Some exclusions may apply

By , January 13, 2012 12:52 pm

Exclusions. Covered expenses of the Plan shall not include … procedures, treatments, equipment, transplants, or implants, any of which are … for, or resulting from, a gender transformation operation. – 215 Illinois Compiled Statutes 105 – Comprehensive Health Insurance Plan Act

It’s unclear whether the State of Illinois has defined – through statute or the courts – what specifically “gender transformation operation” means. But it seems pretty safe to assume that the surgery I’m currently considering would fall under its purview. Surgery in which the “spongiform erectile tissue of the penis is removed, and the skin, with its nerves and vascular system (blood supply) still attached, is used to create a vestibule area and labia minora, which then are inverted into the neovaginal cavity created in the pelvic tissue.” That seems pretty gender transformative to me.

What’s interesting about the Illinois Comprehensive Health Insurance Plan Act (or the ICHIP Act) is what other injuries, procedures, and categories of coverage are excluded.  Gender transformation operations (item 14.iv on the list of exclusions) is lumped in with cosmetic surgery (item 1), anything which exceeds “reasonable or customary” cost (item 4), injury due to war (item 9) , services that are “not provided in accord with generally accepted standards of current medical practice” (item 14), contraceptives (item 19), weight loss programs (item 21), acupuncture (22). Interestingly enough, the act itself does not, as best as I could find, mention abortion or early termination of a pregnancy, but the ICHIP website stil says such services are excluded.

And then there’s my favorite exclusion. Item thirteen. “Blank.” The item isn’t actually blank, but the text reads open-parentheses-b-l-a-n-k-close-parentheses. Blank. I’m assuming there was an item thirteen, but it was removed by some later amendment I’ve been unable to find. Either that or the Illinois State Legislature was worried about the superstitious ramifications of having an exclusion number thirteen. But that seems unlikely, because there is a benefit item number thirteen (diagnostic x?rays and laboratory tests). The ways of government legislatures are opaque and confusing.

As far as I can tell, gender reassignment surgery (or gender transformation operation, or sex change, or whatever you want to call it) is the only accepted standard of medical practice (to use the ICHIP ACT language) explicitly excluded. Nowhere else did the Illinois Legislature say, “Doctors recommend this treatment. There are safe and reasonable guidelines for its use. It has been shown to be beneficial to patients. But there’s no way in hell we’re going to pay for it.”

Because the Illinois State Legislature is obviously the best-equipped body to decide medical coverage and treatment.

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