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

中文翻译：

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跨性别者的健康保险权利和获得医疗保健：医疗必要性的社会建构

近年来，跨性别和/或非二元性人群的医疗保健权利急剧扩大，包括他们需要的治疗和程序的保险范围。然而，跨性别者自己仍然将健康保险问题视为研究和政策变化的重中之重，因为获得和使用保险存在很大困难。覆盖范围确定的争论通过多种类型的互动、官僚、人际关系和医疗来发生。当这些互动变得困难时，这是因为医疗必要性等关键术语既强大又不确定。本研究探讨跨性别者和医疗保健中介如何在医疗保险流程中导航，并质疑医疗必要性在保险范围确定中的意义。这些争议构成了将医疗保健权利实例化为性别肯定护理的基本现实。通过对合同语言的分析和对寻求性别肯定护理的人和相关专业人士的 32 次采访，我们发现健康保险政策的语言、解释和实施通常会给试图获得护理的跨性别者带来不利和障碍。我们的研究强调了保险政策术语的有争议的生命如何产生权利的现实，但也详细说明了保险介导的护理是一个社会争议和协商过程的机制 我们发现，健康保险政策的语言、解释和实施往往会给试图获得医疗服务的跨性别者带来不利和障碍。我们的研究强调了保险政策术语的有争议的生命如何产生权利的现实，但也详细说明了保险介导的护理是一个社会争议和协商过程的机制 我们发现，健康保险政策的语言、解释和实施往往会给试图获得医疗服务的跨性别者带来不利和障碍。我们的研究强调了保险政策术语的有争议的生命如何产生权利的现实，但也详细说明了保险介导的护理是一个社会争议和协商过程的机制