The Denied “Big O” and HRC’s Corporate Equality Index Farce

No, the “Big O” is not about orgasms, or “Oprah,” or “Overstock.com.” This is about another Big O that is specific to pre-operative male-to-female transsexuals, one called an “Orchiectomy,” also called “Orchie” for short. Other words that are used to describe the procedure are; “gelding, neutering” and “orchidectomy.” In other words, “castration.”

One of the biggest health risks facing pre-op and non-op transsexuals is the same one that faces post-menopausal women: taking too much estrogen and testosterone blockers. There have been many studies done on the negative affects of estrogen and progesterone on a woman’s body over the years, some as recent as this year. On the ABC News, March 4, 2008, they had a story on how the affects of estrogen still lingers after a person stops taking it, specifically with breast cancer.

Besides breast cancer, estrogen has a tendency of thickening a person’s blood, which can cause clots, leading to possible heart attacks and strokes. It can also cause bone density lost. The current studies show that the risk of blood clotting lessens when a person stops taking estrogen, but the risk for breast cancer still remains high.

When a transsexual woman has sex reassignment surgery (SRS) or an orchiectomy, the need to block testosterone is gone and the amount of estrogen needed to maintain a healthy level is drastically reduced. I have heard of some trans women who stopped taking estrogen all together, or changed to an estrogen substitute after one of these surgeries. This is one of several benefits for SRS or an orchie.

These studies are important to me because I have been on hormones for over 11 years now. When I started, the negative side affects for estrogen had barely been studied. Not a lot of information on the health issues had been revealed and any negative affects were easily brush aside.

But, I can no longer turn a blind eye to what estrogen and progesterone have been doing to my body over the years. Stopping hormones without stopping testosterone from being made can cause kidney and liver damage, as well as the emotional affects brought on by unbalanced hormones. I’m between a rock and a hard place as far as my health is concern.

Since I am not financially ready for SRS and the company I work for won’t cover it, then I decided to go the route of getting an orchie. It is a common and inexpensive procedure to treat testicular cancer and is usually covered by most medical insurance. I figured the company I work for covered this surgery, but things weren’t going to work out that way.

I am not writing this article to chastise the Fortune 500 Company I work for, so I will not reveal their name. Some of you may already know, so I request you don’t mention it in the comment section. For the purpose of this article, I will just use “the Company.”

I have been working for the Company for 18 years now, which means I transitioned on the job. I was told they would not tolerate harassment, but what I received was subtle bigotry by my coworkers. As I started getting more involved in activism, I decided to see if the Company would add “gender identity and gender expression” in the EEO policy. After six years of asking, in 2005, they finally put in “gender identity” without even saying anything. Up until then, I would get a phone call from the head of HR telling me, “We will not discriminate for any reason.” They called rather than sending me an E-mail so they wouldn’t have any paper trail of our conversation.

I put them to the test on their commitment to this four years ago when an endocrinologist coded a lab test for Gender Identity Disorder, yet he had never done that in the past. The medical insurance company denied the claim and the doctor’s office refused to change the code to what they used in the past. I refused to pay the bill and they sent me to collections.

After discussing this with the insurance company, they told me that if the Company told them to pay for this, they would. I first went to HR to remind them that I was told that they would not discriminate for any reason. If other people in the Company who got the same lab tests and had them paid for, then I should have mine paid for as well. HR told Benefits to handle this.

Things bogged down at that point. They had to “do research” to see if they should cover this, while in the meantime, the collections agency kept calling me. It took six months of being harassed by the collection agency and calling the Benefits office each time to have them finally tell the insurance company to pay the doctor.

Now it’s 2008 and there are new HR and Benefits people. After seeing all the scary news on how estrogen harms the body, I decided to see if my medical doctor saw a need for me to get an orchie and I figured the insurance company would pay for it. However, I have been listed as “female” by the Company and the insurance company for the last 11 years, even though everyone knows of my status.

There are a lot of benefits to be listed as female when it has come to my health. But, getting an orchie is not one of them. Females do not have testicles, so in the beginning of all of this, the insurance company told the doctor’s insurance person, “This would be considered a transsexual procedure and therefore, cosmetic.”

In the orchiectomy procedure, the doctor removes the inside of the testicles, but there are no “cosmetic” benefits from this. Then there is the cost comparison between an ochie and treatment for breast cancer, heart attacks or strokes. These are very expensive procedures. Not only am I trying to protect my health, but I am trying to save the company a lot of money in the future. An orchie can be between $1000 and $4000, depending where a person goes. Treating me for a heart attack or a stroke can be 50 to 100 times that amount.

After the Benefits person talked with the insurance company, they decided to do a “benefits review” and would send me a letter in 3 days. When I received the letter they said they were denying the surgery, but had a paragraph at the bottom of the letter that said it could be sent back with more medical information.

The doctor’s insurance person got the same letter and when she called them, they told her that what she read was part of the “form letter” portion of the letter.” They then said the reason for denial was simply, “We don’t cover that.” There was no medical decision involved, nor any amount of medical proof would change their minds. This looks a lot like the denial of payment for the lab test.

There is more to all of this. Last summer, there was a major discussion with the Company and several people, trying to convince them to cover SRS. We had all kinds of examples of the low overall cost and the frequency of people applying for the surgery. They decided not to cover it. I’m sure that decision affected me and my request for an orchie.

On top of all of this, the Company has a 100% rating by the HRC Corporate Equality Index. To get that rating, they have to say “Yes” to the question of whether they provide various transsexual services, including surgeries. Most of us would read that as meaning SRS, but a few years back, we discovered that if they cover hysterectomies for women, then trans men are supposed to be covered. An orchie falls into that same category. However, if a trans woman is listed as female or a trans man is listed as male, then the insurance companies my Company uses won’t cover them. As your read earlier, they called them, “transsexual surgeries.”

I called HRC and left a voice message to a person involved with HRC’s CEI to have my Company’s index number reduced, but a week later, I still haven’t heard back from them. Then on April 15, I received a form E-mail from them and this is what they said:

“Thanks for contacting the Human Rights Campaign Foundation. The Corporate Equality Index requires the following transgender-related criteria of an employer in order to receive a 100% rating:

-- A non-discrimination/EEO policy that includes gender identity and/or expression;
-- Insurance includes access for transitioning individuals for at least one category: Counseling by a mental health professional; pharmacy benefits covering hormone therapy; medical visits to monitor the effects of hormone therapy and other associated lab procedures; medically necessary surgical procedures such as hysterectomy; or short-term disability leave for surgical procedures; and diversity training that is inclusive of gender identity OR has supportive gender transition guidelines.”

What? “At least ONE Category?” Companies need to cover ALL of those categories and not “at least one category.” This really shows how much of a farce the HRC Corporate Equality Index truly is. Companies can do just one little insignificant thing that falls into one of those categories and they’re rewarded with the coveted 100%. Because my company covers just a few of those categories and not some of the important ones, they get their 100%, while I am still at risk for heart attacks, strokes and breast cancer. This is BS to the Nth degree.

I also see an issue where the insurance company is violating my Company’s EEO Policy by discriminating against me based on my gender identity. Looking up the insurance company in the HRC Corporate Equality Index, I find they also have “gender identity” in their EEO Policy. Oh, wait, I guess they can violate their EEO policy when it comes to their “customers.” I have contacted Lambda Legal on this to get their advice and Cole Thaler sent me letters that worked for other people in a similar situation.

I still cannot understand why Benefits will not tell the insurance company to cover this like they did for the lab test. On March 14, the Benefits person said that it will be from one to two weeks before the official appeal process would be over. I also contacted HR on the possible EEO Policy violation, but they haven’t said anything as of April 14.

When I got back from vacation and went to work on April 9, I had an E-mail from the Benefits person saying the appeal was once again denied. However, this time the reason was the insurance company didn’t see this as medically necessary. Just like we have heard other people experiencing, I have an insurance company telling doctors they don’t know crap about their profession. This has now become another American insurance company fiasco, and it’s not even an HMO.

The urologists’ office canceled the surgery until they get the ok to cover it. This has not been a pleasant journey for me over the last several weeks. I won’t stay quiet on this. My doctor is ready to mount another attempt with the letters form Lambda Legal and my Pastor and I are ready to approach this in the Soul Force fashion.

I felt it was important to bring to light the problems that I am facing at my job when trying to protect my health. There maybe others who will encounter this problem, so I figured they need a heads up on what to expect. I’m wondering. Since they have me listed as “female” in the system, should I ask them to cover me for a hysterectomy?