TRANSSEXUAL RESOURCES IN PORTLAND
INSURANCE COVERAGE FOR SRS
Legal Precedent Set in New York State
Many people have inquired as to the status of insurance coverage for SRS. At present, if your medical insurance
specifically excludes SRS coverage in their master policy statement, you are not covered. You may avoid hassles on other matters (i.e., prescriptions and psychological counseling/assessment) by asking your provider to judiciously word the claim form submitted in your behalf. If no specific mention of SRS is made in your policy, however, then you may successfully argue for full coverage or, alternately - if your insurer is obstinate - you should at least negotiate for partial reimbursement. you have nothing to lose by being assertive, and possibly much to gain. Remember, one way or another you are paying for this coverage. If your coverage originates in New York State, because you live or work there, and if your policy does not specifically exclude SRS, then you must be afforded full coverage, in line with that provided for any other legitimate medical procedure. This is mandated by the finding in Davidson vs. Aetna, as detailed below. This decision, which set a precedent, has been relied upon by other jurisdictions as well, for guidance. Unfortunately, this ruling is not binding in other jurisdictions, but you may introduce it in support of your argument: Victoria L. Davidson vs. Aetna Life & Casualty Insurance Co., 101 misc. 2d 1, 420 N.Y.S. 2d 450 (Sup. CT. 1979) The first [U.S.] case cited involving a private health carrier was decided by the New York Supreme Court in 1979. Davidson’s insurance carrier, Aetna Life Insurance Company, refused to bear the cost of medical expenses for sex reassignment surgery (SRS), alleging: 1.) Gender dysphoria is not an injury; 2.)
Transsexual surgery is cosmetic in nature; 3.) Surgical intervention is not necessary and unreasonable. The court ruled in favor of Davidson, finding the surgery “cannot be considered to be of a strictly cosmetic nature”, and that the “sex change operation of the plaintiff is of a medical nature and is feasible and required for the health and well-being of the plaintiff”.