A Philadelphia transgender woman says she was unfairly denied coverage for trans-related medical services by Cigna Health and Life Insurance Company.
On Dec. 31, “Jane Doe” filed suit against the health insurer based in Connecticut. According to her 23-page lawsuit, Doe has a health-care plan with Cigna that states she has coverage for trans-related services.
However, when Doe’s surgeon placed a request for such coverage, the request was denied by Cigna. Additional remediation didn’t bring about a favorable result for Doe.
Doe has gender dysphoria and her health-care providers say she needs facial-feminization surgery to alleviate her condition, according to her lawsuit.
Cigna’s denial letter states: “Facial feminization surgery is considered not medically necessary when performed as part of a gender reassignment.”
Doe maintains her surgical procedures are medically necessary, so she can function comfortably in society as a woman. The procedures she’s requesting include reduction of forehead with sinus wall setback; augmentation of cheekbones; and the reconstruction of her chin, including an osteotomy.
Doe’s initial request for coverage was made in September 2024 and was denied by Cigna the following month.
“Peer to peer” discussions to resolve the conflict took place, but the outcome wasn’t favorable for Doe. The discussions were among medical professionals who have divergent views on the subject. But they couldn’t resolve the conflict, according to the lawsuit.
On Dec. 6, 2024, Doe submitted a request for reconsideration, maintaining that Cigna’s denial of the coverage was a form of sex discrimination. Doe’s attorney provided case law supporting that position.
However, the attorney’s letter didn’t bring about a favorable result for Doe. Neither did letters from two licensed clinical social workers, supportive of Doe’s request for the coverage, according to the lawsuit.
Ultimately, Doe’s request for reconsideration was denied and Doe subsequently filed suit in federal court.
Doe claims she is being discriminated against by Cigna because she’s transgender.
“[Cigna] discriminated against [Doe] and other people who are transgender by excluding the procedures [Doe] sought because they were gender-affirming procedures which is discriminatory on its face and constitutes discrimination against [Doe] because she is transgender,” the lawsuit states.
Doe’s lawsuit emphasizes the medical procedures being requested are not cosmetic in nature. Instead, they will serve to affirm Doe’s gender identity and alleviate her gender dysphoria.
If Doe were born female she would be treated differently by Cigna, according to the lawsuit.
“A patient who is born female can access the procedures when medically necessary and appropriate but not a patient who is born male; therefore, the exclusion draws a line based on sex,” the lawsuit adds.
Doe’s lawsuit seeks compensation from Cigna to cover her out-of-pocket expenses for the procedures; a judicial order that Cigna cover facial-feminization procedures for trans individuals who suffer from gender dysphoria; and a requirement that Cigna workers undergo LGBTQ+ sensitivity training.
“[Doe] will be forced to expend large sums of money to pay for gender affirming procedures and related treatments not covered by [Cigna] on account of [Cigna’s] discrimination,” the lawsuit states.
The case has been assigned to U.S. District Judge John F. Murphy. Murphy is a relatively new federal judge, nominated to the court by former President Joe Biden on July 12, 2022, and confirmed by the United States Senate on Dec. 7, 2022.
A jury trial has been requested.
Brian W. Shaffer, an attorney for Cigna, issued this statement: “We are committed to supporting the healthcare needs of all our customers, including those who are transgender or nonbinary. While we can’t comment on active litigation, Cigna Healthcare offers a range of coverage options for gender transition services, and employers select the coverage that best meets the unique needs of their members.”
Attorneys for Doe had no comment for this story.