Beth Scott from New Jersey submitted her claim for mammogram to her insurance agency - Aetna, but was denied coverage because she was a transgender.
That was in the year 2010, when on her doctor’s advice she underwent a breast screening test that cost her $385.
She has finally won a legal battle with the insurance company. She reached a settlement with the company with the help of Transgender Legal Defense and Education Fund.
"It's something that gives me hope -- by the fact that Aetna apologized and reimbursed me. Their willingness to treat transgender people is a positive sign,” said Beth Scott, 44.
Transgender Legal Defense and Education Fund (TLDEF) staff attorney Noah Lewis said that the settlement clarified that these denials won’t occur in the future.
"It also added a provision to allow transgender individuals to change their sex on their insurance records by providing a birth certificate or driver's license,” he said to ABC News.
“Transgender people should have their health care needs covered by insurance just like everyone else. The trend is that employers are increasingly removing these harmful exclusions for transgender health care. But as long as exclusions remain in place, Ms. Scott's case makes clear that they cannot be used to deny other medically necessary care simply because someone is transgender,” he said.
"If transgender people are being singled out for denial of care that is provided to other individuals, this makes it clear [that] transgender people have to be treated equally under the plan. Hopefully this will send a message to other insurance companies they can’t keep making these kinds of denials."
In an interview to ABC News Aetna told that the privacy laws required it not to talk about the case now.
"What we can say, in general, is that a mammogram is covered in a situation like the one described. Any denial would have been an error corrected by Aetna in administering the claims in the appeals process,” said Cynthia B. Michener, Aetna’s spokeswoman.
According to reports, Aetna has covered prostate cancer screening for males who have changed to females who have retained prostates and breast cancer screening for female to male transgender who haven’t had their breasts removed.
Published by Medicaldaily.com