FAQ About Health Provider Discrimination
Yes, transgender people are protected from many forms of health-related discrimination.
The Affordable Care Act of 2010 (ACA) prohibits sex discrimination in federally funded health care facilities, and in 2012, the federal Department of Health and Human Services (HHS) clarified that this includes discrimination based on gender identity or failure to conform to stereotypical notions of masculinity or femininity. Also, the Act forbids insurance providers from refusing to cover a person based on a pre-existing condition, and that includes being transgender. Transgender and gender-nonconforming individuals who suffer discrimination at HHS-funded facilities can file complaints with the HHS Office of Civil Rights (OCR), which will investigate complaints of sex discrimination.
Health care discrimination based on gender identity or expression is also barred if you live in a jurisdiction that has a law that prohibiting discrimination on the basis of sex, gender identity or gender expression in public accommodations. A number of states and the District of Columbia have also issued “insurance bulletins” reminding private insurers that it is against state law and the ACA to allow discrimination against transgender policy holders. For more information on jurisdictions with protections for transgender people, contact the Transgender Law Center.
Every state has an agency that licenses or investigates the conduct of health care professionals, and mistreating someone for being transgender certainly falls under the category of misconduct.
Finally, transgender people are protected under the standards promulgated by the Joint Commission, an independent non-profit that accredits thousands of hospitals and other health care organizations throughout the United States. In 2011, the Commission changed its standards to require hospitals to adopt policies prohibiting discrimination based on gender identity or expression. These are voluntary standards, but certification by the Joint Commission is widely recognized as a mark of quality. If you experience discrimination in a hospital or other health care organization, you can file a complaint with the Joint Commission at jointcommission.org/report_a_complaint.aspx.
Yes, the federal Health Insurance Portability and Accountability Act (HIPAA) protects the privacy of all personally identifiable patient information, including your transgender status, your birth-assigned sex or details about your anatomy. This information cannot be shared without your consent, not even to your family and not even to medical personnel unless it is required by your treatment or for the purposes of payment or health care operations (such as inquiries about liability insurance).
Additionally, you can ask that your transgender status not be shared with certain people, groups or companies even if it would normally be part of health care operations or consultations regarding treatment. For example, if you go to a clinic, you can ask the doctor not to share information regarding your transgender status with other doctors or nurses at the clinic. You can also ask your health care provider or pharmacy not to tell your insurance company about care you receive or drugs that you take as long as you pay for the care or drugs in full and the provider or pharmacy does not need to get paid by your insurance company.
If you experience health care discrimination based on your gender identity or expression, consider filing a complaint. One option is to file a complaint with the Office for Civil Rights at the federal Department of Health and Human Services (HHS). Find out more about that here: hhs.gov/ocr/office/file/index.html.
Another option is to contact the agency in your state that monitors professional misconduct. In New York, for example, contact the state Health Department’s Office of Professional Misconduct; in California, contact the Medical Board of California.
If your state, county or city has a law barring discrimination on the basis of sex, gender identity or gender expression in public accommodations, you may file a complaint about the discrimination you have experienced. It’s generally recommended that you consult a lawyer in such a case.
You may also contact Lambda Legal’s Help Desk (toll-free: 866-542-8336 or lambdalegal.org/help), which takes calls from TGNC people who have experienced discrimination.
The Gay & Lesbian Medical Association (GLMA) maintains an online database at glma.org where patients can search for a health care provider by zip code. National Coalition for LGBT Health member organizations can help too. There are some local directories as well:
For instance, the New York Association for Gender Rights Advocacy (NYAGRA) has a “Transgender Health Care Provider Directory” that lists trans-friendly New York City physicians, psychologists, and therapists in a variety of medical fields.
Another way to find transgender-friendly health care providers is to contact facilities such as Fenway Health in Boston; The Fenway Institute in Minnesota; Whitman Walker Health in Washington, DC; Howard Brown Health Center in Chicago; Lyon Martin Health Services in San Francisco; the LA LGBT Center in Los Angeles; and Callen-Lorde Community Health Center in New York City.
No, you do not. A myth about transgender health care (and a handy excuse for negligence) is that a doctor needs to be a specialist of some kind to treat transgender people. But the truth is that most doctors are fully capable of providing care for transgender patients, whether for routine checkups; treatment of health problems; or transition-related hormone therapy. The World Professional Association for Transgender Health (WPATH) affirmed in 2012 that “Many of the screening tasks and management of co-morbidities associated with long-term hormone use...fall more uniformly within the scope of primary care rather than specialist care, particularly in locations where dedicated gender teams or specialized physicians are not available.”
The University of California at San Francisco’s Center of Excellence for Transgender Health in 2011 compiled a Protocol for Transgender Patient Care that doctors of all kinds can use as a reference. The Protocol can be viewed online at http://transhealth.ucsf.edu/trans?page=protocol-00-00. You can also encourage your provider to contact one of the trans-friendly health clinics mentioned above.
FOR MORE INFORMATION: Contact Lambda Legal at 212-809-8585, 120 Wall Street, Suite 1900, New York, NY 10005-3904. If you feel you have experienced discrimination, call our Help Desk toll-free at 866-542-8336 or go to www.lambdalegal.org/help.