TRANSSEXUAL RESOURCES IN PORTLAND
INSURANCE COVERAGE FOR SRS
Legal Precedent Set in
New York State
Many people have inquired as to the status of insurance
coverage for SRS. At present, if your medical insurance specifically excludes
SRS coverage in their master policy statement, you are not covered. You may
avoid hassles on other matters (i.e., prescriptions and psychological
counseling/assessment) by asking your provider to judiciously word the claim
form submitted in your behalf. If no specific mention of SRS is made in your
policy, however, then you may successfully argue for full coverage or,
alternately - if your insurer is obstinate - you should at least negotiate for
partial reimbursement. you have nothing to lose by being assertive, and possibly
much to gain. Remember, one way or another you are paying for this coverage. If
your coverage originates in New York State, because you live or work there, and
if your policy does not specifically exclude SRS, then you must be afforded full
coverage, in line with that provided for any other legitimate medical procedure.
This is mandated by the finding in Davidson vs. Aetna, as detailed below. This
decision, which set a precedent, has been relied upon by other jurisdictions as
well, for guidance. Unfortunately, this ruling is not binding in other
jurisdictions, but you may introduce it in support of your argument: Victoria L.
Davidson vs. Aetna Life & Casualty Insurance Co., 101 misc. 2d 1, 420 N.Y.S.
2d 450 (Sup. CT. 1979) The first [U.S.] case cited involving a private health
carrier was decided by the New York Supreme Court in 1979. Davidson’s insurance
carrier, Aetna Life Insurance Company, refused to bear the cost of medical
expenses for sex reassignment surgery (SRS), alleging: 1.) Gender dysphoria is
not an injury; 2.) Transsexual surgery is cosmetic in nature; 3.) Surgical
intervention is not necessary and unreasonable. The court ruled in favor of
Davidson, finding the surgery “cannot be considered to be of a strictly cosmetic
nature”, and that the “sex change operation of the plaintiff is of a medical
nature and is feasible and required for the health and well-being of the
plaintiff”.