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A judge ruled that Premera Blue Cross illegally discriminated against trans youth.
The decision came in a case involving Premera Blue Cross.
Insurance company Premera Blue Cross illegally discriminated against two transgender teens by denying them coverage for top surgery, a federal judge ruled Friday.
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In Washington State, U.S. District Judge Thomas Zilly ruled that by not covering “procedures known as mastectomy, breast reduction, or chest or top surgery” for trans and nonbinary minors but covering them for cisgender youth violates the Affordable Care Act by “facially discriminating on the basis of sex.” He denied their age discrimination claims, saying they had failed to exhaust all legal remedies, and declined to give their lawsuit class action status.
Still, the sex discrimination finding is a major victory, notes Lambda Legal, which represented the teens along with the law firm of Sirianni Youtz Spoonemore Hamburger. The suit was filed in June 2023 on behalf of trans boy A.B., then 15, and his parents. It was amended in June 2024 to add trans teen J.M., then 17, and his parents.
“The court determined in no uncertain terms that Premera Blue Cross’s policy categorically denying safe, evidence-based, and effective health care for the treatment of gender dysphoria to transgender adolescents under 18 is discriminatory and unlawful,” Lambda Legal Counsel and Health Care Strategist Omar Gonzalez-Pagan said in a press release. “In fact, the court could not have been clearer. As it wrote in the ruling: ‘The Court need not choose between the divergent interpretations of the term “sex” because, under either view, Premera’s medical policy facially discriminates on the basis of sex.’”
“If a health insurer covers a medical treatment for cisgender minors, and Premera does, then it cannot exclude all coverage of the same medical treatment for transgender minors,” Ele Hamburger of Sirianni Youtz Spoonemore Hamburger added in the release. “Premera’s exclusion targeting transgender minors is illegal discrimination, plain and simple.”
A.B. has been living openly as a boy since May 2021 and started hormone therapy in February 2022, according to Lambda Legal. As he struggled with a chest binder, he, his parents, and his medical team decided gender-affirming chest masculinization surgery was not only medically necessary but also critical to his physical and mental health. However, on December 3, 2022, Premera denied all coverage for his chest surgery, citing as the sole reason that A.B. was under 18 years old, even though Premera has covered effectively identical necessary surgeries people under 18 but who are not trans. A.B. and his parents appealed but were denied again later than month, and they had to pay out of pocket for the procedure.
J.M. has been living openly as a boy since 2019 and has been undergoing hormone therapy since 2021. He continually reported difficulties with chest dysphoria, so his health care providers recommended chest surgery. But on August 25, 2023, Premera denied coverage for the surgery, citing as the sole reason that he was under 18. Coverage was denied again that November after J.M. and his parents appealed. Premera finally OK’d the coverage the week before he turned 18.
“We applaud the court’s clear ruling that categorically denying necessary care for our son was discrimination, pure and simple,” A.B.’s father, L.B., said in the release. “We did what we needed to do to ensure our son’s health and well-being, and we are fortunate to be in a position to do so. No family should have to worry about whether they can provide the care that their children need. We trust Premera Blue Cross will no longer put families through what they put us through.”
“It was a real blow when Premera informed us they would not be covering our son’s necessary surgery,” added J.M.’s father, C.M. “It struck us as arbitrary and capricious and, frankly, cruel. The court agreed, and I hope Premera Blue Cross takes this ruling to heart and never again denies other families coverage for the recommended medical care their children need.”
