Trans woman sues Blue Cross for refusing to cover facial feminization surgery

A Philadelphia Trans woman, “Jane Doe,” has filed suit against Independence Blue Cross, claiming she was wrongfully denied coverage for facial feminization surgery.

Facial feminization surgery encompasses a broad range of procedures to change the shape of the face to look feminine. Examples include having the hairline lowered to create a smaller forehead, cheek implants, tracheal shave, rhinoplasty, lip lift, jaw and mandible contouring, brow lift, hair removal and hair transplants. 

Doe filed her lawsuit on April 20, 2023. It’s been assigned to U.S. District Judge Timothy J. Savage of the Eastern District of Pennsylvania. A jury trial has been requested.

About three years ago, after undergoing gender affirmation surgery, Doe requested Blue Cross coverage for facial feminization surgery. Between 2020 and 2021, she contacted Blue Cross multiple times but was given denials by various insurance agents and representatives.

One insurance-claims representative allegedly told Doe that a “physical or functional component must be demonstrated” to her disability in order for Doe’s disability to be covered, according to Doe’s  lawsuit.

In response, Doe read this statement to the insurance claims representative:

“My desire is to obtain a body that enables me to engage and function in society. My current body does not. Here are some examples: Fired from a job for the lone sole reason of being Trans and perceived as Trans. Being insulted and mocked in every interaction including work and every single social encounter I have every day. Every interaction is a high-risk moment that can and has turned violent — including groups of strangers grabbing me in the crotch in public and surrounding me threateningly while laughing, being typically referred to as ‘it’ by cashiers. I just want a body that enables me to engage and function in society. I don’t want to be singled out or noticed. I just want to be normal and be perceived within the normal range of females. I want to blend in.”

The agent simply replied: “A physical or functional impairment must be demonstrated,” according to Doe’s lawsuit.

Doe allegedly had similar conversations with other Blue Cross representatives and agents. They repeatedly misgendered Doe during the conversations. When Doe complained during one of the conversations, the call was disconnected, according to the lawsuit.

On June 7, 2021, Blue Cross issued a final determination, denying Doe coverage for facial feminization surgery. Blue Cross said Doe “did not demonstrate a facial appearance outside the broad range of normal for the female gender.”

Blue Cross also said the requested procedures would be cosmetic and not medically necessary, according to the lawsuit.

Doe was forced to expend large sums of money to undergo various facial-feminization procedures without being covered by Blue Cross, amounting to a cost of $86,618.50.

She also incurred $5,084.08 in out-of-pocket travel expenses for the procedures and $12,902 in attorney’s costs and fees for her first attorney who represented Doe during the pre-litigation administrative process, according to the lawsuit.

She wants to be reimbursed by Blue Cross for those payments, according to the lawsuit.

“By collecting premiums from [Doe’s] pay and refusing to pay [Doe’s] claim, Blue Cross earned a large profit at [Doe’s] expense,” the lawsuit adds.

Doe is suing Blue Cross for sex discrimination, disability discrimination, denial of a public accommodation, insurance bad faith and breach of contract.

Moreover, Doe is requesting a judicial order ensuring that: Blue Cross treat all Trans customers requesting coverage for facial feminization surgery on an equal and non-discriminatory basis; Blue Cross adopt and enforce a written antibias policy regarding facial feminization surgery; Blue Cross perform training for its employees on handling claims; and Blue Cross hold Trans sensitivity trainings for its employees.

Justin F. Robinette, an attorney for Doe, expressed optimism about the case. “My client wants Trans people to be covered for these procedures,” he told PGN. “She wants a decision in this case that makes it easier for other Trans people to get this type of coverage in the future. Unfortunately, today’s climate is extremely hostile towards Trans people and their healthcare. My law firm intends to fully vindicate Ms. Doe’s rights. She’s looking forward to her day in court and we’re all extremely proud of her.”

A spokesperson for Independence Blue Cross issued this statement: “We cannot comment on pending litigation. Our core mission is to enhance the health and well-being of the people and communities we serve. While we can’t comment on this case, what we would emphasize is that we serve all people, regardless of sexual orientation or gender identity. Equitable care and protections against discrimination based on sexual orientation or gender identification are written into our medical policies and required by law. Our policies for gender affirming care also take into consideration the standards published by the World Professional Association for Transgender Health (WPATH). WPATH has recently published new recommendations and we are currently engaged in discussions around these guidelines and are reviewing our medical policies.”

The spokesperson also emailed a link to Independence Blue Cross’ covered services, which include gender affirmation surgeries, hormonal therapies, chest and genital reconstructive surgeries and garments.

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