Connecticut Voice

Your LGBTQ+ Voice

CT’s Best-Kept Healthcare Secret Could Be Your Best Friend

Individual health insurance policy and stethoscope.

Do you own a body? If so, congratulations: you are among the 100 percent of readers who can use this news. If you’re also a member of the LGBTQ+ community, you’re more likely, actually, to need this news.

LGBTQ+ people already face unique and added obstacles to accessing healthcare. Fortunately, in Connecticut, there’s help available (free!) for one of the most stressful of them: insurance.

The state Office of the Healthcare Advocate offers free assistance with health care issues–most commonly with appeals of insurance denials.

Their success rate is high, says OHA General Counsel Sean King. In 2002, the office handled about 4,000 cases and recovered $6.7 million for consumers. And that is despite being, as King puts it, “the best-kept secret in state government.”

“We do have frequent LGBTQ+ issues come into our office, in particular around gender-affirming procedures that are denied, or delayed or untimely,” says King. Frequently, insurers claim that care isn’t medically necessary. The office also often handles appeals of reproductive care denials for same-sex couples, and mental health coverage claims.

King says that requests for help are “substantially” higher now in part due to increased awareness of the office’s existence. A new state law requires that insurers display the OHA’s contact information on the first page of denial letters.

The office was created by law in 1999 and opened in 2000 under the unclear and potentially misleading name “Office of the Managed Care Ombudsman.” The General Assembly improved the name in 2005. Five years later, the Affordable Care Act required that all states establish a healthcare consumer assistance program. Not all did.

Connecticut is “probably the most robust in the nation,” says King, who adds that most states’ programs are poorly funded and staffed; that some designate one person in the attorney general or consumer affairs office as “the program,” and that some assign the job to a nonprofit. Connecticut’s office has 18 staff members.

To request help, fill out a form online and attach pertinent documents. [My personal experience with the OHA was easy, quick, and successful. I filled out the form, and the next day received an email confirmation saying it had been received and that someone would contact me soon, and in less than a week had a phone appointment with a staff attorney. A few days later, the insurer reversed its denial of my wife’s electrolysis, which is medically necessary for trans women.]

The number-one thing the office helps people with is insurance denials, but it also offers one-on-one assistance in selecting, understanding, and using plans.

Education is the office’s secondary focus. They use social media, conduct webinars, offer “lunch-and-learns” to employers and organizations, and attend public health events. “We try to make sure people understand health insurance in general, their own health insurance plans specifically, how laws apply to their plans, and how to deal with in- and out-of-network providers and denied claims,” says King.

The OHA is available to present to LGBTQ+ organizations and at events. Requests can be made on the website.

Advocacy is another one of OHA’s critical missions. The organization lobbies for or against rule changes proposed at the state level and by the federal Department of Health & Human Services and Department of Labor.

The 2020 U.S. Supreme Court Bostock v. Clayton County ruling (that Title VII of the Civil Rights Act prohibits discrimination against employees because of gender identity or sexual orientation) is interpreted as also prohibiting discrimination by private health insurers. In practice, though, it obviously doesn’t. The matter isn’t legally settled, says King. “Whether an employer’s health plan can impose certain restrictions on gender affirming care seems to be an open question that will likely require further litigation to resolve definitively.”

Plans funded by the Affordable Care Act can’t limit LGBTQ+ people’s care, but 26 states currently have no law prohibiting private insurers from discriminating. That leaves behind about half the privately insured people in the country.

For state employees it’s a similar story. According to the Movement Advancement Project (MAP), 13 states explicitly exclude gender affirming care, and another 12 states have no or an unclear policy.

According to MAP, 44 percent of the LGBTQ+ population lives in states without LGBTQ+-inclusive protections for private insurance.

Find out what you need to know at the OHA website:

—Jane Latus