $4.1 million three years later.

Gender confirming surgery can be expensive for individuals—Newberry paid $17,500—but that's pocket change compared to more commonly performed procedures (open-heart surgeries can cost anywhere from $20,000 to $100,000, tracheostomies are about $200,000, and organ transplants start there and spiral upwards) and not all transgender people want it.

.70 a month after adding trans-inclusive care for all of its employees in 2001, only to find itself with a surplus of over .1 million three years later.Gender confirming surgery can be expensive for individuals—Newberry paid ,500—but that's pocket change compared to more commonly performed procedures (open-heart surgeries can cost anywhere from ,000 to 0,000, tracheostomies are about 0,000, and organ transplants start there and spiral upwards) and not all transgender people want it.