Trans man sues Keystone First for a properly-functioning erectile pump

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A Delaware County, Pa. trans man has filed suit against Keystone First, an insurance company that allegedly refuses to pay for a properly-functioning erectile pump and other trans-related medical care.

“John Doe,” 41, filed suit in federal court on Jan. 25. The lower-income trans man lives in Lansdowne, Pa., about six miles southwest of Center City.

According to his 38-page lawsuit, Doe’s problems with Keystone First began in 2018, when the insurance company refused to pay for a procedure to construct a penis for him, which is called a phalloplasty procedure.

However, Doe was able to find surgeons in California who created a penis for him, using California’s Medicaid funds. But Doe needs a new erectile pump to ensure his penis functions properly. The surgeons decline to provide the service unless they receive about $30,000 for a new pump and related expenses — which Doe cannot afford, according to the lawsuit.

Doe will continue to live in pain until a properly-functioning erectile pump is installed. Other procedures Keystone First allegedly refused to cover include testicular implantation and hair removal from Doe’s forearm so that part of his forearm could be used to construct Doe’s penis, according to the lawsuit.

“There are other procedures in the future that we need assurances will be covered by Keystone First,” said Justin F. Robinette, an attorney for Doe.

Doe suffers from gender dysphoria and Keystone First is obligated to help alleviate his symptoms, Robinette added.

Doe’s lawsuit alleges violations of state law, including breach of contract and breach of the duty of good faith and fair dealing — along with a violation of the federal Affordable Care Act.

Doe’s trans-related medical bills total $101,136.89. A Medicaid program based in California has paid for some of those bills but the Medicaid program may seek reimbursement of its payments, which amount to about $70,000, according to the lawsuit.

Doe’s lawsuit seeks in excess of $150,000 in damages, which include payment of medical bills, compensatory damages, punitive damages and attorneys fees, according to the lawsuit.

Robinette said Doe has been fighting for proper medical coverage from Keystone First for about six years.

“Mr. Doe has been fighting for years to have his trans-related medical care covered by Keystone First,” Robinette asserted. “We want our day in court and we’re optimistic that a jury will be fair and vindicate my client’s rights.”

Robinette added: “Keystone First must rectify the harm done to my client and fully insure all other trans participants in the Keystone First health plan.”

A spokesperson for Keystone First issued this statement: “Since our founding as a mission-based organization, we have been steadfast in our commitment to health equity. Keystone First is committed to the health and well-being of our members. Keystone First has a process for appropriately evaluating requests from physicians for health care services that require prior authorization. We remain resolute in our efforts to promote access to quality and timely services for our members.”

Doe’s case has been assigned to U.S. District Judge Kai N. Scott and a jury trial has been requested.

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