I Was Denied Health Care for Months Because of the Gender Marker on One Form

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Culture & Conversation LGBTQ

I Was Denied Health Care for Months Because of the Gender Marker on One Form

Cyrée Jarelle Johnson

This tells me that cis people would rather I languish than be myself.

If anything has been made apparent by the response to a leaked memo reportedly circulated by the U.S. Department of Health and Human Services months ago, it’s that cis people know next to nothing about trans people.

Yes, HHS’s moves to accept only what it considers biological gender as grounds to gut Title IX and other anti-discrimination ordinances will be a major step backward for transgender rights—the few that we even have. But to be truly surprised by this legislation, cis people must have slept through every moment leading up to this announcement. In this century, transgender people in most states can still be fired for who we are, almost a fifth of us have been homeless at some point in our lives, and just as many have been denied medical care just for being trans. And for trans people with disabilities, the refusal to officially codify and otherwise recognize our genders as simultaneously self-determined and legitimate can put our health and lives in even greater danger.

I live with Systemic Lupus Erythematosus. If there’s an office plague going around, I’ll get it first, worst, and longest. I’m in some form of pain every hour of every day, and I will require life-sustaining medication forever. Like many people with lupus, I see a rheumatologist for my disease care—a pricey specialist that requires a referral to acquire and quarterly blood tests. Just three month’s worth of tests costs thousands of dollars.

I spent my late teens and early 20s working a job that required me to perform a gender that was not authentic to me in order to stay employed. So I was relieved when I found a very queer nonprofit opportunity. I looked forward to having insurance, helping LGBTQ folks, and dressing in ways that conformed to my gender for the first time in my professional life.

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During my new employee onboarding meeting, I struggled to choose which gender marker was best. I asked my human resources manager, who told me to pick whichever fit most closely. I didn’t (and don’t) see how my gender is relevant to any insurance proceeding, but I selected the “M” box. Soon, I had insurance and was depositing a portion of my pre-tax income into a health spending account. The setup seemed simple enough.

Or at least it did until I showed up at an appointment for my primary care physician (PCP). I had set the physical weeks in advance; without my PCP’s approval, insurance would no longer pay for me to be seen by specialists. Now, my PCP was refusing to see me. Without access to specialists, I can’t get prescription renewals for my life-sustaining medication. And I began to run low on Azathioprine, the medication that decreases my inflammation enough to make me consistently ambulatory.

With time running out and my mobility in peril, I walked into my PCP’s lobby in a huff. I sharply explained my issue: how I wasn’t being seen despite long-standing appointments, no one would renew my medications—it was as if not even medical professionals gave a damn whether I lived or died. The intake associate took small notes on her clipboard, before ferrying my message into the windowless backrooms of the hospital. She was gone for ages; I felt triumphant for having taken a half-day off rather than attempting to dash back to work after what would no doubt be an emotional experience for me.

The intake associate returned to her desk and summoned me with flattened lips and a wave of her hand. “Your insurance has an ‘M’ on it and the rest of your paperwork doesn’t. That’s why we haven’t been taking it,” she told me in a true whisper, as though it was an embarrassing mistake made by an incompetent superior. “When you get that straightened out with the insurance company you can come for your appointments here again.” And I’m sitting there in front of her thinking, Why the fuck didn’t anyone just say that before now? Why did I have to beg for such a simple answer? Was having an “M” instead of an “F” on a form really enough of a reason to keep a sick person from obtaining necessary medication? I can’t fathom why my gender marker is relevant to their administrative processes at all.

The fact that I was denied medical care for over six months because I selected a more appropriate gender marker on my employment forms tells me that cis people would rather I languish than be myself. It’s not the first or only time I’ve gotten this message about my humanity, and the Trump administration’s proposed revisions are just an extension of that bias.

Online and in person, there are many who think that attacks on tiny minority groups are a decoy to distract from some broader, dreadful threat to come. This ignores the ways that attacks on trans and queer people rally so-called cultural conservatives to more right-wing positions. Gender and sexual minorities make excellent targets for the sort of harassment that brings bullies together, from the schoolyard to the Senate.

The laxness with which cis people have told trans people not to be afraid of these proposed changes is as concerning to me as the potential results of such rollbacks. They traffic in the same lolling misinformation as the HR manager whose hippy-dippy advisement cost me hundreds of dollars in medical bills and hours on the phone with medical and insurance providers. They seem to think that transition is as easy as checking a box—that the world has bent towards trans rights and equity, and so there is no longer a need to protect trans people.

It is not. It has not. And if cis passivity in the face of major threats to transgender people’s right to exist stays as pervasive as it is today, then the only allies trans people have are ourselves, our wits, and our resilience.