Insurance and the Law

Talesh, Shauhin A.

doi:10.1016/b978-0-08-097086-8.86037-7

Cited by 2 publications

(2 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In sum, insurer rules and requirements for achieving medically necessary care force trans people jump through a series of hurdles. Insurers' gatekeeping function in this instance (Talesh, 2015) works in practice to disrupt health care rights expansions for trans people in ways that are hard to see because they are buried in tedious, bureaucratic, and mostly private disputes in the context of ongoing, interrupted care. Rights blockages may not take the form of outright exclusion of transgender coverage, but rather, emerge through a rigid construction of medical necessity and a series of barriers and hoops that are inconsistent with the international standard of care guidelines and despite the fact that the ACA forbids discrimination based on gender identity.…”

Section: Insurer Ignorance and Microaggressions Hinder Access To Carementioning

confidence: 99%

“…Health insurance companies in the United States play a critical gatekeeping role in mediating patient rights because they only provide coverage for treatment that does not fall within policy exclusions (Ericson et al, 2003;Talesh, 2015). A common (but not universal) set of trans health insurance 1 We use the term transgender and/or nonbinary people to capture the widest range of people who may seek gender affirming medical services, and to indicate diversity within this group about how they identify and appear.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Health insurance rights and access to health care for trans people: The social construction of medical necessity

2021

View full text Add to dashboard Cite

Health care rights for transgender and/or nonbinary people have dramatically expanded in recent years, including in insurance coverage for the treatments and procedures they need. Yet, trans people themselves still identify health insurance problems as a top priority for research and policy change because of significant difficulties gaining and using coverage. Wrangling over coverage determinations happens through multiple types of interactions, bureaucratic, interpersonal, and medical. When these interactions become difficult, it is because key terms such as medical necessity are both powerful and indeterminate. This study examines how trans people and health care intermediaries navigate the health insurance process and contest the meaning of medical necessity in coverage determinations. These disputes constitute the ground‐level reality for instantiating health care rights to gender affirming care. Relying on analysis of contract language and 32 interviews with people who sought gender‐affirming care and allied professionals, we find that health insurance policy language, interpretation, and implementation often create disadvantages and barriers for trans people who attempt to access care. Our study highlights how the contested life of insurance policy terminology produces a reality for rights but also details the mechanisms through which insurance‐mediated care is a socially contested and negotiated process

show abstract

Section: Insurer Ignorance and Microaggressions Hinder Access To Carementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Health insurance rights and access to health care for trans people: The social construction of medical necessity

2021

View full text Add to dashboard Cite

show abstract

How Crime Shapes Insurance and Insurance Shapes Crime

Baker,

Shortland

2023

Journal of Legal Analysis

View full text Add to dashboard Cite

Crime creates demand for insurance but supplying insurance may promote crime. We examine five case studies of insured crimes (auto theft, art theft, kidnap and hijack for ransom, ransomware, and payment card fraud) and find a co-evolutionary process through which insurers engage with insureds, governments, and legal and extralegal third parties to mitigate losses, particularly when criminal innovations destabilize the insurance market. “Insurance as crime governance” stimulates demand for security, shapes criminal incentives, engages with the state to combat crime, and tolerates some crime in the interest of profitability.

show abstract

Insurance and the Law

Cited by 2 publications

References 17 publications

Health insurance rights and access to health care for trans people: The social construction of medical necessity

Health insurance rights and access to health care for trans people: The social construction of medical necessity

How Crime Shapes Insurance and Insurance Shapes Crime

Contact Info

Product

Resources

About