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Mammogram Covered; Her Prostate Exam Too

May 3, 2012
Written by: , Filed in: Breast Imaging
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After threatening a lawsuit, Beth Scott got Aetna to cover her mammograms. Also her prostate exams.

Scott used to be male. She started transitioning to female in 2006 and completed the transformation in 2008, according to her lawyer, Noah Lewis. Scott’s estrogen treatments caused her breasts to grow. Her doctor, she said, suggested that she get a screening mammogram.

Twice, Aetna refused to reimburse her the $385 for the mammogram, according to The Star-Ledger of Newark, New Jersey. Aetna said the procedure was related to her sex change, and health insurance companies generally do not cover costs related to gender reassignment. Scott, of course, said the mammogram was a post–sex change procedure that should have been covered under her employer’s health plan.

Lewis, the lawyer, works for the New Transgender Legal Defense and Education Fund, based in New York. He cast the dispute as a discrimination issue:

If transgender people are being singled out for denial of care that is provided to other individuals, this makes it clear transgender people have to be treated equally under the plan. Hopefully, this will send a message to other insurance companies they can’t keep making these kinds of denials.

Aetna said it was all a mistake. Cynthia Michener, a spokeswoman for the insurer, said that, although privacy laws don’t allow her to comment on Scott’s specific case, the company has routinely covered mammograms for male-to-female transgender people since 2009, as well as prostate exams for those who have retained their prostates.

“Any denial would have been an error corrected by Aetna in administering the claims in the appeals process,” Michener said.

Scott said she was happy with the resolution:

I feel pleased that the settlement went smoothly and that Aetna apologized. However, I wish this could have been resolved through the appeals process and that the exclusion had not been misinterpreted. I am hopeful that in the future, transgender care such as hormones and surgery will be covered as is other medically necessary care.

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