Supporting trans employees includes helping them navigate their benefits

When Dr. Angela Rodriguez shifted her specialty from pediatric plastic and craniofacial surgery to gender affirmation care after 20 years of practicing medicine, she didn't consider the move all that different. After all, she was still doing what she set out to do when she became a surgeon: Help everyone feel comfortable in their own skin.    

"My work has to be really aligned with what I believe," Dr. Rodriguez says. "I felt that this was the fight of this century — transgender care, getting this population up to date and serving their needs." 

Now, two years into her new specialty Dr. Rodriguez, who launched her own practice that focuses on gender diverse communities, has continued to advocate for the transgender and non-binary community. That includes ensuring that they understand how to navigate the complicated insurance landscape.  

The number of gender affirming surgeries in the U.S. nearly tripled between 2016 and 2019, according to data from the National Institute of Health, and it's expected to continue to rise steadily over the next few years as access to coverage increases and efforts to be inclusive expand. However, without the right understanding of that coverage, transgender and non-binary folk remain at a significant disadvantage. 

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"This is a population that has been traditionally underserved," Dr. Rodriguez says. "They may not have the tools to navigate insurance and other things that come with gender affirming surgery, which means there is a long preparation in order to even get to surgery." 

Gender affirming surgery refers to the surgical and cosmetic procedures that give transgender and non-binary people "the physical appearance and functional abilities of the gender they know themselves to be," according to the American Society of Plastic Surgeons. 

Not all trans folk take the surgical route, but for those who do, the cost of these procedures — including face and vocal feminization or masculinization, chest and genital surgery and hormone therapy — can range anywhere from $2,000 to $134,000, depending on the procedure and whether the individual has insurance, according to a 2022 study published in The Journal of Law, Medicine and Ethics. 

Fortunately, many major insurance companies, like Aetna, Cigna and United Health, do technically cover gender affirming surgeries. Section 1557 of the Affordable Care Act specifically prohibits federally funded health insurance programs from denying coverage on the basis of gender identity, sexual orientation or sexual characteristics. The section doesn't, however, apply to private insurance companies, meaning that coverage will vary greatly depending on the state, the provider and even the surgeons themselves — and that information isn't always always easy for the employee to find. 

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"You have to read the fine print — and it is very fine print for certain companies," Dr. Rodriguez says. "Sometimes it can be as simple as just asking HR, but other times they need to do more preliminary steps such as getting a diagnosis of gender dysphoria through a mental health provider or trying hormones to even be considered candidates."

Dr. Rodriguez recommends doing as much research as possible into companies' specific policies and having questions ready for either an HR leader or insurance companies. These questions could include: "Do I have gender affirmation benefits? What kind of surgeries do those benefits cover? Is my surgeon in network?"

And while much of the work falls on the patient, companies should also be open and transparent with their offerings. Obstacles to the right kind of care increase the prevalence of gender dysphoria, which is the distress caused by a person's gender identity not matching their assigned sex at birth. This affects 0.6% of Americans and can lead to a number of different mental health struggles, such as depression, anxiety and absenteeism. 

"There is no magical cure," Dr. Rodriguez says. "But we should want a society that is more inclusive and where all members can develop and pursue their happiness and live a productive life. It's up to companies and the public in general to take care of the vulnerable members in society, that's our mission and we need to all get on board."