The Yale Health Plan will now cover sex-reassignment surgeries for students, joining fellow Ivy League schools Harvard, Brown and the University of Pennsylvania in offering insurance for the procedure.

The extended insurance — which was granted to faculty and staff in 2011 and to unionized workers in January — covers expenses related to a medically necessary sex-reassignment surgery “subject to preauthorization based on widely accepted standards of care.” The coverage change will go into effect Aug. 1 and is part of multiple updates to the student plan announced by Yale Health in a Thursday email to the Yale College community.

Although the surgery is infrequently used, the extended coverage is a significant signal to potential applicants that Yale is committed to providing equal-access health care, said Grace Zimmerly ’13, an advocate for sex-reassignment surgery coverage.

“While Yale was not among the first schools to repeal its coverage exclusion, we hope that this represents a commitment to catch up to our peers in terms of offering transgender students an equitable student life and health care experience,” said Gabriel Murchison ’14, a member of the Resource Alliance for Gender Equity.

Each sex-reassignment case will be approved on an individual basis, but Yale Health will use commonly accepted guidelines, which generally require a mental health assessment and a period of hormonal therapy and/or living in the desired gender role, University spokesman Tom Conroy said.

“This additional student coverage follows a period of several years when similar coverage was provided to Yale employees,” Conroy said. “It made sense, after appropriate study, to bring the student coverage in line with Yale’s belief that, in some circumstances, sex-reassignment surgery is medically necessary and appropriate.”

Murchison said he considers the coverage “reasonably comprehensive,” but added that students considering the surgery must have access to qualified mental health professionals and not be “coerced” into hormone therapy, a typical requirement for sex-reassignment surgery.

In addition to the sex-reassignment change, two revisions to mental health policies will remove a waiting period previously required for inpatient care and will increase mental health coverage for children of students, though outpatient counseling — which includes psychiatry visits, therapy and other services for students not admitted to Yale Health facilities — has not been changed.

The modification of inpatient coverage will allow students admitted to Yale Health facilities for mental health or substance abuse to receive 60 days of continuous treatment, said Michael Rigsby MED ’88, medical director of Yale Health. Previously, students still received 60 days of coverage per year but were required to take a 180-day interim period after the first 30 days.

The number of covered visits related to mental health for children of students enrolled in the Yale Health Plan has also been increased from 16 to 25, Rigsby said.

One sophomore, who requested to remain anonymous because she has used mental health resources, said the mental health policy revisions will have no effect on the mental health services used by most students.

“I think it is a pretty hollow gesture since it is not at all a response to what the real mental health needs are for students,” said the student. “Outpatient care is exclusively what students use.”

In another update to the Yale Health Plan, Rigsby said that students no longer have the option of waiving prescription coverage — which includes partial coverage of pharmacy charges as well as psychiatric and substance abuse services for admitted patients — as it will be combined with the hospitalization and specialty coverage insurance that is required for students who do not purchase outside coverage. The decision to package prescription coverage with hospitalization and specialty coverage was made in part to comply with the Affordable Care Act and because students without prescription coverage potentially face “extremely large” out-of-pocket costs for prescription drugs, he added.

While hospitalization and specialty coverage was priced at $810 and prescription coverage at $180 per term this year, the total plan will cost $1,020 per semester next year.

  • http://www.presstitutes.org/ Mike Conrad

    Please stop the world, I want to get off.

  • lakia

    With the world falling apart around us, so glad Yale tackled this critically important item. One which will impact millions and millions of students, employees, and faculty. Well done. Next, perhaps a home and a car for all.

  • Cromulent

    In the name of inclusion and equality I would like a Lexus please.

    • Cromulent

      And a pony.

      • inycepoo

        It has to be a pink one.

    • bettercorporateperson

      yes because luxury automobiles and health care are both basic human needs. Geez your parents should stop wasting their money on all this high priced elite education -it clearly hasn’t taught you to think critically or logically, let alone to be a decent human being. I guess some things money really can’t buy.

      • Cromulent

        I do consider a sense of humor a basic human need. In the name of inclusion and equality I would buy you one if possible. Sadly, your lack may be terminal.

        Since when is a free sex change operation a basic human need?

  • rational14

    For every $50,000 Yale is going to pay per gender reassignment surgery, we could pay for another part-time mental health counselor or completely pay for someone’s tuition…but, seeing this, I take no issue with a new Lexus-on-demand program so students can look rich if that is how they “feel.”

    • Lexington

      Wow, a worrying lack of reason applied to this issue!

      I’m happy that Yale has, albeit some years later than most, decided to offer healthcare to all those who need and deserve it.

      For those who seem confused between trans health and wanting a Lexus:

      http://www.youtube.com/watch?v=crHHycz7T_c

      From 5.30. Perhaps listen to a woman you might already know. She might teach you something about some things about which you appear to have strong thoughts on, but little logic and even less experience. That combination is never the best basis for a good conversation, and this thread seems to confirm that trend.

      @rick131:disqus @embiggen:disqus @MikeConrad:disqus @disqus_IzSoA4FEIR:disqus

  • Ted Eytan, MD

    Dear Yale University Community,

    This is a great step forward in promoting health for all. In joining 37 other universities who now provide this coverage, you are ending longstanding discrimination against people with a treatable medical condition and you should be proud.

    Before anyone looks at the cost of treatment moving forward, make sure you look at the costs of non-treatment, which include complications from non-medically supervised care including illicit hormone use and surgeries. The treatment of these devastating events including blood clots, strokes, heart attacks, infections, are fully covered by most plans, even though their prevention is not, until now.

    These costs do not even cover the mental health toll, which is not from gender dysphoria, it’s from the lack of treatment of it. This results in lost productivity and lost lives.

    The history of our society is filled with the stories of people who were unable to live the lives they wanted to because of who they are. If you’ve been one of those people or ever know someone who has been, you’ll take the time to understand how the successful medically-supervised treatment of this rare condition can give people the same chance that the rest of us have.

    This is not special treatment, it is the end of special mistreatment.

    Major medical organizations, including the American Medical Association are in full support of this change.

    It’s time.

    For more information, check out http://wpath.org , or read the commentary of your peers at Duke University: http://www.dukechronicle.com/articles/2013/03/27/cover-gender-reassignment

    Thanks,

    Ted Eytan MD
    Family Physician
    Washington, DC USA

    • rick131

      Shouldn’t we be happy with the body and capabilities we were born with, than try to surgically alter everything?

      • Ted Eytan, MD

        Hello Rick,

        In the ideal, yes. However, there is a rare condition known as gender dysphoria where this cannot happen.

        From WPATH guidelines:

        “Treatment aimed at trying to change a
        person’s gender identity and expression to
        become more congruent with sex assigned
        at birth has been attempted in the past
        without success (Gelder & Marks, 1969;
        Greenson, 1964), particularly in the long
        term (Cohen-Kettenis & Kuiper, 1984;
        Pauly, 1965). Such treatment is no longer
        considered ethical.”

        The goal is not to surgically alter everything. The goal is to use a combination of medically supervised therapy to treat the condition, that can include surgery. Not everyone requires surgery.

        The question for people with gender dysphoria is not whether they should have surgery – it is whether health care should support their ability to live happy and healthy lives, which is what you and I expect from health care. Without this coverage, a trans person is paying for everyone else’s ability to achieve our goals supported by the health system, but not receiving that care for themselves. Now they can experience equal treatment. Hope this information helps you,

        Ted

    • Cromulent

      Given the University’s mission is to educate students, why in the world should they provide this?

      But I’m not surprised a doctor would endorse measures that mandate more spending on doctors.

      • Ted Eytan, MD

        Hello,

        The issue is if the University if providing health coverage to its students, it should not discriminate against a group of people. Since 2008, the American Medical Association has affirmed that denying coverage for medically necessary care for individuals who are transgender is discrimination.

        If you are asking if providing health insurance coverage for any student is consistent with the University’s mission, that’s a conversation that should happen in a forum different than this one – this is about ending discrimination, not health coverage.

        If I wanted more spending on doctors, then the choice would be to continue discriminating, because as I said in my original post, the costs to treat the complications of non-medically supervised care are currently covered by the insurance plan, so your logic doesn’t follow, I’m afraid.

        If you take a closer look at the data, you’ll see this is the right thing to do, to promote a healthy community where everyone has equal opportunity.

        Thanks and let me know what other questions you have,

        Ted

        • Cromulent

          Yes, Ted, this *is* an appropriate forum for discussing the University’s mission. Where else?

          • Ted Eytan, MD

            Oh sorry, I meant to say “If you are asking if providing health insurance coverage for _all_ students is consistent with the University’s mission” – I think discrimination is not consistent with the University’s mission….hope that’s more clear.

        • eightyfiver

          Ted, I would agree that denying coverage for medically necessary care for individuals who are transgender is indeed discrimination. I would also agree that it is wrongful discrimination.

          The hurdle I can’t clear is the notion that “gender reassigment” surgery or treatment is medically necessary or even a good idea. I’m not even sure that it can be called “health care.” Accordingly, regardless of the pronouncements of the AMA or somebody who happens to be an M.D., there are a number of us who believe that the refusal to pay for surgical mutilation does not constitute wrongful discrimination. There are no “data” that can convince me that this is, as you put it, merely a question of “equal opportunity.” (Opportunity for what?)

          Finally (and this is among the least of my concerns) I really don’t want to pay for it, through higher premiums, just as I don’t want to pay for tattoo removal, somebody’s nose job, or Cromulent’s Lexus. There are legitimate medical needs, right here at the University and in this state, that can and should be addressed with those resources. How about prenatal and neonatal care in this city? Elder care? Let’s address those issues first.

          • Ted Eytan, MD

            Hi again,

            Sorry you are having trouble clearing that hurdle. The medical profession is having trouble with it as well, as you can tell from the recent-ness of the AMA policy (2008).

            If you understand the science, you’ll know that there’s a significant difference between tattoo removal and buying luxury cars and sex affirmation surgery. Prenatal and neonatal care are medically necessary too, and are covered. If you decided you didn’t want to pay for African Americans to be hospitalized in the same facilities as white people, we would be living in the 1940s.

            Times change, medical science advances, and we discover treatments that reduce harm by preventing suicide, lost productivity, and unnecessary medical complications (which are covered by plans today, and you’re already paying for).

            I’m a family doctor who believes in health for everyone. I happened to meet a few people who are transgender and discover that they want the same chance at life that all of us do, and we have the ability to provide it for them, effectively and safely.

            I’ll address any issue any time, what I don’t want the profession to do is discriminate, it’s not why we went into medicine.

            Ted

          • http://www.presstitutes.org/ Mike Conrad

            Your analogies–pregnancy and racism–are insipid and insulting.

          • Ted Eytan, MD

            Mike,

            Unpacking that a bit for readers who might get confused:

            Pregnancy care : medically necessary

            Transgender health care: medically necessary

            Hospital segregation: discrimination

            Denying care to trans people: discrimination

            They show that the world is becoming a more compassionate place, which is good – I hope we all agree that’s a good thing!

            You’re question about cosmetic or not comes up a lot – I’ll write up something on my blog that you’re welcome to reference in the next few days.

            In the meantime, electronic health record systems are also being changed to accommodate this care – it’s becoming institutionalized across medicine -> http://www.tedeytan.com/2013/05/01/13045

            To reference the AMA statement -> http://www.tedeytan.com/2013/04/12/12952

            Thanks for the dialogue,

            Ted

          • badger85

            This is an old thread, but interesting, so I’ll add my two cents. I’m socially liberal and agree that denying care to transgendered people is discrimination. By that I mean kicking them out of the emergency room because they are transgendered, or making them feel any less than fellow human beings while they are in the hospital. Having health insurance pay for cosmetic surgery crosses a line unless that cosmetic surgery is required for proper bodily function (ie physical difficulty using the bathroom). Being transgendered is a recognized medical condition. So is being depressed. If my depression stems from being ugly or having small breasts, health insurance will not (nor should it) cover plastic surgery for me. I support having mental health services for transgendered people and I support giving them *equal* medical treatment to everyone else. I support having health coverage for medically necessary surgical procedures. This is not one of them.

          • Ted Eytan, MD

            Dear Badger,

            Feel free to ask any additional questions here:

            http://www.tedeytan.com/2013/05/17/13112

            Thanks for supporting the health of trans people,

            Ted

          • rational14

            Okay…what should future President Salovey do when a student comes to his office threatening to commit suicide if he or she does not get a Lexus for free? No one has said that transgender students can’t get the surgery if they can afford it. People object to being forced to pay for another’s cosmetic surgery.

            Gender reassignment surgery is cosmetic. “If you understand the science, you’ll know that there’s a significant difference between tattoo removal and buying luxury cars and sex affirmation surgery.” I understand science. I also understand politics. You seem to understand neither. We are very capable of providing people with Lexus-wanting syndrome a luxury car “effectively and safely” as well.

          • Ted Eytan, MD

            Dear rational,

            How about if we turn the statement into a question – “Is gender affirmation surgery cosmetic?”

            It’s not cosmetic, it’s a fair question because others are and have asked it, so give me a few days to pull together some references to review – I’ll post on my blog so it gets more than a passing “it is” or “it isn’t”

            Sound good?

            And, hey, let’s not go ad hominem or mock the people who are facing this situation. It’s not what we do in health care and I don’t think your President would do that either.

            Again, thanks for the dialogue,

            Ted

          • eightyfiver

            “Gender affirmation surgery”? Really?

          • rational14

            The answer to your question is that it is indeed cosmetic, per the AMA definition (below). Pull all the references you want, it is a cosmetic surgery, no different than a boob job. In fact, for male to female surgery, it includes a boob job.

            There was no ad hominem attack or mocking of transgendered people. I stated you clearly don’t know science as evidenced by your statements and whether self-esteem is boosted by a Lexus or plastic surgery, people should not have to pay it. I am not denying a transgender’s self-esteem could improve.

            AMA definition as of 2010:
            “Cosmetic surgery is performed to reshape
            normal structure of the body in order to improve the patient’s
            appearance and self-esteem.”
            http://www.aad.org/forms/policies/uploads/ps/ps-definitions%20of%20cosmetic%20%20reconstructive%20surgery.pdf

          • eightyfiver

            Ted may understand politics and science. It’s understanding the difference between the two that seems to be the problem.

          • eightyfiver

            Ted, this particular post (above) is a terrific example of how the dialogue breaks down when discussing issues like this. As to your statement that you believe in “health for everyone,” I’d assume that everyone on this forum shares that belief. (We might, however, disagree on what constitutes “health care.”) Moreover, why on earth do you bring up the wholly irrelevant topic of segregated hospitalization care?

            It’s a bit passive-aggressive to act as though you are interested in a dialog (“Thanks and let me know what other questions you have.”) and then suggest that those who do not agree with you either do not believe in health for everyone or can be equated with segregationists of the 1940s.

            Finally, I take exception with the notion that our differences in opinion on matters of public policy and politics (i.e., what types of treatment should be covered under a health plan) can be resolved by “science.” Should we let cosmetic surgeons or psychiatrists decide whether nose jobs should be covered by health benefit plans?

            Mike (below) has it right–insipid and insulting.

          • Ted Eytan, MD

            Hello EightyFiver,

            Ok, I’m going to agree with you, the conversation has broken down. It’s okay, we came this far and I think Yale’s doing a great service to its students. I respect that you don’t think that way, just wanted the community to know that a lot of health professionals are in support.

            All the best to you,

            Ted

          • lakia

            A voice of actual reason.

  • eightyfiver

    This is one of those moments when reality leaves no space for parody.

  • rick131

    What is this, for like one student a decade?

  • breakingbad23

    Meanwhile, the University won’t even cover braces for children…

    • Cromulent

      Um, you really think the University should be responsible for the *children* of its students?

      • eightyfiver

        The University has employees as well as students.
        Moreover, where children are covered under a health or dental plan (actually, dependent health care coverage is the norm), orthodontic care is typically covered. I’m a bit surprised to hear that it’s not included.

        • Cromulent

          Since this story is about insurance for students it seemed reasonable to assume the OP was referring to children of students.

  • attila

    If this treats a genuine, recognized condition — and it does — then it is hard to see how the university would have any right to refuse to pay for it. It’s nice to know that it might also save money, but that seems secondary.

    • http://www.presstitutes.org/ Mike Conrad

      Anything can become “genuine and recognized” with the right “studies”… why not pay for cosmetic surgery too? Ugly people are discriminated against all the time. Easy solution which only requires your money and mine. Oh but therapy might work for that too? Same with gender identity.

  • ALPHABRO

    Yale should fund R&D to search for a cure to liberalism, the great mental disorder that affects the proponents of these initiatives.

    • lakia

      It, unfortunately, affects the OPPONENTS as well.

  • ALPHABRO

    I wish Yale would cover my desired pec implant surgery; after years of working out I just cant get the pecs I want. I am seriously troubled by this and need help!

  • kevin24

    Seriously, and they rejected my request for a penile enlargement surgery? Bastards.

    • eightyfiver

      …ask for the “affirmation surgery”. Might get a better response.

  • lakia

    Here is what you have to look forward to:

    DUKE RAISES STUDENT FEES TO PAY FOR SEX CHANGE SURGERY

    The College Fix

    The best in college news

  • claypoint2

    I admire Dr. Eytan’s remarkable patience and forbearance in responding to the comments on this thread. Even when respondents have turned to devaluation and ad hominem attacks, he has maintained a respectful stance toward all.

    In the end, the conversation – if it can be called that – seems to center around fundamental disagreements over how much each individual is responsible for the community that (s)he inhabits and for the well-being of its other members. “Am I my brother/sister’s keeper? If so, to what extent?” Our individual answers to this question will vary, depending on our moral philosophy.

    For my part, as a Christian I am called to be my brother/sister’s keeper in every way that leads to health and fullness of life for that person, as an individual, and for the community. And being able to live authentically seems to me essential for leading a meaningful, emotionally healthy life (unlike owning a Lexus). So, yes, I am quite willing to pay my pro-rated share of the cost of sex-reassignment treatments. Mind you, this is quite aside from the economic argument, given that the cost of covering these surgeries & hormonal therapies appears to be less than that of paying for complications from non-medically supervised procedures.