Health insurance company Blue Cross Blue Shield of Illinois (BCBSIL) may have to change its ways thanks to Tacoma, Washington resident “C.P.,” a 15-year-old trans teen who is suing the company for denying access to gender-affirming care. On Monday, the suit was formally brought by Lambda Legal on C.P.’s behalf, via an 18-page complaint.
In 2016, Pattie Pritchard, C.P.’s mother and an employee of the St. Michael Medical Center in Bremerton, Washington, applied for her son to be preauthorized for a Vantas hormone implant. The request was initially approved through her company health insurer and C.P. went through with the implantation. But months later, a BCBSIL representative told Pritchard that while coverage for the implant would not be “clawed back,” future care would be refused because, according to the complaint, “treatment for transgender services were allowed incorrectly under the medical plan.”
BCBSIL added an exclusion for gender-affirming treatment in January 2018. As a result, C.P. and his mother have had to pay out-of-pocket for gender-affirming care since then.
In a press release, Pritchard said that because her son is transgender, she has to “fight and jump through hoops for him to have access to the care that he needs.” The denial of coverage for her son, she continued, “also sends a message to… all transgender people that their health care needs aren’t real or they’re not worthy of care.”
“I won’t accept that,” she said.
Nor will the World Professional Association for Transgender Health. Although it is not involved directly in the suit, it is cited in the complaint as stating that ”the medical procedures attendant to sex reassignment are not ‘cosmetic’ or ‘elective’ or for the mere convenience of the patient” but instead are “medically necessary for the treatment of the diagnosed condition.”
BCBSIL’s exclusion of gender-affirming care, C.P.’s counsel argues, is a violation of the Affordable Care Act, under which federally funded healthcare centers are not allowed to discriminate on the basis of sex, race, national origin, age, or disability. Currently, 24 states also have implemented their own policies blocking private insurers from engaging in this type of discrimination, Washington among them.
“The law is clear,” said Omar Gonzalez-Pagan, Senior Attorney and Health Care Strategist for Lambda Legal, in a press release. “Section 1557 of the ACA expressly prohibits categorical bans on gender-affirming care… plain and simple. BCBSIL cannot adopt or administer discriminatory terms on behalf of others.”
C.P. may face an uphill battle if the court finds that Section 1557 does not necessarily cover trans individuals seeking gender-affirming care, especially after the Trump administration revoked trans inclusive language from the ACA this year. In response to that decision, 22 states combined forces to sue the White House in July to restore the protections, which were extended to the trans community in 2016 under the Obama administration but were almost immediately blocked by a federal court order.
It also remains to be seen what impact President-elect Joe Biden, who is set to take office in January, will have on the case. Biden, who has vowed to pass the Equality Act during his first 100 days in office, is extremely likely to reinstate the Obama-era guidelines through administrative action, although a timeline is not clear.
Attorney Eleanor Hamburger, who has worked with C.P. and his family for three years, hopes to see justice delivered swiftly. “BCBSIL cannot hide behind a defense that it was ‘just following orders,” Hamburger noted in the press release. “BCBSIL has a separate legal, contractual and fiduciary duty to C.P. and others in the health plans it administers, to comply with the anti-discrimination law.”
The Lambda Legal lawsuit will coincide with a similar action across the pond, where a 14-year-old trans male teen is fighting England’s National Health Service for making him wait more than a year for access to gender-confirming treatment.
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