In cases where a person has surgery to go from male to female should insurance companies be compelled to cover mammograms?

Interesting question. Where it fails is that men are susceptible to breast cancer as well as women; it’s just less common.

If the transgender female has insurance, why shouldn’t she be covered for mammograms? Isn’t it covered by most health insurance policies, be it male or female? It’s all about an individual’s well-being.

If there are disclaimers that relate to hormone injections and/or breast implants, so be it. The person signing on the dotted line is responsible for reading the details. I just don’t understand why someone’s gender should be an issue when it comes to getting a mammogram, especially if there is any concern about breast cancer.

Why would a man that transgendered to a woman be exempt because the breast the person now possess was not natural but manmade. With that theory, women who have breast augmentations would not be eligible for insurance paid mamograms but they are.

@Pied_Pfeffer I just don’t understand why someone’s gender should be an issue when it comes to getting a mammogram, especially if there is any concern about breast cancer.
I guess the best thing I can come up with is insurance companies seem to be about risk and return. There are procedures people I know where denied because they were either too young for the procedure or too old. One person I know really needs a knee replacement but his carrier will not cover it because they say he is too young, that the average knee replacement would mean he would need another when he was in his 70s, as opposed to if they waited until he was near his mid-60s then it might last him until he dies and there would not be a need to go through that rodeo a second time. If they did not see the risk of breast cancer being the usual but lower than, they would not see the urgency to pay for it. That would be like a guy in his late 20s wanting the insurance to pay for a colonoscopy, especially if there were no history of colon cancer in the family tree.

@chyna With that theory, women who have breast augmentations would not be eligible for insurance paid mamograms but they are.
If a woman was denied for having a boob job, it would be for different reasons.

Of course. As @Pied_Pfeffer mentions, men also get breast cancer.

It’s an odd question, however, because it implies that male-to-female is so common that an increase in breast cancer would cause a strain on insurance companies. Note: I’m not sure what the data says about breast cancer rates and transgender women. In an industry that is awash in profit, I can’t imagine this even appearing in any metrics they would use in their awful risk/cost calculations.

Women should get the healthcare they need, period. This includes mammograms. And it doesn’t matter whether that woman was born female or male.

They’re still a person. Are you going to deny coverage on some arbitrary idea like that?

@DoNotKnow Women should get the healthcare they need, period. This includes mammograms. And it doesn’t matter whether that woman was born female or male.
People still seeing to be missing the underlying reason, insurance companies are in it to pay just what is necessary by their methods and not for things that are deemed not necessary. The only way a male to female recipient would have a greater chance at breast cancer after the surgery would be if the surgery itself or the injections leading up to it, made them more susceptible, and that would be a reason to deny them a mammogram or even cancel their policy all together. If a carrier doesn’t see the risk of breast cancer in a male to female recipient why would they be compelled to pay for it? Would they be required to include prostate checkups for a female to male recipient that won’t have a prostate for the procedure to be used on? Simply because it now says ”female” on the driver’s license doesn’t mean that person is still genetically predisposed to things a natural female would be subject to, you certainly won’t go through menopause as a male to female recipient, no matter how ”womanly” one felt.

If the trans gendered woman has breast implants, it is not recommended to have mammograms. Women with implants aren’t advised to have mammograms. Not only is there a likelihood of rupture, but the implants impede the scan.

If breasts develop due to the hormone therapy, then, yes, medically she will need mammograms because the HRT actually results in working breasts that can lactate. It isn’t because they want mammograms to make them feel more ‘womanly’, they will face medical risks of breast cancer, as well as an increased risk of stroke and blood clots.

“As in a genetic woman during puberty, ducts and coopers ligaments will develop under the influence of estrogen. Progesterone will cause the actual milk sacks (alveoli) to grow and develop and given the right stimuli, the breasts can lactate…....”

^ If breasts develop due to the hormone therapy, then, yes, medically she will need mammograms because the HRT actually results in working breasts that can lactate.
What are you saying, men have the equipment to produce lactating breast all one has to do is rub female hormones on it? We are speaking of a male with bonded on female parts, it is the same as going the other way and a female will not be able to father a child no matter how ”manly” she/he feels after the surgery. If a breast doesn’t have the equipment making it highly susceptible or even frequently susceptible, why would an insurance company see fit to pay for something that has about as good of a chance of happening as a snowball hitting a polar bear riding a unicycle in the middle of July on main street? No one hasn’t really addressed that, regardless of what she is legally seen as after the procedure, she is not going to have the material that is prone to breast cancer.

@Hypocrisy_Central You really don’t know anything about this at all. Taking female hormones is an ongoing thing and it radically alters the body. Transitioning into female, the hormones cause actual breasts to develop complete with milk sacks, ducts and coopers ligaments. If you are genuinely asking this question, then accept the answer. Breast tissue develops, just as in a pubescent girl.

^ Then I can see the insurance company taking issue with the ongoing use of artificial hormones, if i ran an insurance company and did not want to pay, that would be an easy route to choose.

why would an insurance company see fit to pay for something that has about as good of a chance of happening as a snowball hitting a polar bear riding a unicycle in the middle of July on main street?

A low probability illness is exactly what an insurance company wants to charge you for. They know it will be very unlikely they will pay out.

That said, breasts are breasts, and will have equal chances to develop cancer. Plus why does it matter the location of the cancer? Insurance needs to cover it, period. If they don’t, it’s a fairly useless plan.

You keep stating your (false) assumption that the breasts of EVERY M2F transsexual are there only because of implants.

That is just not true. Believe it or not, there are some who DO NOT have implants and yet have breasts (even tho they were born as male.)

How is this possible, you may ask? Because they are taking FEMALE HORMONES on an ongoing basis, day after day, year after year. This is a normal part of the transition process.

It’s the hormones which produce the REAL (not artificial) BREASTS. Granted, most, including many born women choose to have implants. But not all do.

The cancer risk is in the breast tissue (and males have natural breast tissue as well as females). Every male does. But obviously most males don’t have as much breast tissue as females, generally speaking. But they still can get breast cancer. Hence the need for mammograms REGARDLESS of someone’s gender identity.

So, your entire supposition is flawed to begin with simply because you evidently are unacquainted with the simple medical facts of the matter. Do a little reading once in a while.

@Inara27 Plus why does it matter the location of the cancer? Insurance needs to cover it, period.
Treating a cancer that is there is different than looking for a cancer not likely to be found. I bad hip or knee is a bad hip or knee, no matter what age the person is, yet some carriers will not replace a knee on someone young because said person will outlive the replacement knee and need another one. The carrier will wait until they are older before authorizing the replacement so that the patient doesn’t out live the knee causing the insurance company to have to pay twice for the procedure. It would be no different than if they passed on mammograms for MTF people.

@Buttonstc The cancer risk is in the breast tissue (and males have natural breast tissue as well as females).
So we are going to play it dumb, and try to say that males and females have the same risk of breast cancer? The base material is still male. I have yet to read anywhere that taking female hormones change anything on a molecular level that is why they have to keep taking it or the body reverses. It is not like the body will stay and become female, a MTF has basically the same chance at cancer than a typical straight male. Being that the original body, its genes, tissue etc. is male, the lack of cancer almost nil, I have seen no argument why insurance carriers should be required to honor a request of claim of a MTF recipient just on GP when the risk is not there.

Hence the need for mammograms REGARDLESS of someone’s gender identity.
Mammograms are for those susceptible for breast cancer and not just by a fluke. MTF have way little chance at breast cancer. If it were heart attacks that can attack males and females rather equally, diabetes, or high blood pressure I can see there it would make no difference. Why would a carrier want to spend money on a likelihood that won’t happen, would you? Would you authorize prostate exams for FTM recipients just because their license says ”male” but they have nothing that is susceptible to prostate or testicular cancer? By the way, I bet I read more than you, romance novels don’t count.

@Buttonstc he’s trolling again and just doesn’t WANT to understand the situation. I’m sure he’d like to see all TG’d people marginalized and have their medical rights taken away because it gives him the heebeegeebees.

@Hypocrisy_Central, sounds like we have those dreaded “Death Panels” that Sara Palin warned is about. All thanks to corporate greed.

Amazing how @Hypocrisy_Central has suddenly become both a medical doctor and an insurance adjuster overnight.

Your premise is wrong, which many people have pointed out.

There is no clinical evidence that MTF transgendered people have no or “way little chance at breast cancer”. In fact, it is biologically implausible that they are at no/“way little” risk because they take hormones to maintain their female gender. Hormones are clearly linked, in the clinical research, to breast cancer.

For an insurance company to select a subset of women, in this instance that would be MTF transgendered people, and determine, with no clinical evidence, that they do not qualify for a screening that is recommended for all other women – that would be discriminatory. If clinical trials are done (assuming a large enough population of MTF transgendered people) and demonstrate without reservation that MTF transgendered people are at no higher risk for developing breast cancer then the insurance company could change their recommendation for that population alone.

There are ethics, laws and standards of clinical evidence (determined by clinical trials) that insurance companies must follow. They can screen above and beyond these ethics, laws and practices (that’s called preventive medicine and it saves money), but they need to do the bare minimum. Otherwise they are liable for discrimination and a host of lawsuits.

You’re bent on the risk of non-screening being zero… but it is not. It is unknown to well above 0 (based on the known effect of hormone use). So in their risk-benefit analysis, they would not only have to consider the financial cost of paying for breast cancer treatment, but the social costs of not covering MTF transgendered preventive care, lawsuits and legal fees and so on.

^ Your premise is wrong, which many people have pointed out.
How do you figure that? Insurance companies are to insure you against some eventuality, however if you are at more of a risk of said eventuality you either pay way more, or you are not insured for it. Are you saying it is prudent for an insurance company to cover a person against flooding when they live in a flood plain or are known for flooding? If you have a carrier who would do that, a lot of home owners would love to speak to you. Many home insurance carriers will not cover your house for flood in areas known for flooding, why? Because they will be paying on it a lot, and they really don’t care to. I guess you will argue that as inaccurate?

Hormones are clearly linked, in the clinical research, to breast cancer.
Taking that is true and taking hormones are linked to breast cancer insurance companies want to insure someone against breast cancer because they know someone is doing something that puts them at risk for it. That is like a company insuring someone for lung cancer when they know they are a 3 pack a day smoker and had been since their teens. I don’t know many insurance companies that will do that do you? There might be some exceptions and I am sure some here will use those exceptions as arguing points as if it is standard policy. If a carrier can or believes a person is likely to get cancer because they are doing this or that, in this case, having breast cancer why would they want to insure them? If they don’t insure them in the 1st place, they sure would not have the issue of providing mammograms. So, where is the premise of risk vs payout flawed.

Actually, the link between HRT and breast cancer are extremely tenuous, at best, and there are still some camps who believe it protects women from actually getting breast cancer. So it is in NO WAY linked to cancer like smoking is. Your point is erroneous.

@cazzie So it is in NO WAY linked to cancer like smoking is. Your point is erroneous.
I never said it was equal in cancer causing as smoking, I was merely making the point as if there was an ideal or actual link to it causing cancer do you think a prudent insurance company would insure a person taking it long-term? Why do you think people with many speeding tickets and/or accidents have to pay way more than safe drivers? If speeding drivers or those with many crashes were not going to cost the carrier more money than those who drive safely, why doesn’t everyone pay just one standard flat price? But let’s cut to the chase, do you believe that one, a company should pay for procedures that has little value finding conditions that are so scarce as to be virtually irrelevant? Two, do you think insurance companies should insure everyone even for things they have a predisposition to get be it by habit or because it is hereditary?

There IS no link between HRT and breast cancer. Who ever mentioned that was mistaken. There were studies, yes, of course, but there was no conclusive link found. Therefore, no increased risk.

@cazzie There IS no link between HRT and breast cancer. Who ever mentioned that was mistaken. There were studies, yes, of course, but there was no conclusive link found. Therefore, no increased risk.
Then someone is wrong and someone is right; if it is right a carrier would reject issuing a policy from the start, if it is wrong then using HRT would not increase the likelihood of cancer than before it was used, which would leave the MTF at the same acceptability level as the man they were before. If they are not recommending breast cancer screening or mammograms for men and paying for it, why would they want to pay for a MTF just because they have HRT created breast of the same male flesh that has no greater chance at cancer? If the susceptibility is no greater, why pay for a mammogram to find it, or pay for every man to have it even when the chances of it happening are very, very slim? Give me a logical reason why they would do that, especially making financial sense?

Did you know that Insurance companies not only PAY for the transition, but they also assume the risks for the MTF TG’d person after wards as well. I’m certain, if YOU were in charge they wouldn’t. But you are neither a medical doctor or an insurance risk adjuster and you certainly don’t want a logical answer because you ask questions just to argue.

Just the tip of the insurance iceberg. They do.
http://transhealthaccess.org/index.php/List_of_employers_with_employee_insurance_plans_covering_transition

Here is a good article about the studies done on exactly what you are arguing about. Read it.

http://openmindedhealth.com/2013/09/article-review-breast-cancer-development-transsexual-subjects-receiving-cross-sex-hormone-treatment/

What does the bible say about insurance companies ?

Jesus never charged for his healings.

@cazzie Not even a copay?

@cazzie Here is a good article about the studies done on exactly what you are arguing about.
It is other people that want to argue, the article basically says what I have said this whole thread that no one wanted to believe simply because I said it. The article backs up what I said: ”Gooren et al found that trans women and trans men who have had hormone therapy may be at the same level of risk for breast cancer as cis men.”, and ”This study’s authors found 8 cases of breast cancer in trans women in the medical literature, ranging from 1968 to 2013. That hardly makes breast cancer in a MTF recipient common, being hardly likely it is not fiscally conducive to just pay for mammograms for MTF recipients just because they have breast that look like naturally created on but have no natural female DNA, gene, etc. The article said it, so how are you going to say insurance companies should pay for them when it is so common you have only 8 cases in many decades or maybe one in X thousands of people? Take into account ”Three of those cases appeared not to be related to hormones.” the numbers drop, but it actually should help, because if there is a link to HRT use and breast cancer, that alone might bar them from a policy. It also said, ”Three out of 3102 is not many! That’s 0.097%.”, halleluiah, just what I was saying. Why would an insurance company want to pay for a bunch of mammograms for MTF when the chance of them catching breast cancer is a mere 0.097%, not even a whole percent? Make the case; tell me why they would do it, how would they profit?

The conclusion is roughly the same, but the reasoning was very different. You had no idea that breast tissue even developed for a start. You weren’t basing your conclusions on anything resembling facts. Not to mention, there were limits to this study. It was ONE clinic in ONE country and the time frame was relatively short, 21 to 23 years. There are so many other risk factors involved. And mammograms aren’t even the only suggested course of action for detection, so I don’t know why you are fixated on it.

The fact remains that ‘health’ insurance companies aren’t there to provide health care. They exist to earn money. I don’t even understand that entire concept. Premiums are paid for a set of services available to the ‘patient’ that are not clearly mapped out, as I understand it, so as to take best advantage of any illness that may happen to occur. It is an insurance clerks job to reject any claims and to find ways to NOT pay out. I think you would probably be good at that job.

How would they profit? Well, if that 0.97% received no early screening, then the insurance company would pay out big time when those few people reached advanced stages of cancer. Prevention is better than a cure for all involved.

Health plans should not be treated like a for profit commodity, nor should healthcare. The fact that they are is the prime driver of the high costs involved.