January 26, 2021

Hartford-based health insurer Aetna has agreed to expand its coverage of gender-affirming surgeries to include breast augmentation for qualifying transgender women.

The decision is a result of a collaboration between Aetna, the Transgender Legal Defense & Education Fund, a civil rights organization; Cohen Milstein Sellers & Toll, a national civil rights law firm; and four women who were denied coverage for the surgery, which Aetna previously viewed as cosmetic. The group first contacted Aetna in 2019, hoping to resolve the issue collaboratively, in lieu of filing a lawsuit.

Dr. Jordan Pritzker, senior director of clinical solutions for Aetna, said in written a statement that the company’s decision to revise its policy “is consistent with many changes we have made over the years to better serve the needs of the LGBTQ community.”

The revised policy recognizes breast augmentation as a medically necessary procedure that will be covered for transgender women who demonstrate persistent gender dysphoria, completion of one year of feminizing hormone therapy and a referral from a qualified mental health professional.

“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,” Nancy Menusan, one of the women involved in the effort, said in a written statement. “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.”

Kalpana Kotagal, a partner at Cohen Milstein, said that Aetna’s decision could be “transformative,” signaling “the kind of industrywide effort that is needed to bring greater equity to the provision of health care.”

The complete article can be accessed here.