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Aetna Updates Policies to Cover Transgender Feminizing Surgeries

Health Payer Intelligence

February 1, 2021

The payer updated its policies in response to four transgender members who came forward and demanded better access to care after their feminizing surgery claims were denied.

Aetna has updated its coverage policies to correct care disparities and to include gender-affirming surgeries for transgender women in most of its commercial plans, CVS Health announced.

Aetna worked with the Transgender Legal Defense & Education Fund (TLDEF), the law firm Cohen Milstein Sellers & Toll (Cohen Milstein), and individual transgender Aetna members in order to redesign the payer’s clinical policies around transgender surgeries.

The alterations cover transfeminine breast augmentation as a medically necessary clinical service, when certain criteria have been met.

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Aetna members motivated this policy change. A total of four transgender women came to TLDEF and Cohen Milstein when Aetna denied coverage for their breast augmentation.

TLDEF and Cohen Milstein then approached Aetna to promote changes to the policies that prevented the four Aetna members from receiving coverage for their treatments.

“My hope is that being part of this groundbreaking collaboration helps other transgender and non-binary people have access to the health care we deserve,” said Nancy Menusan, an Aetna beneficiary who pushed for this change.

“By dropping exclusions for medically-necessary care like top surgery, Aetna is paving the way and setting an example for other health insurance providers, and I hope others will take note.”

. . .

“This marks an important moment for transgender women, who are increasingly speaking out to demand better support for their physical and mental health,” said Kalpana Kotagal, partner at Cohen Milstein.

“Aetna has a history of ensuring health care coverage for the transgender community, and we appreciate its cooperation in revising this policy to enhance medical coverage for transgender women who suffer from gender dysphoria.”

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