Lambda Legal Sues Premera Blue Cross on Behalf of Transgender Teen Denied Needed Medical Care

"A.B., his parents, and his doctors all agree surgery is necessary treatment for A.B.'s gender dysphoria, and to ensure his mental and physical well-being."

(Seattle, WA, June 27, 2023) - Today, Lambda Legal, Sirianni Youtz Spoonemore Hamburger PLLC, and QLaw Foundation of Washington filed a federal class action lawsuit on behalf of 15-year-old transgender adolescent A.B. and his parents challenging Premera Blue Cross' arbitrary and categorical policy to deny coverage for gender-affirming chest surgery for patients under 18, regardless of the patient's medical needs. Identified by his initials, A.B.'s medical providers recommended gender-affirming chest surgery as treatment for his gender dysphoria, but Premera has refused to authorize coverage for the surgery that A.B., his parents, and medical providers all agree is necessary and appropriate.

"Gender-affirming medical care is evidence-based, safe, and effective health care. A.B., his parents, and his doctors all agree surgery is necessary treatment for A.B.'s gender dysphoria, and to ensure his mental and physical well-being," said Lambda Legal Counsel and Health Care Strategist Omar Gonzalez-Pagan. "Premera's denial of coverage based on a categorical age cutoff policy is arbitrary, discriminatory, and divorced from any clinical practice guidelines. Wearing a chest binder has had a direct, negative effect on A.B.'s health, making him unable to live the happy, healthy, physically active life he deserves. We look forward to demonstrating how Premera's policy unlawfully discriminates based on sex and age, which is forbidden by the Affordable Care Act."

A.B. has been living openly as the boy he is since May 2021 and started hormone therapy in February 2022. During the months that A.B. struggled with the chest binder, it became clear to A.B., his parents, his therapist, and his doctors that gender-affirming chest masculinization surgery was not only medically necessary but also critical to A.B.'s physical and mental health. The procedure has been scheduled for June 27, 2023.

However, on December 3, 2022, Premera Blue Cross, administrator of the health plan that covers A.B. through his father, denied all coverage for A.B.'s chest surgery, citing as the sole reason that A.B. was under 18 years old, even though Premera has covered effectively identical necessary surgeries for insureds also under 18 but who are not transgender. A.B. and his parents appealed the determination but were denied again on December 30, 2023, forcing A.B.'s parents to pay out-of-pocket for the expensive and necessary care.

"We will of course do whatever we need to do to ensure our son's health and well-being," A.B.'s father, L.B. said. "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. What about those families unable to pay the full price for this care? Are they just supposed to sit there and see their children suffer? This policy has to change."

Today's filing is similar to one filed more than two years ago by Lambda Legal and Sirianni Youtz Spoonemore Hamburger PLLC challenging Blue Cross Blue Shield of Illinois (BCBSIL)'s administration of employer-provided ERISA health plans that excluded coverage for medically necessary gender-affirming care. Also a class action lawsuit, a federal district judge last December ruled that BCBSIL cannot discriminate on the basis of sex in any of its operations - even as a third-party administrator - and therefore cannot administer discriminatory terms of any health plans.

"We are hopeful the court here will apply the same test as in the last case we co-litigated with Lambda Legal and will determine that Premera cannot approve coverage for one policy holder's medically necessary claim that it then arbitrarily and discriminatorily denies to another," said Eleanor Hamburger of Sirianni Youtz Spoonemore Hamburger. "To deny A.B. coverage because of who he is is unfair, unjust, and cruel."

"Every day, we see our Washington community members denied the basic dignity of being able to access health care and use our health insurance in the ways we see our cisgender peers doing. We are proud to stand with A.B. and his family in supporting all young people to be their authentic selves," said J. Denise Diskin of QLaw Foundation.

The case is A.B. v. Premera Blue Cross and is being litigated by Counsel and Health Care Strategist Omar Gonzalez-Pagan of Lambda Legal, Eleanor Hamburger and Daniel Gross of Sirianni Youtz Spoonemore Hamburger PLLC, in Seattle, Washington, and J. Denise Diskin and Dallas Martinez of QLaw Foundation of Washington

Read the complaint here: https://lambdalegal.org/legal_document/ wa_ab_20230627_complaint/

Lambda Legal is a national organization committed to achieving full recognition of the civil rights of lesbians, gay men, bisexuals, transgender people and everyone living with HIV through impact litigation, education and policy work. www.lambdalegal.org