Chicago Mayor Rahm Emanuel announced Aug. 6 that the City of Chicago is poised to remove the exclusion of gender reassignment services from city health care benefits.
The change to city policy comes after the American Civil Liberties Union (ACLU) of Illinois brought the denial of health insurance coverage for a transgender city employee to their attention. The ACLU of Illinois did not immediately return calls from the American Media Institute for comment.
Last year, a U.S. Department of Health and Human Services appeals board ruled that Medicare may no longer exclude sex-reassignment surgery from coverage.
According to a press release issued by the mayor’s office, the change will be implemented for all non-union employees, and the city is working with labor partners to also remove the exclusion for union members. The change, which will apply to current city employees and their dependents, would go into effect Oct. 1.
Under the policy change, coverage of male-to-female or female-to-male surgical procedures would be standard for city employees covered by city health care plans and their dependents.
Chicago will be the largest city to remove the exclusion of these services from their health care plans, joining San Francisco, Washington, D.C. and Philadelphia.
Doctor Loren S. Schechter is a Morton Grove, Illinois-based private practicing plastic surgeon. Schechter has the distinction of being the first doctor in the United States to perform sexual reassignment surgery (SRS) covered by Medicare. The surgery was performed at Weiss Medical Center in Chicago late last year.
“Access to care up until recently has been very limited due to the lack of third party coverage,” Schechter said. “Over the last few years as insurance companies are covering SRS more people have been able to get access to care. The Medicare ruling was very significant.”
Schechter went on to explain that until recently SRS was not covered by insurance because it was originally considered cosmetic surgery. However, insurance companies now recognize SRS surgery as reconstructive, and reconstructive surgery is typically covered by insurance companies.
“In the past 15 years maybe 10 percent of SRS surgeries were covered by insurance, now it’s about 85 percent,” Schechter said.
In addition to Weiss, Schechter also performs SRS at Advocate Lutheran General Hospital in Park Ridge, Illinois, and SRS is slated to begin soon at the University of Illinois Hospital, Chicago.
“SRS is only performed at a handful of hospitals nationwide,” Schechter said. “I know of a doctor who performs SRS in San Francisco and another who performs isolated surgeries in Arizona.”
Depending on the type of SRS performed, male-to-female surgery costs $25,000-$50,000.
“Female-to-male surgery is much more expensive,” Schechter said. “Those are typically performed in stages and require implants, and could cost upwards of $100,000.”
Schechter said how much an insurance company might cover for SRS depends on several factors.
“I would say someone with good commercial insurance could expect the insurance company to pay up to 80 percent.”