The medical coding system used by health care facilities in the U.S. contributes to access and affordability challenges for transgender patients.

Kulembera zamankhwala kumapanga zolepheretsa kusamalira odwala transgender

Chaka chatha, Tim Chevalier adalandira kukana kwake koyamba kuchokera ku kampani yake ya inshuwaransi chifukwa chochotsa tsitsi chomwe amafunikira monga gawo la kukongola kwa mbolo, mwachitsanzo, kupanga mbolo.

Electrolysis ndi njira yodziwika bwino pakati pa anthu a transgender monga Chevalier, wopanga mapulogalamu ku Oakland, California, ndipo nthawi zina, amagwiritsidwa ntchito kuchotsa tsitsi losafunika kumaso kapena thupi. Koma pamafunikanso phalloplasty kapena vaginoplasty, ndiko kuti, kulengedwa kwa nyini, chifukwa tsitsi lonse liyenera kuchotsedwa ku minofu yomwe idzasamutsidwe panthawi ya opaleshoni.

Inshuwaransi ya Chevalier, Anthem Blue Cross, adamuuza kuti akufunikira zomwe zimadziwika kuti ndi chilolezo choyendetsera ntchitoyi. Ngakhale Chevalier atalandira udindowu, adati, zonena zake zobweza zidapitilira kukanidwa. Malinga ndi Chevalier, Anthem adati njirayi ndi yodzikongoletsera.

“Nthawi zonse pamakhala funso ili: Kodi muyenera kuuza chiyani kampani ya inshuwaransi?”

Nick Gorton, MD, dokotala wazachipatala ku Davis, California.

Odwala ambiri amavutikira kuti makampani awo a inshuwaransi azilipira chithandizo chotsimikizira kuti amuna kapena akazi ndi amuna. Chifukwa chimodzi ndi transphobia mkati mwa machitidwe azachipatala aku US, koma chinacho chikugwirizana ndi momwe makampani a inshuwaransi amalembera matenda ndi njira zamankhwala. Padziko lonse, opereka chithandizo chamankhwala amagwiritsa ntchito mndandanda wa zizindikiro zozindikiritsa zomwe zimaperekedwa ndi International Classification of Diseases, 10th revision, kapena ICD-10. Othandizira a Transgender ati ambiri mwa awa sanakwaniritse zosowa za odwala. Zizindikiro zodziwira matendazi zimapereka maziko odziwa njira zomwe zidzatsatidwe ndi inshuwalansi, monga electrolysis kapena opaleshoni.

“Anthu ambiri amakhulupirira kuti zizindikiro ndizochepa kwambiri mu ICD-10,” anatero Joanna Olson Kennedy, MD, mkulu wa zachipatala wa Trans Youth Center for Health and Development ku Children’s Hospital Los Angeles.

Ikufuna kusintha kwa mtundu wa 11 wa makina osindikizira, omwe adavomerezedwa ndi World Health Organisation mu 2019 ndipo kukhazikitsidwa kwawo padziko lonse lapansi kudayamba mu February. Masiku ano, mayiko opitilira 34 amagwiritsa ntchito kope la khumi ndi limodzi la International Classification of Diseases.

Kusindikiza kwatsopanoku kwasintha mawu akale monga “kusintha kwa kugonana” ndi “kuzindikirika kwa amuna ndi akazi” ndi “kusagwirizana pakati pa amuna ndi akazi,” zomwe sizimatchulidwanso ngati matenda a maganizo, koma ngati chikhalidwe cha kugonana. Olson Kennedy adati izi ndizofunikira kwambiri pochepetsa kusalidwa kwa anthu omwe amasinthana ndi amuna pazachipatala.

»Werengani zambiri: Chithandizo cha mawu chimatha kuthandiza anthu omwe ali ndi transgender kuti aziwoneka ngati iwowo komanso kukhala otetezeka

Kuchoka pamalingaliro amisala kungatanthauzenso chithandizo chowonjezereka cha chisamaliro chotsimikizira kuti amuna kapena akazi ndi amuna ndi makampani a inshuwaransi, omwe nthawi zina amakayikira zonena za thanzi laubongo kuposa omwe amadwala. Akuluakulu a WHO ati akuyembekeza kuti kuwonjezera kusiyana pakati pa amuna ndi akazi pamutu wokhudzana ndi kugonana “kumathandizira kuwonjezera mwayi wopeza chithandizo chamankhwala” komanso “kuchotsa manyazi amtunduwu,” malinga ndi tsamba la WHO.

Komabe, mbiri ikuwonetsa kuti ICD-11 sichingachitike ku United States kwa zaka zambiri. Bungwe la World Health Organization lidavomereza ICD 10 koyamba mu 1990, koma United States sinayigwiritse ntchito kwa zaka 25.

Pakadali pano, odwala omwe amadziwika kuti ndi transgender ndi madokotala awo amatha maola ambiri kuyesa kupeza chithandizo – kapena kugwiritsa ntchito ndalama zambiri kuti alipire ngongole zazikulu zotuluka m’thumba. Chevalier akuti adalandira maola 78 a electrolysis pa $140 pa ola, pamtengo wa $10,920.

Mneneri wa Anthem a Michael Bowman adalemba mu imelo kuti “panalibe zokanira zachipatala kapena kukana kufalitsa” chifukwa Anthem “idavomerezedwa kale kuti izi zitheke.”

Komabe, ngakhale atalandira chilolezo chodziwitsidwa, Anthem adayankha zomwe Chevalier adanena ponena kuti electrolysis sichidzalipidwa chifukwa ndondomekoyi imaonedwa kuti ndi yodzikongoletsera osati yofunikira kuchipatala. Izi ziribe kanthu kuti Chevalier akudziwa kuti ali ndi vuto la kudziwika kwa amuna kapena akazi – kuvutika maganizo komwe munthu amamva pamene kugonana kwachibadwa sikufanana ndi umunthu wake – zomwe madokotala ambiri amawona chifukwa chovomerezeka chachipatala chochotsa tsitsi.

»Werengani zambiri: Philadelphia imakhala ndi msonkhano waukulu kwambiri padziko lonse lapansi wokhudzana ndi matenda amisala padziko lonse lapansi, kuyesa kusintha nkhaniyo kuti isinthe thanzi labwino

Bowman adalemba kuti “Nkhaniyi itadziwika, Anthem idakhazikitsa njira yamkati yomwe imakhudzanso kuwongolera pamakina olipira.”

Komabe, Chevalier adasumira madandaulo ku dipatimenti yoyang’anira zaumoyo ku California, ndipo boma lidalengeza kuti Anthem Blue Cross satsatira. Kuphatikiza apo, a Kaiser Health News atafunsa Anthem za ngongole za Chevalier, zonena ziwiri zomwe sizinayankhidwe kuyambira Epulo zidathetsedwa mu Julayi. Pakadali pano, Anthem yalipira Chevalier pafupifupi $8,000.

Njira zina zolandilidwa ndi odwala trans zitha kuchotsedwanso chifukwa makampani a inshuwaransi amaziwona ngati “zogwirizana ndi jenda.” Mwachitsanzo, ulendo wa gynecologist kwa mwamuna transgender sungathe kulipidwa chifukwa ndondomeko yake ya inshuwaransi imakhudza kokha maulendo a anthu omwe adalembetsa ngati akazi.

“Nthawi zonse pamakhala funso ili: Kodi muyenera kuuza chiyani kampani ya inshuwaransi?” Nick Gorton, dotolo wamankhwala mwadzidzidzi ku Davis, Calif., Anati Gorton, yemwe ndi transgender, amalimbikitsa odwala ake omwe ali ndi inshuwaransi yomwe imapatula chisamaliro cha transgender kuti azipereka ndalama zomwe zingafunike panjira zina potengera wodwala amadzilemba okha ngati amuna kapena akazi pamapepala a inshuwaransi Yawo. Mwachitsanzo, Gorton adati, funso la mwamuna wosinthana ndi mwamuna limakhala “Kodi mtengo wake ndi chiyani – kulipira testosterone kapena kulipira Pap smear?” – Popeza inshuwaransi siyingakwaniritse zonse ziwiri.

Kwa zaka zambiri, madokotala ena athandiza odwala transgender kupeza chithandizo popeza zifukwa zina zachipatala zokhuza chisamaliro chawo chokhudzana. Gorton adanena kuti ngati mwamuna wa transgender, mwachitsanzo, akufuna hysterectomy koma inshuwaransi yake siinapereke chithandizo chotsimikizira kuti ali ndi amuna kapena akazi, Gorton amalowetsa ICD-10 code ya ululu wa m’chiuno, mosiyana ndi dysphoria ya jenda, pa mbiri ya malipiro a wodwalayo. Gorton adati kupweteka kwa m’chiuno ndi chifukwa chomveka chopangira opaleshoni ndipo nthawi zambiri amavomerezedwa ndi makampani a inshuwaransi. Koma makampani ena a inshuwalansi anabwerera m’mbuyo, ndipo anakakamizika kupeza njira zina zothandizira odwala ake.

»Werengani zambiri: Zinthu 7 zoti mudziwe za inshuwaransi yanu yazaumoyo komanso chilolezo chisanachitike

Mu 2005, California idapereka lamulo loyamba la mtundu wake loletsa tsankho la inshuwaransi yaumoyo malinga ndi jenda kapena jenda. Tsopano, maiko 24 ndi Washington, D.C., amaletsa inshuwaransi yachinsinsi kuti isaphatikizepo chithandizo chamankhwala chokhudzana ndi transgender.

Pennsylvania ndi New Jersey amaletsa mapulani a inshuwaransi yazaumoyo kuti asasalane chifukwa chodziwika kuti ndi amuna kapena akazi, pomwe chitetezo cha Delaware chimafikira pamalingaliro ogonana ndi amuna kapena akazi, malinga ndi Movement Progress Project, yomwe imatsata malamulo olingana paumoyo.

Chifukwa chake, Gorton safunikanso kugwiritsa ntchito zizindikiro zosiyanasiyana kwa odwala omwe akufuna chithandizo chotsimikizira kuti ali ndi amuna kapena akazi pachipatala chake ku California. Koma madokotala m’mayiko ena akuvutikabe.

Pamene Eric Menninger, MD, internist ndi dokotala wa ana ku Indiana University’s Sexual Health Program, akuchitira mwana wam’manja yemwe akufuna chithandizo cha mahomoni, amagwiritsa ntchito code ya ICD-10 “yopereka mankhwala” monga chifukwa chachikulu chochezera odwala. Izi ndichifukwa choti Indiana ilibe lamulo lopereka inshuwaransi kwa anthu a LGBTQ +, ndipo vuto la kudziwika kwa amuna ndi akazi litalembedwa kuti ndilomwe limayambitsa, makampani a inshuwaransi amakana kuperekedwa.

Ndizokhumudwitsa, “adatero Menninger. Pa mbiri ya bilu ya wodwala, nthawi zina amawonetsa matenda angapo, kuphatikizapo matenda odziwika kuti ndi amuna kapena akazi, kuti achulukitse mwayi woti njirayi iphimbidwe. “Nthawi zambiri zimakhala zovuta kupeza matenda asanu, asanu ndi awiri kapena asanu ndi atatu kwa munthu chifukwa pali matenda ambiri osadziwika bwino.”

Kukhazikitsa kwa ICD-11 sikungakonze zovuta zonse zamakalata, chifukwa makampani a inshuwaransi angapitirize kukana kuperekedwa pazochitika zokhudzana ndi kusiyana pakati pa amuna ndi akazi ngakhale zitalembedwa ngati chikhalidwe cha kugonana. Komanso sizingasinthe mfundo yoti mayiko ambiri amalolabe inshuwaransi kuti isaphatikizepo chisamaliro chotsimikizira kugonana. Koma Olson Kennedy adati pankhani yochepetsa kusalana, iyi ndi sitepe yopita patsogolo.

Chimodzi mwa zifukwa zomwe United States idatengera nthawi yayitali kuti isinthe ku ICD-10 ndikuti American Medical Association yatsutsa mwamphamvu kusunthaku. Iye ananena kuti dongosolo latsopanoli lidzaika mtolo wodabwitsa kwa madokotala. M’kalata ya 2014, AMA inalemba kuti, madokotala “ayenera kuthana ndi zizindikiro za matenda a 68,000 – kuwonjezeka kasanu kuchokera ku zizindikiro za 13,000 zomwe zikugwiritsidwa ntchito masiku ano.” Mgwirizanowu unanena kuti kukhazikitsa pulogalamu yosinthira makina opangira ma coding amakono kungakhalenso kokwera mtengo, ndikuwononga ndalama pazachipatala zing’onozing’ono.

Mosiyana ndi machitidwe am’mbuyomu, ICD-11 ndi yamagetsi kwathunthu, popanda umboni weniweni wa ma code, ndipo imatha kuphatikizidwa muzolembera zachipatala zomwe zilipo popanda kufunikira kwatsopano, atero a Christian Lindmeier, wolankhulira WHO.

Sizinadziwikebe ngati kusinthaku kupangitsa kuti kutengera Baibuloli kukhale kosavuta ku United States. Pakadali pano, odwala ambiri omwe amafunikira chithandizo chotsimikizira kuti ali ndi amuna kapena akazi ayenera kulipira ngongole zawo m’thumba, kumenyana ndi kampani yawo ya inshuwaransi kuti iwathandize, kapena kudalira kuwolowa manja kwa ena.

“Ngakhale kuti ndinalandira malipiro, malipiro anga anali mochedwa, ndipo zinanditengera nthawi yambiri,” adatero Chevalier. “Anthu ambiri anali atangotaya mtima.”

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