Insurance company allegedly won’t cover puberty blockers for trans boy

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The mother of a trans boy is suing in federal court because an insurance company allegedly refuses to cover puberty blockers for her trans son. 

In October 2023, “Jane Doe” was denied coverage for puberty blockers for her trans son by Illinois Blue Cross and Blue Shield, according to a 35-page lawsuit filed in the Middle District of Pennsylvania on Feb. 19.

Doe paid for her son’s trans-related medical care with her own funds and now she’s seeking reimbursement from the insurance company.

Doe currently lives in Maryland but she lived in Mercersburg, Pa. at the time of the alleged denial of coverage. Her son received treatment at the Milton S. Hershey Medical Center in Hershey, Pa., according to the lawsuit.

Doe’s son, known as “John Doe” in court papers, is 13 years old. He’s doing well but so far he’s incurred about $50,000 in trans-related medical expenses, according to the lawsuit.

At the time of the alleged insurance-coverage denial, Doe worked for a printing company based in Maryland known as Phoenix Color Corp, which is also named as a defendant in the lawsuit.

Illinois Blue Cross and Blue Shield administered the health plan of Phoenix Color Corp., according to the lawsuit.

Illinois Blue Cross and Blue Shield has a blanket policy of refusing to cover any trans-related medical procedures for anyone — regardless of whether they’re an adult or a child, according to the lawsuit.

John Doe has gender dysphoria and required puberty blockers and a surgically-implanted device to administer the blockers throughout his system. Without that necessary medical care, his condition would have worsened, according to the lawsuit.

“Jane Doe sought pre-clearance or pre-authorization for gender-affirming treatments including hormone therapy — puberty blockers or inhibitors —  which involved, among other things, surgical implantation of a Histrelin medical device, anesthesia, and pharmacy services for John Doe,” the lawsuit states.

Illinois Blue Cross and Blue Shield consistently refused to grant approval for the requested coverage. Jane Doe exhausted all of her administrative appeals, to no avail, according to the lawsuit.

The lawsuit alleges discrimination on the basis of sex and disability. 

“Illinois Blue Cross and Blue Shield allegedly has a categorical exclusion of all gender-affirming care and treatment when intended for ‘gender reassignment surgery,’ or words to that effect, which constitutes discrimination based on sex and disability,” the lawsuit states.

The lawsuit also faults the insurance company for using outdated terms such as “gender reassignment surgery” and “transsexual surgery,” rather than “gender affirmation care.”

The lawsuit claims the insurance company’s actions “shock the conscience,” and deserve the imposition of significant financial penalties upon the company.

John Doe’s medical fees at Hershey Medical Center amounted to $49,735.19. In total, Jane Doe is seeking $700,000 from the defendants, which includes compensatory damages; punitive damages; medical fees and attorneys fees, according to the lawsuit.

Jane Doe is also seeking a court order requiring Illinois Blue Cross and Blue Shield to provide coverage for trans-related medical care and to educate its workers about trans-related issues.

The case has been assigned to U.S. District Court Judge Jennifer P. Wilson and a jury trial has been requested.

Neither side had a comment for this story.

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