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The health insurer covered similar procedures for cisgender plan holders but denied coverage for transgender patients saying the surgery was cosmetic.
Three transgender women have filed a federal class action civil rights lawsuit against health insurance giant Aetna after they were denied coverage for medically necessary gender-affirming facial reconstruction (GAFR).
The suit claims Aetna discriminated against the three trans women and others because the health insurer covered similar reconstructive surgeries for cisgender patients, instead classifying all GAFR for trans women as cosmetic and issuing blanket denials of coverage in violation of the Affordable Care Act.
The suit, known as Binah Gordon, Kay Mayers, and S.N. v. Aetna Life Insurance Company, was filed in the United States District Court for the District of Connecticut by the Transgender Legal Defense and Education Fund (TLDEF), now known as Advocates for Trans Equality (A4TE), Wardenski P.C., and Cohen Milstein Sellers & Toll PLLC, on behalf of the three transgender litigants.
Kay Mayers, 52, of Alaska had her claims denied and cannot afford GAFR. Binah Gordon, 42, of Nebraska, endured long delays and spent $35,000 of her own money to cover her GAFR when it was rejected by Aetna. S.N., 48, of Pennsylvania, paid almost $50,000 for GAFR and voice surgeries when her appeals to Aetna were denied.
The suit hopes to force Aetna to provide coverage to the three women and ensure the insurer ends what they say is a discriminatory and anti-trans policy regarding coverage of GAFR for trans patients.
“With my job, I am on the road every week, spending a lot of time in places that are not as safe for trans people as the community where I am blessed to work,” plaintiff Gordon said in a statement. “For years, I struggled with fear and anxiety around the danger my facial features put me in while traveling and finding lodging, and even leaving my home, which made me less effective at work and impacted my weekends and all my relationships. My doctors knew I was desperate to improve my quality of life,” said Binah Gordon, who is a plaintiff in the case. “When I was finally able to get the gender-affirming surgeries that I needed, it was like my life finally began. When I looked in the mirror, I used to see an obstacle, a laughingstock, a target, or a victim. Today in the mirror I see a capable, socially and spiritually connected, empowered and confident professional, partner, sister and aunt.”
“Aetna’s refusal to cover gender-affirming healthcare, despite the medical necessity, forces many trans women to continue to suffer, and a minority to assume the major financial burden of paying out-of-pocket,” Gabriel Arkles, co-interim legal director at Advocates for Trans Equality (A4TE), said in a statement.
“Aetna has ignored the medical consensus and wrongly treated this critical health care as ‘'cosmetic,’” Joseph Wardenski, principal of Wardenski P.C., said in a statement. “Aetna’s refusal to recognize the medical necessity of this critical health care is causing unnecessary harm to many transgender women on Aetna health plans.”
The suit seeks a permanent injunction against Aetna’s blanket denial of GAFR for transgender Aetna plan holders, compensatory damages for all Aetna plan holders who have been forced to pay for similar surgeries and treatment, and their attorneys’ fees and costs.
