Should health plans cover sex reassignment surgery?
When the subject is transsexuality, many doubts arise. As June is LGBTQIA+ Pride Month, we decided to address this issue, more precisely to comment on sex reassignment surgery and how health plans should deal with it.
The LGBT community (now called LGBTQIA+) has been gaining more and more rights, one of which was the right to donate blood, something that in Brazil, until a few years ago, was not allowed for male homosexuals. We even commented on the subject in our article on LGBTQIA+ achievements in health.
Another right related to the LGBT community concerns sex reassignment surgery, popularly known as "sex change" surgery. By the way, it is important to know that the term "sex change" is quite uncomfortable for trans people, as it is reconstructive surgery, thus serving to monitor the gender with which this person identifies. Thus, it is correct to call it sexual reassignment, transgenitalization, or neophalloplasty.
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What happens is that some health plans end up refusing coverage for this procedure, as many claims that it is not provided for in the ANS list and that it has only an aesthetic nature. However, sex reassignment surgery is part of a set of procedures, which are included in the list of ANS. Some examples are partial or total limb amputation (genital and male reproductive system) and even neovagina.
Despite this, other procedures are not included in this list, such as clitoroplasty. For this reason, there is difficulty for transsexual women to fully undergo the procedure with a health insurance plan. However, the simple fact that one or another procedure is not included in the ANS's list does not remove the health plan's duty to fully cover the costs of the surgical procedure.
In addition, it is not correct to state that sex reassignment surgery only brings aesthetic benefits, as transsexuals may experience various psychological problems due to the impossibility of performing such surgery. For trans women who wish to undergo the sex reassignment procedure, here is the tip: ask the health care professional to make a document requesting surgery with all the codes and procedures listed, to be delivered to the health plan.
In some cases, health plans end up approving only a part of this list, refusing those procedures that are not expressly included in the ANS list.
When there is a refusal by the health plan, it is possible to file a lawsuit, with a request for an injunction. According to lawyer Elton Fernandes, in most cases judges throughout Brazil have ignored the fact that not all procedures are on the ANS's list, thus determining that the health plan pays the costs of the surgery in full, including medical fees when the health plan does not have a professional trained to perform this surgical procedure.
Recently, there are many cases of trans people who go to court because the health plan does not agree with the coverage of the surgery, and there is always a victory for the patient. In addition to the surgery, it is possible to guarantee compensation for moral damages against the plan.
Transgenitalization is a surgical procedure that is already covered and guaranteed to patients in the Unified Health System (SUS). In Ordinance No. 2.803/2013, the Ministry of Health defines which procedures must be covered during the sex reassignment process:
- Pre and postoperative clinical and outpatient follow-up;
- Hormonal treatment;
- Bilateral orchiectomy;
- Neocolpoplasty;
- Thyroplasty;
- Amputation of genital organs;
- Mastectomy;
- Hysterectomy;
- Colpectomy;
- Meatoplasty;
- Meatotomy;
- fistulectomy;
- reconstructive breast plastic;
- Cosmetic surgeries for complementary corrections.
It is noteworthy that before performing the surgery, it is necessary to follow a path full of visits to various health professionals. First, the patient must visit a psychiatrist, who must be able to evaluate the definition and diagnosis of this condition.
The patient's next step will be with a psychologist. It is then necessary to start a psychological follow-up, which can even take years. This is a very important step in this process, and only when the patient is fit can start hormonal treatment with an endocrinologist. It is also important to know that it is necessary to sign a consent form, where the patient is informed about the treatment and possible side effects.