For a transgender person, navigating registration, scheduling, and billing aspects of healthcare is very complicated. Ben Viohl was born female but identifies as male, and has been on hormone replacement therapy for almost 10 years.
“Within that time frame, I have changed my gender marker and name legally, but I haven’t had any surgery yet,” Viohl says. Under state law, Viohl is unable to amend his birth certificate until that occurs.
“Because of that, my driver’s license does not match my birth certificate. This would make me a male with a uterus,” he explains.
This makes filling out registration forms difficult for a variety of reasons.
“The inconsistency leads to confusion. If filled out incorrectly, it tends to lead to insurance denial,” Viohl says.
Some common examples: A transgender man may need screening for cervical cancer, needs a hysterectomy, or has uterine cancer.
“Is the hospital going to be able to register, code, and bill those procedures correctly? Will the hospital communicate correctly with insurance, or vice versa? These are concerns that the transgender community faces every day,” Viohl says.
Additional Categories Needed
Miscommunication has led to delays in treatment, lab results, and insurance denying coverage for a service that is actually covered.
“It is vital that hospitals and doctor’s offices educate themselves about transgender healthcare pitfalls,” Viohl says.
Most registration systems allow only for “male” and “female” options when classifying the patient. Some transgender people identify as the gender opposite of their sex assigned at birth. Some do not identify as either, and some fall somewhere in the middle of the gender spectrum.
“I feel that categories in addition to male and female, such as ‘transgender, transsexual, and/or other,’ should be available choices,” Viohl says. “This may allow for more flexibility when billing insurance.”
Many states have laws restricting a transgender person’s ability to change his or her gender documentation.
“Registration staff should be aware of this,” Viohl says.
He would like to see registrars ask the transgender patient how they identify.
“I have found that if initial registration is performed in an open, informative, and respectful manner, there are fewer issues with insurance because the right questions are being asked,” Viohl says.
For a transgender person, navigating registration, scheduling, and billing aspects of healthcare is very complicated.
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