More Necessary than Medical: Reframing the Insurance Argument for Transition-Related Care

To qualify for insurance coverage, healthcare must be classified as "medically necessary," which often excludes transition-related interventions. This access problem raises broader questions about the goals of the healthcare system and the narrow kinds of stories required to access care. Through an examination of gatekeeping and informed consent models of care provision, diagnostic categories related to gender identity, and strategic narratives told to move transgender people into patient categories and render their needs legible to insurance companies, this paper reframes "medical necessity" to extend its selective elasticity and incorporate ideas of well-being into determinations of eligibility for transition-related coverage.