Department of Financial Services Notifies Insurance Industry That Medically Necessary Treatment For Gender Dysphoria Cannot be Denied
Governor Andrew M. Cuomo today announced that regulatory guidance has been issued to help ensure that transgender New Yorkers have equal access to commercial health insurance coverage. The Department of Financial Services (DFS) today sent industry guidance to all New York insurers stating that they may not deny medically necessary treatment for gender dysphoria – a condition when a person's gender at birth is contrary to the one with which they identify.
“Respecting the rights and dignity of all New Yorkers is paramount,” Governor Cuomo said. “By taking this action, we are ensuring that principle rightfully extends to transgender people across our state and continuing New York’s legacy as a progressive leader for the nation. I urge other states to follow our example on this issue, because discriminating against people on the basis of their gender identity simply should not be tolerated.”
Benjamin M. Lawsky, Superintendent of Financial Services, said, “We hope this action sends a powerful message that discrimination against transgender people will not be tolerated. Transgender New Yorkers deserve the same access to essential health care as every other New Yorker. We especially thank Senator Brad Hoylman for working with us on this matter and for his steadfast leadership on LGBT rights.”
Senator Brad Hoylman said, “I commend Governor Cuomo and Superintendent Lawsky for ending discrimination in health insurance in New York based on gender identity or expression. Moving forward, health insurance providers must cover treatments related to gender transition, which is regarded as medically necessary by leading professional medical organizations for many transgender people. Today’s announcement is important to the health and well-being of transgender New Yorkers and I’m honored to have worked with them on this important issue.”
Alphonso David, Deputy Secretary and Counsel for Civil Rights said, “The regulatory guidance issued by the Department of Financial Service today is yet another step forward by Governor Cuomo and the administration to remove long-standing, systemic barriers to equality. The guidance will help ensure that transgender New Yorkers have equal access to coverage in the private marketplace. The Governor is committed to, consistent with law, continuing efforts to modernize New York State’s policies and practices to guarantee fair treatment for all New Yorkers.”
An insurer retains the right to review gender dysphoria treatment for medical necessity purposes, as it may do with any benefit covered under a health insurance policy. But, as with any covered benefit, any such review in a gender dysphoria treatment case must be performed with the full range of appeal rights set forth in Article 49 of both the Insurance Law and the Public Health Law.
A consumer whose gender dysphoria treatment has been denied has the right to file an internal appeal of the denial with the insurer. Information on filing an internal appeal is provided on the notice of the denial that an insurer is required to provide to the consumer. If an insurer denies the treatment on internal appeal, the consumer has the right to file an external appeal with an independent external appeal agent who will make their own medical necessity determination. Information on filing an external appeal can be found here.
A copy of the letter sent by the NYDFS to all New York insurers is available here.