Story URL: http://news.medill.northwestern.edu/chicago/news.aspx?id=220870
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Rebecca Kling

Peter McCullough/ RebeccaKling.com Used with permission.

Edgewater resident Rebecca Kling presents a solo performance on gender and identity. She is undergoing gender reassignment surgery later this year.


Transgender community fears inadequate health care

by Emily Nelson
May 1, 2013


Rebecca Kling, 28, is a transgender artist and educator and is undergoing gender reassignment surgery later this year. The Edgewater resident knows firsthand about the challenges transgender people face when it comes to receiving healthcare.

In 2010, Kling had to get her gallbladder removed and was concerned with how the medical staff would treat her. She said many of her transgender friends have experienced discrimination, mistreatment and even refused treatment when seeking medical care.  

“To be totally honest I delayed going to the ER for longer than I probably should have because that was a concern of mine, “ Kling said.  “It has everything to do with my comfort with being a transgender going to that hospital,” she said.  

When it comes to health care, transgender people are less likely to get adequate care and insurance coverage than those identifying with the gender they are born with, sources said. 

Britta Larson, director of senior services at Center on Halsted, works with transgender people on a daily basis. Center on Halsted is located in Chicago’s Lake View neighborhood and is considered the Midwest's most comprehensive community center dedicated to building and strengthening the lesbian, gay, bisexual, transgender and queer/questioning community.


“This community has various health disparities,” she said. “The transgender is very reluctant to want to go to the doctor.  What I hear is that they often have to explain what it means to be transgender,” she said.  

Larson said the biggest issue transgender people face is the fear of receiving inappropriate care. “We rely on our community health partners, and we have a long way to go. They are not aware of their unique needs,” Larson said.

A Report of the National Transgender Discrimination Survey, published in 2011 by the National Gay and Lesbian Task Force, revealed that 28 percent of survey respondents postponed medical care due to discrimination. Fifty percent reported having to teach their medical providers about transgender care.

Not only do transgender people worry about the quality of healthcare they receive, they also have concerns about how to pay for it. The same survey found that 86 percent of transgender survey respondents postponed healthcare because they lacked insurance.

According to the American Civil Liberties Union, Illinois is one of 17 states with some sort of discrimination protection laws for the transgender community. However, these laws do not always apply to healthcare.  California is the only state where transgender people have succeeded in securing Medicaid coverage for the costs of transition-related care, referring to gender reassignment procedures such as surgery and hormone therapy.

Most private insurers do not offer health care coverage for transgender people either. “I attempted to get health insurance through the open market and I was denied.  So, I got insurance through the state.” Kling said. “In its provisions, it explicitly excludes costs for gender specific procedures.” 

She is on the Illinois Comprehensive Health Insurance plan that provides health care coverage for those who have been denied coverage by traditional providers due to a pre-existing condition.

Because her gender reassignment procedure is not covered by insurance, Kling is paying for the cost of her $20,000 surgery through a combination of loans she will have to pay back and donations from supporters. 

Before she could be approved for the surgery, Kling underwent the required evaluation by a certified mental health professional, also not covered by insurance.
 
Even after surgery, Kling will have challenges related to health care coverage. “For the surgery I am getting I am going to need to go in for gynecological exams to make sure everything is healing right.  But I will still have a prostate so later in life I will need a prostate exam,” she said. 

Most medical procedures are reimbursed by insurance providers based on a code inputted for the type of procedure being done.  Many medical providers often don’t know how to correctly code and bill for exams that are traditionally for men, like prostate exams, performed on a person now identifying as a woman.

The Center for Medicare and Medicaid Services approved a special billing code in 2010 to assist processing of inappropriate denials of coverage where gender discrepancies are a problem, according to the National Center for Transgender Equality.  However, not all private insurers have followed suit, making access to even preventative services difficult for transgender people.

When it comes to transgender health, Kling said she realizes there is still a learning curve for healthcare providers.  “I not expecting them to be an expert, I am expecting them to be respectful of names and pronouns,” she said.