1 Trending: Cornyn And Tillis’ Anti-Blanche Jihad Epitomizes The GOP’s Hatred For Its Voters

2 Trending: How Obamacare Pushes Big Pharma To Overcharge You For Prescriptions

3 Trending: The Foreign Invasion In The UK Will Ruin Your English Countryside Vacation

4 Trending: Bill Would Make Insurance Cover Body-Acceptance Treatments For Trans Desisters

Little-Known Bureaucratic Procedure Pushed Medical Insurance To Be More Pro-Trans

The statistics provided to The Federalist by California regulators show a little-known process overturned a majority of denials for transgender procedures.

Share Article on Facebook

Share Article on Twitter

Share Article on Truth Social

Share Article via Email

Cultural shifts sometimes happen in ways you can’t help but notice, like the sudden growth of transgender themes on television. But there are also a bunch of quiet maneuvers you don’t see, producing change through obscure bureaucratic procedures.

To begin your introduction to one of those little-noticed avenues of change, take a moment to read the Independent Medical Review (IMR) obtained by California health care regulators in 2025 on behalf of a biological male (in the record, a “transgender female”) who wanted his health insurance company to buy him a prosthetic “vagina”:

The transgender patient had a history of depression, “with possible psychotic features,” and was taking anti-psychotic medication when his insurer denied coverage for a surgically created artificial vagina. (Surgical neo-vaginas are created by penile inversion, or less frequently by cutting out a piece of the patient’s bowels and sewing it into a surgical hole between his legs.)

Appealing that decision, the potentially psychotic patient asked the California Department of Managed Health Care (DMHC), which regulates health insurance plans, to conduct a review in which an independent medical expert would decide if his surgery was medically necessary.

A finding on an IMR is binding. Insurers must cover procedures an “independent expert” finds “medically necessary.” As the state’s IMR request form says: “Health plans must follow the IMR decision and promptly provide the service.”

In this case, a psychiatrist reviewed the patient’s surgical request, with no review by a surgeon. The psychiatrist overturned the insurer’s refusal to pay. A male on anti-psychotic medications got a surgically implanted fake vagina, in a procedure covered by insurance, because a psychiatrist found the surgery to be medically necessary.

You can see these medical reviews for yourself. The DMHC maintains a searchable public database of IMR outcomes. Try searching with different terms to see how the results vary, like “dysphoria,” “gender identity,” and “transgender.” The results will look like this screenshot, and on the DMHC page you can click the plus sign on the left to read the details of each case:

In the single “upheld” decision above, with the case number ending in 46638, a patient sought “facial feminization surgery” and a hair transplant........

© The Federalist