This day had to come eventually. It is a small step, but it is, in fact, a step. In the right direction.
Aetna has quietly published a "Clinical Policy Bulletin" wherein it says:
Aetna considers sex reassignment surgery medically necessary when all of the following criteria are met:
The criteria are the usual things: the patient isn't suffering from schizophrenia, finds his or her biological sex repugnant, and has followed the Harry Benjamin Standards. At least they don't require married patients to get a divorce first!
This isn't perfect (indeed, far from it) -- and even Aetna admits that "[m]ost Aetna plans exclude coverage of sex change surgery (gender reassignment surgery, transgender surgery) or any treatment of gender identity disorders. Please check benefit plan descriptions." Still. It's slowly moving in the right direction!