15-year-old female sues Premera Blue Cross for not paying for transgender breast mutilation surgery


Lambda Legal and other LGBTQ advocacy lawyers have filed a federal class action lawsuit in Washington state against Premera Blue Cross, challenging the insurance company’s policy of denying coverage for gender-affirming chest surgery, also known as breast mutilation surgery, for patients under 18.

The lawsuit was filed on behalf of a 15-year-old girl who has her parents’ permission to do whatever it takes to live as transgender male adolescent.

A.B.’s medical providers recommended the breast removal as part of the child’s treatment for gender dysphoria. However, Premera Blue Cross, which also serves Alaska businesses and residents, has refused to authorize coverage for the surgery, despite the agreement of A.B., his parents, and his medical providers’ insistence that it’s needed.

Lambda Legal Counsel and Health Care Strategist Omar Gonzalez-Pagan said the surgery is evidence-based, safe, and effective. He criticized Premera’s denial of coverage, citing an arbitrary age cutoff policy that Lambda says is discriminatory and not in line with clinical practice guidelines.

A.B. has experienced negative effects on her health due to wearing a chest binder, hindering her ability to live a happy, healthy, and physically active life, according to the lawyers, who say that Premera’s policy violates the Affordable Care Act by unlawfully discriminating based on sex and age. Premera does covering similar necessary surgeries for insured individuals under 18 who are not transgender, the lawyers allege.

The child’s parents appealed the Premera denial decision but were denied again on Dec. 30. As a result, the parents had to pay out-of-pocket for the expensive procedure.

Premera filed documents showing that the prefrontal cortex–the area of the brain that regulates planning, memory, and impulse control doesn’t develop fully until people are in their mid-20s. Thus, 15-year-olds are not seen as mature enough to take such risks as surgery.

The insurance company covers other forms of gender-affirming care for minors, including prescriptions for puberty blockers hormones and mental health care.


  1. This poor adolescent girl needs compassionate counseling, not mutilation, and not even puberty-blocking hormones. The adults who now surround her are truly demented. As for the mutilation-supporting politicians and government officials, the appellation of ‘evil’ is much more appropriate.

  2. If she’s not old enough to drink or drive, she’s not old enough to engage in self mutilation.

    Wait 3 years. She’ll be legal and can do all the self mutilation she wants.

    • On her own dime. Elective surgery should not be covered. If it were then breast augmentation would need to be covered as well as a zillion other cosmetic matters.

      • Exactly. Not a penny from Medicaid, and private health plans must be completely free to deny payment benefits for sex-change surgeries and puberty blocking drugs, no matter the age. Like rhinoplasty or facelift, one must expect to save up to pay for their elective mutilations.

    • It’s a sort of retroactive abortion. Let the kid either chose to self destruct, or talk a troubled kid into it.

      Canadian style euthanasia can’t be far behind.

  3. Let the lawsuits proceed. On one hand, the lawsuits after the medical mutilation, on the other the lawsuits aimed at those who chose not to play. Give the courts something useful to do. Cheers –

  4. A few years in the future she may change thinking completely. These should not be done in youth.

  5. Suing for the right to be butchered. Sigh

    I have to agree with the above post. Wait until she is of legal age (18 yo) and she can make her own decisions for her body. But no way should an under age person/child make these choices.

  6. Hold on there, I thought tranny issues weren’t our business?
    The same left wing jacka—- always chime in, “OMG – why are conservatives SO obsessed with something that doesn’t affect them?”

    This mentally ill teenager is now suing my medical provider, increasing costs, raising my premiums.
    Guess it was ‘my business’ after all.

    • Apu, Didn’t take the Lawyers long to intervene on behalf of this poor confused girl who needs our prayers and a competent shrink instead of a legal team enabling her mental illness, looking for the “prime cut” payoff. But hey, it’s their job, Right? Being a hyena is what these Lawyers do.

  7. Two inconvenient facts regarding these acts of butchery.

    -if the kid goes full Monty, she will be a lifetime patient for whoever does the work. The cocktail of drugs she’ll be on and their massive side effects require lifetime maintenance.

    Unlike most drugs, they don’t correct a flaw in the body, they create one.

    -many, many people regret making the irreversible decision to mutilate themselves. Leading to a high rate of suicide. Higher than the ones who seek mental health treatments.

  8. Why should insurance pay for an elective surgery this is ridiculous. Just another unnecessary cost to insurance. If this childs, and I stress child, parents want it let them pay.

  9. These people wanna mutilate themselves whatever! Do not expect an insurance company to comply with your insanity. You pay for the dam surgery yourself! No private insurance, no Medicaid or other freebie crap. There is a cost to being retarded like this and having your own parents check out and say do whatever you want. It all must be stopped. It’s child neglect and mutilation!! Parents should be in jail and the kid sent for serious therapy. Period.

  10. It’s an elective procedure. Cosmetic surgery usually is not covered. As for a so called surgeon. So much for the the “ do no harm “ motto.

  11. Negative effects on her health due to wearing a chest binder???
    So if she is not happy with her state of mind would she put her head in a vice and continue to crank it down?
    She is ill. Her parents are ill. Her Dr is ill.
    Where did all this illness come from?

    I just cant find any compassion in my heart for those that are not content with what they have compared to those that are challenged with paralysis cancer polio and the endless list of defects that they are born with and now after years of dealing with it she wants someone else to pay for her choice to be someone else.

    She can pretend to be whoever she wants to be.
    Thats the great part of America but dont ask for money or psychological help after you screwed yourself into a hole you cant scape from.

  12. The problem goes right to the parents. They are doing the wrong thing by going along with this.

  13. Sure take it to court. The way our court system works she will be 25 by the time this is all said and done. No insurer or state entity should pay for cosmetic surgery, especially on a minor. My bigger problem is with those parents, who are either too chicken to stand up to her or have convinced her of this to begin with. IF this is truly what she wants then another 3 years will not make any difference and give everyone time to think it through, get the those teenage hormones/emotions back under control and make a logical choice. Who knows in a year or so she may find the “guy of her dreams” and all this will be for naught.

  14. Wasn’t all that long ago the “party of science” was constantly getting soiled diapers chanting “what are we doing to our children?”

    Seems the answer is killing and mutilating them.

  15. If your own house is in shambles , and you choose to burn it down to collect on the insurance , if I’m correct that would not be covered as well, it’s considered Insurance fraud, and I believe you can spend time in prison for doing it. And can someone please tell
    Me why all these quack Doctors performing these disgusting surgery’s are not charged in this crime as an accomplice!

  16. I thought conservatives believed in parental control and supervision over their own children? Does this only apply when its things like making sure their kids don’t have the potential to read some icky book that might say something about the real world?

    • Valid point cman!
      While I find these parents despicable, they certainly have the right to decide for their child (which they apparently did). Premera by the same token has the right to decide what they cover for underage teens. Since they apparently cover drugs and therapy but not invasive surgery, the family made a choice instead of waiting until this young lady is of age. I am always leery of the “need it now! before it is too late” harassment crowd. Now some activist group wants their pound of flesh. Seems to meet this isn’t so much about this child, but about a cause! Those are the worst kind of lawsuits because it isn’t about the “victim” it is about providing a platform for zealots.

      • To be clear, I’m not supporting what these parents did, but from what I understand about the timing of these procedures, it is important to begin hormone therapy prior to puberty, or else the secondary sex characteristics become more and more pronounced.

        • There is a world of difference between hormone therapy and surgery. Considering that Premera offers hormones and therapy, the radical surgery route seems even more extreme to me. This child did not wake up one morning at age 15 and decide she is a he. However if that is the case, there is much more concern regarding her doctors haste and rush to surgery. Why not explore to see if this is a real desire or just a phase because “everyone is doing it now”. More and more I think there is much to that story that isn’t told and my concern is for this young woman, whose life will be forever affected.

          • One last observation.
            In the end this your lady will never be a real man. Oh sure she can mutilate her body and trick it with hormones, but genetically biologically she will remain a woman. All those procedures will also not alter her personality and miraculously transform her life into the utopia she clearly desires.
            All this reminds me of those kids who went to “find themselves” after college, the “midlife crisis” of people unhappy what they did with their life, or those who continuously undergo plastic surgery to strive for an ideal that will transform them into perpetual happiness. If adults wish to waste their precious days on earth chasing after these goals, that’s their business, but 15 year olds don’t have the life experience to understand the enormity of this choice or the psychological wherewithal to deal with it.

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