Family of trans teen sues after insurance refuses to cover gender-affirming surgery

The family of a transgender 15-year-old Washington boy has filed a federal lawsuit against Premera Blue Cross alleging that the health insurer is violating the Affordable Care Act by refusing to cover the costs of gender-affirming chest surgery.

Omar Gonzalez-Pagan is an attorney with Lambda Legal representing the teen – identified in court papers as “A.B.” – and his family. Gonzalez-Pagan said the health insurance company doesn’t cover gender affirming surgery until after the age of 18.

“A.B. needs this surgery and he is being unlawfully denied coverage of that surgery because of who he is," Gonzalez-Pagan said. "In doing so Premera is not just breaking the law, it is imposing grave harm, and those harms have serious consequences.”

A.B. was initially set to have surgery Tuesday. He now wears chest binders, but his family, therapists, and doctors soon came to the conclusion that surgery was still the way to go.

"Premera has here imposed a policy that is just not consistent with the practice of medicine, not consistent with A.B.’s – our client's – needs, and in doing so it discriminates against trans patients under 18 based on sex and age," Gonzalez-Pagan said.

Lawyers say the insurer has no problem with covering this procedure for other young people under 18 who aren’t transgender.

Amanda Lansford, a spokesperson for Premera Blue Cross, wouldn't comment on the specifics of the lawsuit but said the provider believes LGBTQUIA+ people have a right to safe, affordable care.

“Our medical policy for gender-affirming services has been thoroughly researched and is based on the most current scientifically sound clinical evidence," Lansford said.

The insurance company covers forms of gender-affirming care for minors like puberty blockers, cross-hormone treatments, and mental health care.

"There is not strong evidentiary support for surgical interventions in minors,” Lansford said.

Gonzalez-Pagan expects to hear an official response to the lawsuit from Premera lawyers by late July.