In My Own Words: Jack’s Story

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April 1, 2016
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This is LGBT Health Awareness Week, and Lambda Legal is partnering with the National Coalition for LGBT Health and other organizations to shine a light on stigma in LGBT health care and raise awareness of LGBT health disparities. 

This year, the theme for LGBT Health Awareness Week is “OUTvisible: Redefining Stigma in LGBT Healthcare from Invisible to OUTvisible.”

We are proud to share Jack’s story. Last year, through Lambda Legal’s representation and advocacy efforts, Jack and his mom obtained an important victory for themselves and transgender people in Connecticut.

Jack came out as transgender at age 15. At first, through his mother’s health insurance, Jack was able to access the necessary gender-affirming health care services for his transition without much trouble. However, when it came time for the insurance to cover Jack’s top surgery, the insurance company (Cigna) refused based first on an exclusion of transgender health care and later on a set of arbitrary criteria.   

After multiple denials and appeals pursued by Lambda Legal, Cigna was ordered by the Connecticut Insurance Department to cover Jack’s gender-affirming top surgery because it is a well-established treatment for gender dysphoria and each patient must be considered on a case-by-case basis to determine the medical necessity of treatment.  

Here is Jack’s story, in his own words:

Coming out as transgender was easy for me. At 15, I came out, and began seeing specialists at a transgender medical center for children in Connecticut, where I live with my mother. For a year, we participated in a series of clinical interviews and assessments, as well as over 15 sessions with a psychologist, before I was told I could begin hormone therapy, and later have gender-affirming top surgery.

Despite all of this, I was excited to finally have the opportunity to fully be and present as my true self. Then came the hard part: my mother’s medical insurance refused to cover the surgery. Three times. They claimed that the plan did not cover “transsexual surgery including medical or psychological counseling and hormonal therapy in preparation for, or subsequent to, any such surgery.”

Even my doctor got involved, pleading with the insurance company to approve the procedure as part of my treatment. Not only was the surgery a critical means of treating my gender dysphoria, he told them, but it was also illegal under Connecticut to refuse to cover it.

As the rejections poured in, a piece of me was wounded more and more deeply. I felt frustrated and invalidated as a person. There seemed like no way around this. The surgery was almost six thousand dollars, close to what my mother made in 4 months. But she paid it, all out of pocket.

While I was happy to finally get the surgery, it pained me to watch my mother spend so much of her savings and babysitting money to cover the cost. Throughout my transition however, my mom was fully supportive of me. She was my safety net throughout the whole long, scary, frustrating and dark way. It was her idea to reach out to Lambda Legal, despite my fear.

Lambda Legal took our case and sought an external review of the insurance company’s denials, arguing that these denials were discriminatory and arbitrary. After working with the team at Lambda Legal, the Connecticut Insurance Department reversed the insurance company’s decision and my mother received the full amount of her out of pocket payment for the surgery.

Getting this news made me feel like I could finally exhale and enjoy my transition, without worrying about the cost. I am wholeheartedly thankful for my mother, as well as the lawyers at Lambda Legal who helped us make this possible.

Other people in my position should not give up hope. While at times things seem bleak, there is hope. Find compassion and love in your life. Find allies and support systems that can help you fight for your rights, because in the end, no one can take those from you.

 

Jack’s last name has been omitted to ensure his privacy. The Lambda Legal staff referenced in this post were led by Staff Attorney Omar Gonzalez-Pagan.