Aetna's denial of gender-affirming care taken to court
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A class-action complaint claims Aetna violated federal non-discrimination law by denying coverage of certain gender-affirming surgeries.
Why it matters: The lawsuit filed Tuesday cites civil rights protections in the Affordable Care Act that are currently being challenged by conservative-led states.
Driving the news: The lawsuit states Aetna "categorically excludes" coverage for facial reconstruction surgeries when they're prescribed to treat gender dysphoria, even though it covers the same surgeries for other medical diagnoses.
- Two of the lead plaintiffs in the lawsuit ended up paying more than $35,000 out of pocket after Aetna denied their claims for surgery, while a third has not yet been able to afford a procedure.
- The complaint estimates this issue affects more than 70,000 people covered by Aetna across the country.
- The American Medical Association and other major medical groups support gender-affirming treatment standards that recognize facial reconstruction surgeries as safe and effective for changing facial features linked to gender dysphoria. The procedures are typically used to make facial features more feminine.
- Gender-affirming care varies by patient, and not all transgender people choose to get facial reconstruction surgery.
Between the lines: These surgeries are usually reserved for adults and haven't been heavily targeted by recent state bans on transgender care. But systemic barriers still make them hard to access, said Gabriel Arkles, a lawyer for the plaintiffs and co-interim legal director at Advocates for Trans Equality.
What they're saying: "Facial surgery is important healthcare. It's also something that helps people be a little bit safer ... Your face is so visible. It's one of the first ways people will try to identify what gender you are."
- "I'm hoping and I'm praying for this lawsuit to make it possible for people to envision asking for their needs to be met because even that wasn't possible for me at a certain point," said Binah Gordon, one of the three lead plaintiffs on the complaint.
The other side: "Aetna has a strong track record of supporting the LGBTQ+ community and is committed to meeting the health care needs of all our members," spokesperson Alex Kepnes told Axios.
- Kepnes said Aetna cannot comment on pending litigation.
- Aetna plans cover other types of gender-affirming surgeries, including breast and genital surgeries, when deemed medically necessary.
