For most, scheduling and attending a doctor’s appointment is nothing short of a chore — easy, if not boring. But for thousands of queer Americans, something as seemingly painless as a routine check-up often leads to an overwhelming sense of hopelessness.
Gaurang Choksi, founder and CEO of Violet, a platform dedicated to help the LGBTQ community access culturally competent healthcare, is no stranger to the negative impact a bad consultation can have on an individual. While attempting to refill his PrEP prescription — an antiviral medication most often used as a preventative measure against HIV/AIDS — his network primary care physician in New York City revealed he didn’t know about the market drug, which has been in circulation since 2012.
In the end, Choksi was able to fill his prescription, but not before having an uncomfortable conversation that left him feeling deflated and unheard.
“The thing that disappoints me was that I was there asking for a refill for a medication that I knew I should be on,” Choksi says. “But think about all the other gay men that ended up there or other individuals that never received the guidance they wanted because the provider wasn’t culturally competent for the community.”
Members of the LGBTQ community don’t just want better, more inclusive benefits — they want educated providers who are medically qualified to tend to their physical needs and culturally aware enough to ease their psychological ones, too.
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Eleven million Americans identify as lesbian, gay, bisexual or transgender, 88% of whom are employed, according to the National LGBTQ Workers Center. Fifty-six percent of the LGBTQ community report experiencing discrimination from a provider and are two to three times more likely to avoid care compared to straight and cisgender populations, according to data from Included Health.
Often the conversation surrounding LGBTQ benefits doesn’t address the disparities these individuals face when seeking out qualified medical professionals, according to Colin Quinn, co-founder and CEO of Included Health. The first step to providing an inclusive healthcare experience is to ensure that the doctors treating queer patients are taking a holistic appraoch.
“Our needs are very much the same as a straight person — we suffer from the same chronic illnesses and we need to go in for our physical routine exams,” Quinn says. “But what we've noticed is that providers themselves might not be aware of how to create a safe environment or how to ask the questions the right way.”
Both Quinn and Choksi used their negative healthcare experiences as gay men to found two separate care companies dedicated to bettering queer members’ experience. Quinn’s platform, Included Health, is offered as a workplace employee benefit and connects LGBTQ employees with services that match their identities and preferences. Violet deals directly with the insurance providers, vetting physicians within their network and choosing the ones best suited to tend to queer patients.
“We know members [of the LGBTQ community] suffer from higher rates of certain illnesses like anxiety, depression and chronic illness,” Quinn says. “We've got to create a better experience for members of the community. We need to be that safe re-entry point for them.”
Queer patients say the most important thing they’re looking for when it comes to medical care is a ‘credit score’ for the cultural competencies of clinicians — a set standard employees can use when searching for inclusive healthcare, according to Choksi.
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Common pain points for the LGBTQ community involve issues around infertility, as well as transgender-specific medical needs. For example, many insurance providers still require a medical diagnosis for infertility before offering any sort of fertility coverage, despite the fact that 68% of participants in a recent Reproductive Medicine Associates of New Jersey survey said members of the LGBTQ community should have equal access to reproductive care.
In the trans community, more than 50% reported having to explain certain aspects of transgender-specific medical necessities to their healthcare providers — a knowledge gap that keeps many from accessing trans-specific medical procedures like hormone therapy or gender affirmation surgery, according to a survey by the National Center for Transgender Equality and the National Gay and Lesbian Task Force.
Bridging this gap requires accountability and transparency from the industry, Choksi says. An open dialogue should enable queer individuals to bring their their full selves to a clinician.
“The benefits space should be looking at the employee base and understanding the representation they have,” he says. “Then understand the disparities their communities may be having and what they can do about it today.
Director of inclusiveness at consulting firm Ernst & Young, Chris Crespo, remembers reaching out to their benefit coordinator over a decade ago asking if the firm had any benefits for same-sex couples — they did not. Crespo took matters into their own hands: after contributing to a business case for providing benefits to same-sex couples and presenting some competitive analysis, they were finally able to add their partner and three kids to their benefits enrollment.
Since then, Crespo has spearheaded a number of benefit inclusion efforts at EY, such as the company’s Pathways to Parenthood program, which provides a lifetime benefit of up to $25,000 to cover expenses related to fertility, surrogacy and adoption for all. The firm also has a Pathway to Transitions program, which provides a lifetime benefit of up to $25,000 for certain gender affirming medical expenses that are not covered through medical insurance.
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“Workplace transitions have multiplied over the years and really differ by person,” Crespo says. “Therefore, the benefits and needs of each person truly differ as well. EY needed to be open to questions that came up and think about how to best accommodate the diverse needs of our people, while also ensuring consistency in how we approach all of our benefits.”
Generationally, approximately 16% of Gen Z openly identifies as LGBTQ, millennials at 9% and Gen-X and baby boomers at 3%, according to a survey by Gallup. Although there is more work to be done, there’s hope for a more inclusive landscape as the population becomes more comfortable with disclosing their sexuality and demanding change, according to Quinn.
“HR benefits leaders are beginning to recognize that this one size fits all approach hasn't been working,” he says. “We shouldn't have these roadblocks and barriers. Healthcare is a basic human right.”
