Umm... This is kind of a big deal.
If this ruling stands, it'd mean that basically every health insurance plans in America (because of the health insurance marketplace) would be required to cover everything WPATH SoC8 deems medically necessary.
Which is... *everything*.
Holy crap.
So uhh, let's break this down.
The ruling is based directly on Bostock's sex protections. It means that even plans which are fully paid by the employer would be bound by this, as long as whichever company runs the processing takes even one red cent of federal money.
The ruling will definitely be appealed to the SC. But unless Roberts and Gorsuch reverse their positions in Bostock, I think this one stands.
Overwhelmingly, fully funded insurance plans are administered by big corps, like BCBS or Aetna. All of those companies take federal $.
All of them. Because of the Health Insurance Marketplace.
And once the standard is on medical necessity, the definitive worldwide standards is WPATH SoC8. Which, if you want to check coverage, I did a write up a few months ago (https://stainedglasswoman.substack.com/p/what-do-wpath-standards-of-care-8).
Or you can check this list. **Everything's** on it.
If this ruling stands, it's over.
We won.
Every last fucking transition-related procedure will have to be fully covered, by federal law. No asterisks. No ifs, ands, or buts.
Everything.
@ShatteredWorldCrisis The ruling is in effect immediately.
Probably the best thing to do is to put a copy of this ruling and WPATH SoC8 in your insurer's hands ASAP. Call customer service and tell them you have documents that you'd like their legal team to review.
Then...? Well, here's a guide.
https://stainedglasswoman.substack.com/p/how-to-force-your-insurer-to-cover
@ShatteredWorldCrisis @Impossible_PhD just read SOC8, and yeah, everything does seem to fall under medically necessary!
Medically necessary gender-affirming interventions are discussed in SOC-8. These include but are not limited to hysterectomy +/- bilateral salpingo-oophorectomy; bilateral mastectomy, chest reconstruction or feminizing mammoplasty, nipple resizing or placement of breast prostheses; genital reconstruction, for example, phalloplasty and metoidioplasty, scrotoplasty, and penile and testicular prostheses, penectomy, orchiectomy, vaginoplasty, and vulvoplasty; hair removal from the face, body, and genital areas for gender affirmation or as part of a preoperative preparation process; gender-affirming facial surgery and body contouring; voice therapy and/or surgery; as well as puberty blocking medication and gender-affirming hormones; counseling or psychotherapeutic treatment as appropriate for the patient and based on a review of the patient’s individual circumstances and needs
emphasis on the procedures that often have issue with coverage.
super exciting! i suspect even if it does pass, there will be a delay, and issues in the speed at which people pick it up.
for example, my insurance already covered gender-affirming hair removal, however the medical clinic of my dermatologist had a policy of not dealing with insurance specifically when it had to do with those procedures.
which means even if your insurance must cover it in the future, you might still run into issues resulting in having to submit superbills yourself in the form of a claim.
@b_cavello WPATH SoC8 basically sets therapists as the arbiters of trans identities, which is better than it was, and psychology has moved our way by leaps and bounds.
It's not perfect, but if it gets people what they need, I'll take it.
@Impossible_PhD I really hate to rain on this parade, because we absolutely deserve a win, but this ruling is only the start, and its scope is very limited.
As of now, it only ensures that folks with
(1) ERISA-backed insurance plans
(2) in the Western District of Washington
(3) who want to have medically necessary gender affirming procedures covered
will be able to have those procedures covered.
The case does NOT decide what medically necessary care is OR that SOC-8 is an automatic green light, just that you can't have a blanket ban on gender affirming care. The case could (and very likely will) be appealed, and the appellate court could take a very different view on things.
It's a great start for sure! and something that I was really hoping would happen after Bostock. But most insurance providers aren't bound by the decision.
@control_shift_z WPATH is, per BCBS' own internal documentation, the arbiter of medical necessity, so SoC8 is indeed going to be the authoritative document here. Virtually all US insurance plans say the same.
The blanket bans are also common, which make that part of the ruling portable.
And while the judge was in WA, this was a federal judge ruling on an interstate commerce matter, bc the plan and admin were IL. You'll note that every law involved in the judgment was federal.
@Impossible_PhD Even though the Washington court was ruling on an Illinois insurance dispute, the case only has effect in the Western District of Washington. It doesn’t matter that the case relates to interstate commerce or federal law - a District Court’s ruling is only effective in its District.
You’re right - the blanket bans are unfortunately common. This case will be a great resource for arguing inclusivity to other courts!
But, other courts aren’t required to follow it.
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