Medical debt is a big problem in New York. In 2021, HCFANY held focus groups to find out more about how this issue affects different people across the state. This issue brief from HCFANY member Raising Women’s Voices – NY discusses some of the specific billing and coverage issues that can result in unfair medical debt and barriers to care for LGBTQ+ people. One major barrier is arbitrary insurance denials for gender-affirming care. Focus group participants also described difficult-to-understand medical bills and receiving surprise bills even after New York’s landmark Surprise Bill law.