Christin Milloy:

Rise up and seize equality

Trans Ontarians: Update the Sex on your OHIP Card and Prepare to Die* for your Cause


This article has nothing to do with the question of government funding for SRS. While that is a very important issue to be sure, there are still other considerations which are of equal importance for trans and genderqueer persons looking to change their ID in Ontario.

Now that Ontario will very shortly be forced to begin issuing dignified, appropriate birth certificates with proper sex/gender identification flag to trans persons of all shape and description (or at least, to those whose identities presently conform to the binary), we collectively trans and genderqueer Ontarians will soon have greatly expanded options when it comes to controlling the identification documents our governments force us to live with.

This is indeed a great victory, one worthy of story and song. Problem is, great victories often lead to new battles when the war is not yet completely won.

Whether you might be classified as one of those post-ops, pre-ops, non-ops, cyclops or triceratops… If you were born in Ontario, because your birth certificate is the “gateway” ID to changing the rest of them, you will soon be able to have all your ID marked with whichever binary state most closely represents your identity. We’ll still have to work toward the right to non-classification and the ultimate deconstruction of the gender binary altogether, but more on that at some later date.

Once you get your new birth certificate (circa Q4 2012), you will be able to change your Passport, update your SIN registration, your hunting and fishing license… any ID you want, and also your OHIP card.

As an Ontarian person, you are legally entitled to the same standard of care, with access to the same set of medical treatments, as any cisgender person. This is not in question, and your medical practitioners being sentient, intelligent human beings, will of course acknowledge this human right (or goodness gracious, you need new HCPs). So, it stands to reason that continuing to access care from your doctor(s) using your new and gender-improved OHIP card should be no problemo. But oh no. Muchos problemos.

Let me explain.

OHIP isn’t really designed as an ID card, per se. In fact, our OHIP card is not legally valid as ID for any purpose other than accessing health care (ever tried for booze or smokes with one? It’s hit and miss). This might have something to do with minimizing OHIP fraud, as is commonly believed. However, I think it is more likely because government imposition of a compulsory photo ID card is a recipe for disaster, one which the ACLU says “will pose serious threats to our civil liberties and civil rights” and which even elements of our own federal government agree leads inevitably to dire consequences.

In other words, the province of Ontario wanted to sidestep the additional expense and problems associated with responsibility for issuing a compulsory ID.

Rather, your OHIP card signifies your “membership” in the mandatory single-payer “Ontario Health Insurance Plan.” Your OHIP card isn’t so much about your right to access free health care as it is about your doctor’s right to charge Ontario for selling you health care (under certain conditions, for a specific price). When you get treatment, it’s not really free – there’s a pricetag on every tongue depressor, and when you leave the clinic, your doctor bills it to your OHIP number.

Think of your check-up as a shopping spree, your Doctor is the store clerk, and your OHIP card is like a credit card Mommy and Daddy pay the bill for. Now the Doctor knows that you will never see the bill, since it goes directly to Ontario. The problem is that some enterprising (read: fraudulent) doctors figured out this is a great way to make extra money by charging the government extra dollars for treatments that were never performed.

Enter the misguided antiheroes of our story: government computer programmers. See, OHIP has an anti-fraud department. Part of their job is to make it so that the computer system can detect and refuse charges that are probably bullshit.

For example.

If a clinic tries to charge for three full leg casts at the same time on the same OHIP number, this is probably fraud because generally speaking humans have a maximum of two legs to break at any one time. Similarly, if a single clinic tries to charge OHIP for a leg cast for every single patient who walks in their door, this is probably fraud because generally speaking not every clinic patient has a broken leg. Also, 15 year olds aren’t likely to need treatment for chronic arthritis, a 6 month old child isn’t going to need crutches, and so on. I’m totally generalizing here, but this is how it works: the computers are set up to look for that sort of thing.

Preventing fraud is considered important to OHIP and it’s easy to understand why.

Fast forward: let us imagine a future clinic visit with your new OHIP card. Taking responsible care of your trans body means that every now and then it may be necessary to see your doctor for a manly pap smear, or perhaps it is time for a ladylike prostate exam. There is no shame in respecting the body you live in, after all.

Trouble is, OHIP’s computers are not equipped with ethical subroutines which respect trans bodies. The computer “knows” that women do not need a prostate exam, and men do not need a pap smear. So when your doctor charges for it, the computer calls bullshit. Trans equals fraud. I’ve been told this causes problems for intersex people as well.

Suddenly need an emergency hysterectomy? Or maybe you’ve decided it’s time for that orchiectomy we’ve been discussing… Let me check with billing. Your OHIP card was declined. The government says your body does not compute with projected budgetary expenditures.

Here are a few things that might happen to you.

  • If the situation is serious, you could die waiting for the hospital bureaucrats to work out that your sex parts need the same health care as everyone else’s. It’s unlikely this would happen, but not impossible, especially if you find yourself somewhere rural, or if they think you’re using someone else’s OHIP card because maybe they’re just totally fucking stupid.
  • You might be turned away by clinics or doctors who don’t consider your business worth the extra trouble to clear your charges through the pyramid of nonsense.
  • Your doctor’s office might be willing to put up with the added trouble, but it could be a huge hassle for you every time you try to go for care, waiting for them to work through it (possibly outing you to a waiting room full of gawking influenza patients, and who needs that). So you might not bother keeping up with your check-ups. And so then you get cancer, and nobody notices until it’s too late.

So what should we do?

If I’ve terrified you with this article, I apologize. Please note, first and foremost: if you turn up at the emergency room, they are legally obligated to give you life-saving treatment, no matter what.

The most important thing to remember here is that this is not your problem. This is an issue between OHIP and your doctor, because of the way their billing system works, and it’s happening because Ontario has to fix a bug in their computer system.

Another important thing to remember is, your trans health care is legitimate. Because your needs are real, they are not fraudulent, no matter what the damn computer says. OHIP exists for all Ontarians, and that includes trans Ontarians. If you need treatment, the law says you are entitled to receive it, and OHIP is required to pay your doctor for it.

I was born with male physiology. But I am a woman. No matter what I have done, or might ever do to my body, I will always have a trans body. If they are going to insist on classifying me in a government record, and force me to present it on a card, that record and that card are damn well going to represent me for who I really am; as much a woman as any woman. And trans men, as men. That is our right, which even the province of Ontario has now recognized.

If you do not feel safe and comfortable updating your OHIP card in light of the potential fraud-confusion issue, I respect your decision. Only you can decide how best to reconcile your identity with shitty government bureaucracy. For my part, I am getting my OHIP card changed at the first possible opportunity.

Furthermore, I will be providing instructions on this site for anyone who wants help getting their own record changed when the time comes later this year.

The more of us there are, the quicker they will have to fix their systems to respect trans bodies.

Stick to your guns, people. We’re winning this war.

20 Comments

  1. Desiree Terrebonne - London, Ontario
    Wednesday, 2012.09.05 at 00:33

    I posted this on my Facebook Timeline on August 28, 2012:

    Okay, so I can help maybe the next people caught in the gender marking drama; I know some things may get better in October / November of 2012 because of the recent court ruling, but in the meantime, I will share what I have done so IF anyone in transition is wanting to be marked correctly in the Province of Ontario, here is the 411, as I have experienced.

    ===========================
    First; Birth Certificate – Province …of Ontario
    You will need to contact The Registrar General located in Thunder Bay to get an Adult Legal Name Change form. You will need to provide your original birth certificate (either the plastic laminated ones pre 1990′ or the paper one you cannot laminate) and any original copies of a short form or long form copy of the birth record. [Take a photo copy for yourself if you want something to archive]
    You will need a lawyer to review the information you are providing,there may or may not be a fee involved so shop around; cut a cheque or money order to the Recieiver General Of Ontario for the current price ($137.00) and send it all to the Red River Road address.
    >>You can call them at (800) 461-2156

    Reminder: This WILL NOT change your gender marker, just your legal name and you will get two documents; one is the new birth certificate with your previous gender marker, and the second is a document showing both the OLD and NEW names.
    =============================
    Second; Gender Marker – Province of Ontario
    The Registrar General of Ontario is located in Thunder Bay and has a separate form to change the gender marker. I was told there is no fee to do this. Will take approximately 2 weeks to get the form, then time for it too to be processed. At time of writing this I do not know IF a lawyer is needed or not….
    >>You can call them at (800) 461-2156

    =========================
    Third; Driver’s License and Health Card
    You will need a letter from your Ontario doctor along with his/her office address and contact information on the top, and a calendar date the letter is written.
    This letter will have your (new) legal name, current address, your driver’s license number and health card number on the letter. The letter will state that you are under the care of the named physician, you have been confirmed with gender identity dysphoria/disorder and you are under successful sexual reassignment, for which your chosen gender should be changed on your documents to reflect your correct gender.

    Take this letter, along with your former incorrectly gender marked id cards to any local Service Ontario office; the clerk will take a copy of the letter, then they will fill out two seperate forms (1 for driver’s license change, 1 for health card change), they MAY take new pictures of you so present the gender you are. You will sign these two forms and wait for the new cards to move through the system in 4 to 6 weeks time. I was not asked for a fee at my change over, so just be prepared just in case in the future.

    **********************************************
    I hope this will help anyone who may be on the path to their true selves and want to get Ontario to recognize who you are, at least on paper and legal identification.
    **********************************************
    I do hope the Passport will be the next and easy hurdle for identification; this currently limits my personal movement on this planet to only Canada, without a properly gender presented passport, especially for US travels.
    **********************************************
    Thank you for your time and allowing me to share – Desiree T

    • Christin Scarlett Milloy
      Wednesday, 2012.09.05 at 01:21

      Thank you for this, Desiree, but a large part of the point is that they need to be willing to change all the markers without needing to be under treatment for sex reassignment surgery.

      Christin

      • Desiree Terrebonne - London, Ontario
        Saturday, 2012.11.03 at 21:44

        Agreed Christin, I am pleased there is progress, bit by bit. We are people too. Ghosts of older mindsets will eventually fade over time, perhaps not fully in my lifetime, but eventually. We all should stand shoulder to shoulder in full acceptance of where humanity must go. Move from the dream to reality of TRUE equality. Not needing for anyone to see what is under our waistline for proof of who we are.

        • Catherine Gill
          Tuesday, 2013.05.28 at 13:22

          OHIP gender marker can only be done at a FULL service Service Ontario. Your local one might not be able to do it

    • Catherine Gill
      Tuesday, 2013.05.28 at 13:23

      OHIP gender marker can only be done at a FULL service Service Ontario. Your local one might not be able to do it

  2. Kaye Martin
    Wednesday, 2012.09.05 at 02:53

    Christin: A very interesting and instructive article. One question though, for those amongst us who were not born in Canada, how do they go about changing all of their Ontario ID if the country they were born in will not change their birth certificates?

    Kaye Martin

    • Christin Scarlett Milloy
      Wednesday, 2012.09.05 at 04:23

      Hello Kaye,

      That is an issue we are still working on. The Ontario ruling was hugely beneficial to those born in Ontario – an analogous change is still required at the Federal level in order to help those born in other provinces, or abroad. But, there are a number of people and organizations working toward that goal, including me – I am embroiled in a Human Rights Complaint against Social Insurance Registration in what I hope will be a precedent setting case, more info on that is available here: http://chrismilloy.ca/tag/sin/

      I will also be updating that story in the near future.

      Christin

  3. femme
    Wednesday, 2012.09.05 at 09:43

    Ok so the health card was never designed as identification, neither the green one, the red one before that or the paper one with just a number on it. It’s a billing number plain and simple and nothing new there. The fraud part is much more in depth then you suggested and actually looks at the history of the patient. For instance your visiting your doctor once a month or every other month, then all of a sudden you’re seeing them twice a week and other doctors too. Patient gets a letter asking to confirm that you did indeed see said doctor on said date/time, patient sends said letter in and end of story. Patient all of a sudden finds themselves in need of emergency care, or in need of a pap but it does not make sense to the billing system. Don’t know about you but most people will be seeing their own doctor not just anyone for said pap. And if it will be put through. But say there was a problem, well again pap will be completed it’s only after the billing hits ohip do they see something and send a letter to the doctor. If said doctor is confused (again not sure about you but most will see their own doctor) then you’ll get a letter saying hey you owe us this money……..

    What I’m saying is you will not be refused needed treatment at the time it’s happening.

    And yes I agree that in the end it shouldn’t be an issue just as men should not have to pay for PSAs, or the all women regardless of their age should be able to have an HPV vaccine should they wish one. But that’s another issue.

    There will forever in our life times be the issues of binary problems, least until other countries we are trading with make changes to their own systems. And consider even more that if one looks at extended health coverage you’re in for other surprises.

    I guess my whole thing here is that your article is misleading and does tend to lean on the “the sky is falling” slant when it’s not. There are things needing fixing.

    • Christin Scarlett Milloy
      Wednesday, 2012.09.05 at 18:48

      Hello Femme,

      I did point out that you will not be turned down for needed treatment (probably).

      Your point about the doctor receiving trouble for trying to bill is what I was referring to as the “extra trouble” you may face when going back for additional treatments. If you have to deal with a lot of extra hassle, some people may just not want to face it and so avoid the doctor. That’s exactly what I was talking about, and it is risky. lots of people especially in disadvantaged situations neglect their own health care needs even though they are presently legally entitled to care in Ontario.

      I disagree that we cannot see the dissolution of the gender binary in our life times. It is already happening now.

      Sincerely,

      Christin Milloy

  4. Wednesday, 2012.09.05 at 11:19

    Ok, now, this article addresses the needs of people born in Canada, what happens when you WERE NOT born in Canada and you ARE a transgender person? . I went through all the hoops and had my Canadian Citizenship Certificate changed after considerable hardships which solved my problem, this only happened after SRS; however, what happens if you are non-op or pre-op? Before surgery I was able to change only my driver’s licence.

    • Christin Scarlett Milloy
      Wednesday, 2012.09.05 at 18:44

      Lucia,

      All good questions. Please see the response I gave to Kaye, above. We are working on it.

      Christin

  5. Leslea
    Thursday, 2012.09.06 at 02:47

    As a Trans & intersexed person, I KNOW first hand just how much the doctors will be idiots and ignoramuses… Need a breast exam, vaginal exam AND prostate exam? Freaks them out. To the point I’ve had a doctor looking at my girly bits, right in his face for such an exam and the SOB kept trying to call me “sir”… Apparently staring at a vagina isn’t even enough of a clue for some of these guys, nor the skirt the breasts, the “my name is FEMININE for a reason”…

    And yes, their machines even here in Alberta, FREAK out and have fits when they try to run both male & female type tests on the same person.

    If only it was JUST the machines acting stupid.

    • Christin Scarlett Milloy
      Thursday, 2012.09.06 at 09:17

      That is idiotic. I’m sorry to hear you faced that.

      Christin

  6. Thursday, 2012.09.06 at 02:50

    Logic dictates that OHIP [and all other health insurance systems; and INSURANCE COMPANIES] be barred from having algorithms for healthcare that are antiquated (read incorrect to begin with) gender specific treatments. That prostate exams, pap smears, hysterectomies, orchiectomies, mastectomies, oophorectemies, vaginoplasty, breast augmentation, breast reduction, breast exams, FFS, etc, etc be equally permitted for either females or males. Practically, ELIMINATE gender specificity in ALL treatment altogether.
    It’s about time… logic reigns, rather than ignorant nonsense about what humans are like. Oversimplified and misleading generalities should not be allowed in such systems just for THEIR CONVENIENCE, at EVERYONE ELSE’S EXPENSE, period.

  7. Thursday, 2012.09.06 at 02:54

    At the moment, even if one is allowed to correct one’s gender marker and name, is there still the dilemma of what if one updates/changes one’s ID to the correct gender… BEFORE treatment?

    Will the medical insurance systems bar ‘vaginoplasty/SRS/BA’ for women who need them? Atypical women, of course, you know who I mean.

    • Christin Scarlett Milloy
      Thursday, 2012.09.06 at 09:15

      Good Question. Legally, no. Logistically, time will tell.

      Christin

  8. simone.murphy
    Thursday, 2013.03.07 at 07:28

    I’m from B.C …. living for 20yrs in ONT … B.C will not change my marker…still require surgery there for that… So my question to all is …..Is there away around this so i can change my ONT id without the marker being changed in B.C??? I’m quite far along my transition …and am being constantly frustrated by trying to use I.D that in no way represents my currant state of being! So yah if anyone has any ideas on ways for people not borne but living here in ONT to accomplish this …..thanks

  9. Jen
    Tuesday, 2015.09.08 at 19:47

    Im vlad that theres funnding and grants to help with the mental health aspect but why cant people like myself get the certility treatment into a funding or paid by ohip? Ive been off of work for 6 years battling depression and so on but not once has anyone looked to help the people that cannot have children.

    Maybe the government should consider belping us out as well .mentally these people want to be sho they want to be and your willing to help them then why cant we get funding for infertility as well its not like we chose to be this way

  10. Steven Field
    Monday, 2016.07.18 at 07:38

    booo hooo.

    Grow up, and stop your belly aching

    • Christin Scarlett Milloy
      Monday, 2016.07.18 at 18:08

      GFYS

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Christin Milloy