Tiffany Najberg, a Louisiana doctor who is transgender, said three insurance companies refused to reimburse her since she legally changed her name nearly two years ago.
The companies have since come to agreements with her and her Shreveport clinic, UrgentEMS, but not until after she started a petition that has garnered nearly 12,000 signatures and received news media attention about her cause, including inquiries from NBC News.
While the three insurers have agreed to update her name in their records and pay back claims, Najberg and her clinic have yet to receive any checks. In the meantime, she has spent her life savings — about $200,000 — to sustain her clinic, where she provides both primary and urgent care, including to more than 100 transgender patients, some of whom come from Alabama and Tennessee, two states that have passed restrictions on gender-affirming medical care for minors.
After Najberg changed her name in April 2021, she said, she updated it with all the necessary government offices and with databases from which most insurance companies pull information about providers.
She said Medicare, Medicaid, Blue Cross Blue Shield and United all updated the information and continued to reimburse her for the care she provided to her patients. But she said Aetna, Cigna and Humana had repeatedly denied her claims and refused to reimburse her.
“They were flagging each claim and rejecting it because of a name incompatibility with their internal database. They did not change my deadname,” she said, referring to the name she used prior to her transition.
She said all three companies told her that they don’t source information from the same database used by the government, Blue Cross and United. When she asked which database they use so that she could go through whatever steps necessary to update it, she said they wouldn’t tell her what it was. Even after her office sent the companies the court order granting her name change and copies of her updated IDs, they still wouldn’t update her name, she said.
Last March, Najberg began posting videos about the reimbursement denials on her TikTok account, where she has more than 150,000 followers. Last month, she also started a petition demanding that the three companies change her name and pay all of the back claims — something she said she did “out of sheer desperation because nothing else worked.”
“I’ve run through every dime I’ve ever had,” Najberg said. “I don’t have three to seven years for a court fight. I’ve got to make a living now. I have hundreds of patients, and most of them are in vulnerable populations. I want to keep taking care of them.”
Najberg said the situation has also had an impact on her mental health, because every time she would reach out to the three companies, their representatives would use her deadname, which at the time was still in their databases.
English Perez, who since 1998 has done medical credentialing — including helping hundreds of medical providers update their credentials following a name change after marriage or divorce, or an error in their name — said she has never encountered a problem like the one Najberg has been facing.
“That’s why I volunteered to help her,” Perez said, adding that she came across Najberg’s story on TikTok. “This needs to stop for her, for the next person that becomes their true self and lives in their authentic self — they should never have to incur this type of embarrassment.”
Perez added that Najberg’s relevant medical identification numbers and tax ID number all reflect her legal name change.
“That’s why I said it’s more about the transition, less about a name change,” Perez speculated.
By mid-January, after Najberg’s petition received more than 10,000 signatures and her story was covered by local news outlets, the three companies reached out, but they did not immediately agree to pay the back claims, she said.
As of Jan. 23, Aetna created a new contract with Najberg and agreed to process all of the back claims. Humana and Cigna had not agreed to anything at that point, she said.
NBC News reached out to all three companies on Jan. 24 for comment regarding Najberg’s reimbursement denials, their processes for updating medical provider names in their systems and Najberg’s allegations that company representatives repeatedly misgendered her. All three responded the following day, though none responded to specific questions regarding Najberg’s allegations.
A spokesperson for Aetna said, “We value our relationship with our providers and strive to resolve any issues they may experience as quickly as possible.”
Cigna’s spokesperson said name changes “have no impact on our payments to doctors or other health care providers; and we are committed to fair and prompt payment for both in- and out-of-network clinicians.”
Humana shared its first on-the-record response Jan. 27, with a spokesperson telling NBC News in an email that, “We are glad to have Dr. Tiffany Najberg as a provider in Humana’s network, and we look forward to continuing to partner with her and her office.”
The day prior, Humana had informed Najberg that the company would pay all of the back claims with interest and would create an immediately effective updated contract that puts her in their network.
On Monday, Jan. 30, Najberg said Cigna tentatively accepted her terms, and that she and her clinic now have agreements with all three insurance companies.
Perez, who noted that two of the three insurance companies did not help Najberg find a solution until they received an inquiry from NBC News, said, “We can’t relax and breathe until those checks start coming in the door.”
There is little available data on how many openly transgender medical providers there are and whether others have had issues similar to Najberg’s. Of 15,794 entering medical students surveyed by the Association of American Medical Colleges last year, 1.4% reported that their gender identity is different from their sex assigned at birth — up from 1.2% in 2021 and 0.8% in 2020.
Najberg said that she hasn’t had to stop seeing any patients as a result of the three companies denying claims for nearly two years now, but her practice has had to postpone plans to expand its telehealth services to Texas, Mississippi, Alabama and Florida, because she cannot afford the malpractice insurance in those states right now. She said she’s had more than 100 requests from residents in those states regarding telehealth care.
She said that she has been living off of Go Fund Me fundraisers for about eight months and that if she doesn’t start receiving reimbursements from the insurance companies soon, she could lose both her business and her home. She has dropped both her dental and health insurance and has eliminated all nonessential medications.
“I am literally in survival mode right now,” she said.
She said her goal isn’t to attack any of the insurance companies — but to draw attention to what has happened so that it doesn’t happen again.
“I’m not asking for anything special,” she said. “I just want to be an equal.”
Source: | This article originally belongs to Nbcnews.com
