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Discrimination

Does the Affordable Care Act protect LGBTQ people from discrimination?

Yes. The Affordable Care Act is the first federal law to prohibit discrimination against LGBTQ people in the health system. The law contains explicit protections for transgender, gender nonconforming, non-binary, and intersex individuals as well as LGB people based on sex stereotyping. This includes most types of health insurance coverage and most types of health care providers.

But we all need to pitch in to make sure that these protections are being honored. If you face discrimination at any point during the enrollment process, please let us know at info@out2enroll.org. If your coverage is denied, appeal with your health insurer – visit http://bit.ly/2hGFuWn. If you face discrimination by an insurer or health provider, file a complaint with the Office for Civil Rights at hhs.gov/ocr or contact a legal organization at http://bit.ly/2hHkLxi.

Read about Section 1557 of the Affordable Care Act to learn more about nondiscrimination protections.

 

What if my plan refuses to cover benefits and services related to gender transition?

You have rights. The coverage of transition-related care continues to vary by insurer and state. But you have the right to expect that your plan will cover the services you need as long as those services are covered for other people on your plan. These services may include preventive screenings such as mammograms, Pap tests, and prostate exams; hormone therapy; mental health services; and surgical procedures related to gender transition.

To help you understand your options, we’ve created new state-specific Transgender Health Insurance Guides and encourage you to make an appointment with an LGBT-friendly expert who can help you enroll for free. If your transition-related care is denied, appeal with your health insurer – visit http://bit.ly/2hGFuWn. If you face discrimination by an insurer or health provider, file a complaint with the Office for Civil Rights at hhs.gov/ocr or contact a legal organization at http://bit.ly/2hHkLxi.

Read about Section 1557 of the Affordable Care Act to learn more about nondiscrimination protections.

What if my plan refuses to cover the services that I need?

If your plan refuses to cover medically necessary services that are recommended by your doctor, you have the right to appeal this decision and have it reviewed by an independent third party.
You have the right to:

  • Ask the insurer to reconsider its decision.
  • Know why an insurer denied your claim or ended your coverage.
  • Know how to challenge the insurer’s decision.

 

Typically, you must first go through a process called the “internal appeals process” where you appeal directly to your insurer. If you are unhappy with the result from the internal appeal, you can then request an “external review” from an independent third party.

We recommend going through this process because many denials are overturned during the appeals process. If you need help filing an internal appeal or external review, contact your state’s consumer assistance program or insurance department.

If you are denied coverage for transition-related care or discriminated against at any point in this process, you can file a complaint of gender identity discrimination with the Office for Civil Rights at the U.S. Department of Health and Human Services. Read more here.

What if my plan doesn’t carry the prescription drug that I need?

Every plan sold in the Marketplace must provide a link to its drug formulary (the list of drugs that are covered). If you need a certain drug, you can use this formulary to find out if your drug is covered before you sign up for coverage. If you have a specific health need, we encourage you to take advantage of free help (either in-person or by phone) from a trained assister to help you consider your options.

If your doctor prescribes a drug for you but your insurer doesn’t cover the drug, you may be able to appeal for an exception to get the drug covered. To do so, contact your insurer. If you want help with your appeal, contact your state’s consumer assistance program or insurance department.

Can I visit my partner or spouse in the hospital or nursing home?

Yes, you have the right to visit your partner in the hospital, nursing home, and most other types of health care facilities. If you face discrimination, you have new rights. If you experience any form of discrimination, you should file a complaint with the Office for Civil Rights and let us know at info@out2enroll.org.

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