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.