Melanie Cole (Host): MIT Health is committed to providing comprehensive support of personalized health care and information to individuals with diverse expressions of gender and sexuality. Welcome to Conversations with MIT Health. I'm Melanie Cole. My guest today is Colleen McDonald. She’s a family nurse practitioner and primary care coordinator at MIT Health. Welcome to the show, Colleen. Let’s talk about some of the medical services that are available to transgender patients at MIT Health.

Colleen McDonald (Guest):  At MIT Health, transgender patients can receive several types of care including primary care which would include if people wanted or required hormone treatment, they could get that here. Also, if they need a referral for surgery they could also get that here. Any mental health and counseling issues related to general health or transgender care are also available here at MIT Health. The amount of care can vary a little bit based on type of insurance plan. The students who come to MIT Health with what’s called a “basic plan” are much more reliant on the other insurance or most often the parent’s insurance for coverage around transgender health care. When students sign up for MIT extended insurance plan, they get full coverage for primary care, for specialty care related to anything and also, specifically, transgender care in terms of coverage for hormone treatment, coverage for follow-up tests, coverage for any consultation that might be needed and coverage for surgery that might be desired.

Melanie: Can they choose the gender and name by which they’re identified in their medical records at MIT Health?

Colleen:  They can absolutely choose that. It is, unfortunately, probably a one- or two-step process for us because as a component of the larger MIT campus, our systems are linked to the bursar’s office or the registrar’s office. With registration information and the name and date of birth linked to the registration information, patients have to change their name officially in the registrar’s office – students have to change it in the registrar’s office. If they change it here at MIT Health, unfortunately, with an update in just basic information meaning – name, address – that happens on a regular basis, it would get switched back to whatever the default is from the registrar’s office. We also have a way to identify in the chart if somebody goes by a nickname. Not that someone’s new name is identified with their gender is a nickname but it’s a place where we can indicate what the patient prefers to be called if they don’t want to go through the registrar’s office to change that. For people who are employees or they are on an employee’s health plan, it’s in human resources where you would have to officially change the name. The human resources site is accessible to any employee and they could actually go in and update the information to reflect the desired name change.

Melanie:  Colleen, if people are going through this change or even questioning, do you find that they have trouble wanting to come in or getting the courage to come in? What do you want them to know about your accessibility for them?

Colleen:  We’re trying to be high profile across campus. There’s a Rainbow Lounge for all GLBT students that certainly we are connected with and have information displaying that our services are available here. There is also a website that very clearly lists clinicians’ names who have an interest in providing care to transgender patients with all of our contact information. Some kids will come in through mental health – they might be going to counseling for many reasons--and will get linked to us through mental health. I do think it takes a bit to get up the courage to talk to somebody about wanting to transition. I think we can always--and we are always--looking for ways to improve our visibility and communication with anybody who would want to access the services. 

Melanie:  Some people are hesitant to discuss these issues unless it’s with their healthcare provider. If a patient is dependent on a family member or someone else’s health insurance policy, will that person have access to the patient’s medical records? How confidential are these?

Colleen:  Medical records are bound by law to be confidential of anyone who is not a minor. It’s called “HIPAA” which does not allow us to discuss any information about a patient’s care with anyone else without the expressed consent of that patient. For any reason, we cannot share information about a patient with anyone unless they have given us permission to do that. These are very confidential records. When people are dependent on someone else’s plan, bills get sent to the person’s plan. So, if you’re on your mother’s plan she will get bills for services. They don’t have a ton of detail but we encourage patients to directly speak with the billing office to understand exactly what would show up on a bill and how much information someone could glean off of a bill.

Melanie:  If they really want to talk to somebody because they are not quite sure what they want to do, tell us about the mental health counseling services for transgender people at MIT.

Colleen:  There are a few clinicians that are specifically designated as transgender counselors who are willing to meet with anyone who is in any stage – from contemplation to fully recognizing their gender fluency or gender status. They can reach out many, many ways. There are names, again, on our website. Their primary care physician can help them get in touch with these people and, again, the larger MIT campus LGBT services has a direct line to the mental health and counseling services around these needs.

Melanie:  Do you help them with their insurance to determine if hormone treatments or surgery? It would seem to be so confusing about what would be covered and what isn’t.

Colleen:  Yes, we help. With the MIT Health plan itself, it’s not that confusing. What is hard is that although some insurance carriers, including ours--Blue Cross and Blue Shield--have come on board to cover services such as surgery, the processes to support clearing that surgery recognizing gender markers and the need for surgery have not been set up yet. Yes, we do a lot of communication with our insurance office, with Blue Cross and Blue Shield to try and smooth out this process as much as possible but it does take some extra effort. I think until this becomes a more common phenomenon that will be true but we are willing to help people step-by-step with that.

Melanie:  In just the last few minutes, give your best advice to students that are transgender that are maybe confused, don’t know where to turn for help and support and what you really want them to know.  

Colleen:  I really want them to know to just come and talk to us from any point of confusion or uncertainty and that they should not be alone thinking about things that will affect their life or are currently affecting their life; that there is no stake in getting someone hormones or not giving someone hormones. We really try to individualize what would be appropriate for an individual’s situation and just want to provide support for being judged as different than society.

Melanie: That’s great information. Thank you so much for being with us today, Colleen. Listeners can visit Health.mit.edu for more information and to get connected to one of our providers. That concludes this episode of Conversations with MIT Health. Please remember to subscribe, rate and review this podcast and all the other MIT Health podcasts. . I'm Melanie Cole. Thanks so much for joining us today.