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Across the United States, thousands of youths are lining up for gender-affirming care. But when families decide to take the medical route, they must make decisions about life-altering treatments that have little scientific evidence of their long-term safety and efficacy.
Many trans patients have trouble getting their insurers to cover gender-affirming care. One reason is transphobia within the U.S. health care system, but another involves how medical diagnoses and procedures are coded for insurance companies. Advocates for transgender people say those codes haven’t caught up to the needs of patients. Such diagnostic codes provide the basis for determining which procedures, such as electrolysis or surgery, insurance will cover.
When seeing a doctor, each diagnosis, procedure, and service has a code. Those labels and classifications affect what insurance will pay for, but they haven’t kept up with transgender care.
The codes used by U.S. medical providers to bill insurers haven’t caught up to the needs of trans patients or even international standards. Consequently, doctors are forced to get creative with what codes they use, or patients spend hours fighting big out-of-pocket bills.
Doctors are forced to get creative with what codes they use, or patients spend hours fighting hefty out-of-pocket bills. More than 30 countries use the new ICD-11 medical coding system, but not the US.