A procedure required for surgery shouldn’t be hard to get covered, but for many transgender patients seeking gender-affirming care, pre-operative electrolysis sits in a frustrating gray zone. Ash Eisen, a second-year Masters of Social Work student at UW-Madison, spent the past year learning exactly how deep that gray zone goes.
Eisen joined the Center for Patient Partnerships’ Health Justice Clinic to focus on systems-level change while still supporting individual patients. That focus became especially meaningful through their work on pre-operative electrolysis, a medically necessary step for many patients undergoing gender-affirming surgery that insurance companies routinely classify as cosmetic.
“Insurance is not user friendly,” Eisen said. “Particularly when you’re dealing with something that your insurance plan isn’t laying out. They’ll blanket statement say it’s not covered, even though within their clauses it’ll say gender affirming care is covered if it’s medically necessary and pre-operative electrolysis is medically necessary.”
Through the clinic, Eisen worked directly with a patient navigating this process over the course of a year. The case involved multiple denials, shifting requirements, and extensive communication with the insurance company.
The patient ultimately received full coverage and reimbursement, but for Eisen, the experience highlighted how difficult the process can be to navigate.
“It’s a long, annoying process,” Eisen said. “There’s a lot of contact back and forth.”
At the same time, Eisen worked on a patient education brochure requested by UW Gender Services to help others navigate electrolysis coverage. The goal was to create something useful and accessible for all patients regardless of their insurance provider.
“I was really drawn to the fact that this project benefits people directly, rather than just being research for the sake of research,” Eisen said.
Designing the brochure required a fine balance between providing actionable advice and being general enough to remain applicable to a wide audience, as many insurance requirements differ based on provider and no single guide can capture every scenario. Eisen focused on helping patients understand the process while encouraging them to engage directly with their own insurance plans.
“We approached it as a supplementary material, rather than like it’s a be all, end all,” Eisen said. “I’m hoping that, because of this brochure, patients from gender services are able to navigate the process more independently and feel like they have more autonomy over their own body and their own medical decisions.”
At its core, the project is about increasing independence and confidence in navigating care.
“People shouldn’t have to rely on an advocacy organization to access and navigate their own health,” Eisen said. “People should be able to do that independently. Our media literacy, our insurance literacy, our financial literacy, is not super great, and so being able to provide this as an option for people to feel empowered, to empower themselves, is the goal, knowing that they can still always come for help from the Center for Patient Partnerships if they need it.”
That perspective was shaped by Eisen’s work with clients who voiced frustration at not being able to manage their healthcare journey on their own.
“Some clients wish that they could just do it themselves, and that’s perfectly fine,” Eisen said. “Self advocacy is, I think, one of the most important things that we can teach and learn as humans. It’s the ability to do what we need to do depending on what makes sense for our bodies, our brains, our situations.”
In healthcare settings, where choices can be limited and there is not always one clear, best option, that sense of control matters.
“You may not have a lot of decisions to make,” Eisen said. “Maybe none of the options are the right option, but the fact that you’re making an option is still taking back a form of power over a medical system that isn’t designed for you to feel powerful in any way.”
Eisen’s experience at the Health Justice Clinic has reinforced the importance of supporting patients without trying to “fix things.” Looking ahead, Eisen hopes to apply this framework in a career in sexual health education. Their long-term goal is to expand comprehensive sex education at the federal level and ground it in a framework of self advocacy.
“We’re not just communicating for the sake of communicating,” Eisen said. “We’re not just talking about consent for the sake of consent. We’re talking about sexual health for the sake of giving young people the ability to make healthy decisions and make safe decisions and have fun while they’re doing it, but also feel empowered while they’re making these decisions. That’s my dream.”
At the Center for Patient Partnerships, that work is already taking shape. The pre-operative electrolysis brochure will outlast Eisen’s time at the clinic, giving patients a starting point to understand their options, ask informed questions, and move through a complex system with more confidence.