This article is the third and final instalment in a series looking at trans-inclusive reproductive health care in B.C. Find the entire series online at saanichnews.com/tag/transgender-inclusive.
The B.C. Medical Services Plan (MSP) has codes for medical procedures to make billing very specific. When someone visits a walk-in clinic, for example, the clinic will submit a 0100 code for the visit and a diagnostic code to define the reason for the visit. This determines how much the doctor is paid. There are hundreds of codes for different medical concerns and types of doctor visits.
However, many of the billing codes are gendered. There are several codes for all facets of reproductive health and most are gender-specific within the gender binary. This means that if the diagnostic code 608 — other disorders of male genital organs — was billed for a patient with ‘F’ on their B.C. Services card, the code would be rejected by MSP. If the code 635 — a legally induced abortion — was billed for a patient with ‘M’ on their card, it would also be rejected.
This means that trans men who require any care deemed to be for women and trans women who need care deemed to be for men may run into problems with MSP.
When a billing code is refused, MSP provides a reason in the form of an Explanatory Code — ‘FO’ is used when a gendered code is refused.
When asked about the gendered codes, Ministry of Health communications manager Meribeth Burton pointed out the non-binary distinction ‘X’ had recently been introduced for care cards, but she wasn’t sure how it actually applied to the MSP billing codes.
Upon further inquiry, a Ministry of Health spokesperson stated “therapeutic abortion is an insured medical benefit, regardless of gender identity, when treatment is provided by a licensed physician in B.C. to a B.C. resident who is eligible for provincial coverage.”
They went on to note they are unaware of anyone being declined abortion care due to their gender identity, but that if anyone has had their care coverage refused and has been told they must pay for the care themselves, they can contact Health Insurance B.C. for assistance.
However, this may require a person to reveal personal information and answer invasive questions about their gender identity and body.
Dawn Fowler, the executive director at the Vancouver Island Women’s Clinic, confirmed the medical abortion MSP code is gendered, but that she’s only had the code rejected once and that was eight years ago.
The first time she billed the code for someone with an ‘M’ on their B.C. Services card, MSP contacted the clinic asking why a female reproduction code was being billed for a male patient. Fowler explained the situation and MSP accepted the code.
“The patient never knew [the code] got rejected,” she said.
Now, staff at the Vancouver Island Women’s Clinic make sure to send an explanation if they bill a gendered code for someone who is trans. There have been no problems with rejected gendered codes at the clinic since, Fowler said. In her opinion, MSP has been quite progressive.
A.J. Lowik, a PhD candidate with the Institute for Gender, Race, Sexuality and Social Justice at the University of British Columbia, noted gendered billing codes are just a small piece of the puzzle.
Lowik, who uses the gender-neutral pronoun they, explained the codes exemplify the broader issue that reproductive health and experiences such as pregnancy and abortion are viewed with a binary lens.
Looking at pregnancy as ciswomen’s experience (women assigned female at birth) creates challenges for “non-woman-identified pregnant people” when it comes to seeking care related to reproduction, Lowik explained.
One of the participants in Lowik’s dissertation research said the billing for their pap smear was rejected because their gender marker didn’t match the expectation for that code. The doctor’s office told the patient it was their responsibility to contact MSP to sort it out so that the doctor would get paid.
While technically a trans person can access any and all medical care in B.C., whether or not they will feel safe and receive competent and inclusive care is another story, said Lowik.
Trans folks are often forced to spend time and energy self-advocating, educating and acting as “guinea pigs” when it comes to health care because many medical settings are not inclusive or are not expecting a trans person in their clinic, they explained.
“We are either treated as unexpected inconveniences, spectacles to be confused by, or like it is our job to teach our providers how to serve us.”