Denied Coverage For Surgery, Transgender Man Sues His Insurance Provider

A transgender man in Phoenix is suing his employer in federal court to pay for sex reassignment surgery. The costs of the procedures are substantial; insurance plans only recently began covering them.

DAVID GREENE, HOST:

For transgender people, the cost of sex reassignment can be substantial. Only in recent years have some employers began covering these surgical procedures through insurance plans, but others still don't. And as Will Stone of member station KJZZ in Phoenix reports, this is an issue that is now headed to federal court.

WILL STONE, BYLINE: Growing up, Joe Robinson never knew the term transgender even existed.

JOE ROBINSON: I just knew of gay and lesbian. And although I knew that female didn't feel right, I - we deal with labels in this world. So I was like, well, who am I?

STONE: Robinson is a transgender man and a nurse living outside Phoenix. It wasn't until relatively recently, at the age of 50, that he decided to pursue sex reassignment surgery. Or that was the plan.

ROBINSON: When I got that denial back because my policy has an exclusion, I was - I literally - I was very shocked by that.

STONE: Turns out his employer, Dignity Health, the country's fifth-largest health care system, would not cover his procedures.

ROBINSON: What if I, as a nurse, a patient came in and I was prejudiced against an individual and I said, I'm not going to treat them? We just don't do that.

STONE: So he sued with the help of the American Civil Liberties Union. Josh Block is his attorney.

JOSH BLOCK: An exclusion like that, on its face, discriminates on the basis of sex.

STONE: Block says this is the first case of its kind filed since the federal government issued new regulations on what constitutes discrimination under the Affordable Care Act. Those specify health care programs receiving federal dollars can't, for example, cover a hysterectomy for a woman but not a transgender male.

BLOCK: The hospital would be refusing to provide coverage for exactly the same procedure.

STONE: Dignity Health would not agree to an interview. But in court documents, it argues the policy isn't discriminatory and that there's no consensus gender reassignment surgery is medically necessary. That's how Dr. David Stevens sees it. He's CEO of the Christian Medical and Dental Associations.

DAVID STEVENS: It's no different than having a young girl who's anorexic and believes she's fat come in, and instead of trying to help her with her psychosocial mental illness, say, well, no, let's do liposuction.

STONE: Stevens' organization, along with the Catholic Church, opposed the new federal nondiscrimination rules, both for medical and religious reasons. Dignity Health has its roots in the Catholic Church and continues to run Christian-affiliated hospitals. The health care provider said in emails to Robinson that he considered his situation through the lens of its religious and ethical directives but has not yet made that as a legal argument.

STEVENS: Should we force health care professionals to do something that they think is scientifically wrong and perhaps morally or religiously something they shouldn't participate in?

STONE: According to a position statement Dignity submitted to the Equal Employment Opportunity Commission, its medical rationale for denying coverage is this, that its policy doesn't provide benefits for, quote, "personality disorders, including sexual and gender identity disorders," unquote. Phoenix-based gender therapist Michael Peck says that argument is way off base.

MICHAEL PECK: Personality disorders are an entirely different classification of disorders.

STONE: Peck explains that gender dysphoria is the feeling that one's gender identity is different from the one assigned at birth. That's diagnosable. But Peck says it's not a mental illness. Rather, it's a description.

PECK: It used to be called gender identity disorder. That was - diagnosis was taken away. It seemed to be almost what we might call an oxymoron.

STONE: Because people do know who they are, says Peck. The lawsuit alleges sex discrimination not just under the Affordable Care Act but also under Title VII of the Civil Rights Act. If the court agrees, the case could have implications for many industries beyond just health care. For NPR News, I'm Will Stone in Phoenix.

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