Advocating for transgender health care

There are about 1.4 million transgender and non-binary adults in the United States, and for each of them, transition can mean a lot of things. Often, there may be many steps to get to where they want to be. This might involve things like, legal documentation for name changes, coming out to those around them, finding the right physical and mental care to meet one’s needs — and overall, discovering their place in the world.

Oftentimes, this may be confusing and overwhelming. When a person who is transgender receives care, there are often barriers in the way. No matter what transition path a trans or non-binary person takes in conjunction with their physician, it requires navigating access, finding correct specialists and receiving proper documentation, which is often required for gender affirming surgeries. The entire process may be draining and frustrating.

In fact, 28% of trans people report avoiding health care altogether, due to stigmatization and harassment, even among health care professionals or pharmacists.

UnitedHealthcare transgender benefits specialists work to ensure transgender and non-binary members are supported along their journey, whatever form that may take. For some, having that support in place can help make a difficult road feel a little less overwhelming.

Nadine Hauf, vice president and chief operating officer of Premier and Health Hub operations, remembered one such moment with an advocate on her team.

“I remember a case after all the arrangements were put in place, the member and advocate actually prayed together," she said. "So many hurdles to overcome, and finally it was approved, everything was taken care of, and they just had that moment. Because it was finally here.”

In another case, a member called a transgender benefits specialist to inquire about a prior authorization for an upcoming surgery. During the conversation, the specialist asked the member about the new name he chose for his new gender identity so his file could be updated, and future agents would use the proper name going forward.

That seemingly small gesture can mean a lot. The member later told the specialist that no one else ever cared enough to ask him about his name preference before. 

“We understand the struggles that they’ve had to go through — from getting coverage to the biases that are out there,” said Tina Buss, business manager of the Health Hub. “We don’t stop at a roadblock. We keep going, trying to find different avenues, whether that be supporting a family with getting them Trevor Project information (a national LGBTQ organization that provides crisis support) to finding them a facial feminization provider because they live in a rural area. We are consistently making sure that their needs are met.”

Transgender benefit specialists are there to support members every step of the way. This involves things like connecting members — as well as family members — to support services for LGBTQ issues, finding therapists or mental health resources and helping them with claims for services.

The evidence-based path for many transgender people for care is to treat gender dysphoria. This includes (but is not limited to) things like hormone replacement therapy (HRT) and surgery to make one’s body more congruent with one’s gender identity. Many times, depending on the state, different procedures have varying requirements for pre-authorization, including letters of support from mental health professionals. 

“We can support the member’s journey,” said Dr. Paul Solomon, family physician and senior national medical director for the Support Team. “Sometimes it’s a matter of finding the right provider, getting services approved, finding the right documentation that’s necessary … those are the kinds of things that the team is involved in.”

And if there are clinical needs, the advocates can reach out to the nurses or the medical director directly.

The program also takes a holistic view and not only addresses medical issues but also referrals to psychological and social support, or assistance with social determinants of health.

At the end of the day, the stakes to receiving this compassionate level of medically necessary care are high for transgender or non-binary people. Supporting them with high-touch advocacy can mean better outcomes to help this community thrive and ultimately be their full selves.

“We are literally walking in the shoes of that member,” Nadine said.