The Washington State Office of the Insurance Commissioner (OIC) is investigating three complaints that Kaiser Permanente Washington won’t cover breast augmentation, better known as implants, for trans women who have been prescribed them for gender dysphoria.

According to transgender advocacy organization Gender Justice League (GJL), Kaiser told the group it offered the same coverage for transgender women as it does for cisgender women. But cisgender women (or women who are not trans) do not need medical services related to gender dysphoria.

The OIC is in the early stages of investigating the complaints, filed last week, according to OIC spokesperson Stephanie Marquis.

In an email to GJL, Kaiser notes that it only covers breast augmentation following a mastectomy. In other words, Kaiser would cover breast augmentation for a trans patient who had a mastectomy due to breast cancer.

“That is not a reasonable policy,” Danni Askini, executive director of Gender Justice League, tells INTO. “The point is, they are required to treat gender dysphoria, and the treatment for gender dysphoria is that these patients have been prescribed is breast augmentation.”

A spokesperson for Kaiser Permanente Washington did not respond to a request to comment by deadline, but the company does not deny the policy in a Facebook post where its email to GJL is published.

“The field of transgender medicine has been rapidly evolving over the last several years and so too does our approach, which will match the market in coverage,” Kaiser writes. “We honor the feedback of our patients and members, are committed to reexamining our medical policy and to moving toward matching coverage that is market standard.”

In June 2014, Washington State Insurance Commissioner Mike Kriedler issued a letter to insurers clarifying anti-discrimination protections covering transgender policy holders and reminding them that, “denial of a medically necessary service on the basis of gender identity is prohibited under Washington state law.”

The OIC website also lists breast augmentation among its services insurance providers are required to provide as part of the transition process.

Marquis said she can’t yet comment on if a violation has occurred.

“It’s something that we’re taking very seriously, I can tell you that,” she tells INTO. “We have serious concerns, and at this point we’re going to be looking into it, and that will be a thorough evaluation of what the contract says and what coverage people have access to what our interpretation of that is.”