“it's not a bug, it's a feature.” Health insurance [systems] are created and run in ways that are meant to hold back and deny access!


“Hope and Assistance” – Ashley’s Story About Gender-Affirming Advocacy

By Guy John, former CPP Student Advocate, candidate for dual degree in JD & MA-Education Policy, May 2023 

I got the chance to meet up with Ashley, a former client at the Center for Patient Partnerships, to chat with her about her experience going through the partnership with one of our Student Advocates and how things have been for her afterwards. Through her time with CPP, Ashley was able to get her insurance provider to cover her care for facial feminization surgery. Ashley, like many other trans folks seeking out gender-affirming facial procedures, was originally denied insurance coverage. Despite having a well-considered insurance provider, which she has through her job as a critical care nurse, Ashley has been through multiple roadblocks in her efforts to receive care. Originally when she first sought-out gender-affirming care, an individual on the phone had told her that the insurer did not cover any gender-affirming procedures. Later on, Ashley discovered that this was not true and continued forward seeking care.

Value of Advocacy

With her most recent procedure, facial feminization surgery, Ashley teamed up with the Center for Patient Partnerships to appeal the denial of coverage she received. This appeal went all the way to the last review level before successfully being overturned. Ashley communicated to me that navigating insurance coverage has been difficult; she expressed that if it wasn’t for the assistance and support from the folks at CPP, she doesn’t know if she would have fought the insurance denial all the way till the point that she did.

In our conversation, Ashley mentioned an extremely powerful statement: “it’s not a bug, it’s a feature.” Ashley was referring to the fact that these systems, specifically health insurance, are created and run in ways that are meant to hold back and deny access to folks. Ashley shared that working with the Center provided her hope and a form of assistance that allowed her to successfully appeal the denial she faced. One of the greatest things out of the experience for her was that she was not left to do all of the work on her own. As both a mother and a critical care nurse, Ashley has a lot on her plate; when we consider the additional barriers and systemic discrimination trans folks like Ashley face, we can get a bigger picture of how critical it is for programs like CPP to exist and advocate for trans clients. In our discussion about the future work of CPP and, in general, advocacy work for improved outcomes for trans patients, Ashley emphasized the importance of outreach and communicating with folks to reassure them that there are people out there that can help in the process and there are ways that you can fight insurance denials.

Next Steps – for Ashley and CPP

When she has time, Ashley runs a social media platform on YouTube and discusses some of her journey as a trans woman. She hopes that creating a video in the future focused on the work here at CPP, along with this article, will help to get other trans folks aware of the support the Center has to offer. Despite winning her insurance appeal, Ashley still has remaining concerns relating to her care. As we discussed, it is not uncommon for folks to still have obstacles after insurance coverage is approved.

The Center for Patient Partnerships understands this, and aims to provide a space that looks at advocacy for patients in a holistic way. Ashley, and other trans folks who seek out our help, do not have to limit what they bring to the table in our discussions solely to the denial of gender-affirming care. We hope and are working towards making sure the Center’s trans health advocacy is not just insurance appeals but is assisting and supporting trans folks as they navigate the complex systems that are put in place; systems, which Ashley wonderfully explains to us, are established with “not bugs, but features”. The Center for Patient Partnerships is committed to helping our trans and gender-expansive clients as they deal with these bugs, and we hope that the clinical learning environment we have here creates future leaders who enter into their professional life with a drive to help this community.