Aetna sued after denial of facial surgeries

HARTFORD -- Three transgender women from across the U.S. filed a federal class action civil rights lawsuit against Aetna Life Insurance Company after the women were denied coverage for gender-affirming facial procedures.

Announced Tuesday, the complaint said the Hartford-based company refused to pay for these surgeries based on a policy that excludes gender-affirming facial procedures from the types of medically necessary gender-affirming surgery they cover. The policy, CPB 0615, states that gender-affirming facial procedures are a form of "cosmetic" and "medically unnecessary."

All the plaintiffs were diagnosed with gender dysphoria for several years before seeking out the procedures. They had received other types of gender-affirming care but were denied facial surgeries due to the policy. The complaint states that the denial violates section 1557 of the Affordable Care Act, which prohibits discrimination based on sex in federally funded health care programs.

"For transgender women, gender-affirming facial surgeries are not about vanity or appearance - they are about providing lifesaving medical care that enable them to live full authentic lives and reduce distress caused by gender dysphoria," said Gabriel Arkles, co-interim legal director at Advocates for Trans Equality, in a press release announcing the suit. "Aetna's refusal to cover gender-affirming healthcare, despite the medical necessity, forces many trans women to continue to suffer, and a minority to assume the major financial burden of paying out-of-pocket."

Gender dysphoria symptoms can be addressed through gender-affirming medical care, like hormone treatment, surgery and procedures, including facial surgery. A UCLA study found that trans patients who receive gender-affirming facial feminization surgery reported better mental health after their procedures.

According to the complaints, all the plaintiffs were on health plans offered by Aetna and were receiving gender-affirming care to treat their gender dysphoria and further their transition.

One of the plaintiffs, Binah Gordon, a 42-year-old Nebraska resident, spent about $35,000 out-of-pocket on facial surgery after Aetna refused to cover it. The delays caused her distress and anxiety, she said in a press release.

Gordon said she spends a lot of time in unsafe places for trans people because she often travels for work. In a climate of rising anti-LGBTQ+ rhetoric and violence, she was afraid of the danger her masculine facial features may place her. Although she ultimately raised the money, she said it was a "long and painful delay" in obtaining care.

"My doctors knew I was desperate to improve my quality of life," she said. "When I was finally able to get the gender-affirming surgeries that I needed, it was like my life finally began. When I looked in the mirror, I used to see an obstacle, a laughingstock, a target, or a victim. Today, in the mirror, I see a capable, socially and spiritually connected, empowered and confident professional, partner, sister and aunt."

Similarly, S.N. of Pennsylvania paid nearly $50,000 out of pocket for gender-affirming facial and voice surgeries, according to the complaint. The last plaintiff, Kay Mayers, a 52-year-old Alaskan resident, is unable to afford the surgery, so she continues to experience severe gender dysphoria and fears for her safety, the suit says.

The complaint states that Aetna has made exceptions to cover facial reconstructive surgery after a traumatic injury or cancer treatment. It concludes that Aetna is ignoring the medical consensus and standards of care regarding gender-affirming facial surgery under their policy.

Filed in the U.S District Court for Connecticut, the three plaintiffs are represented by Wardenski P.C., and Cohen Milstein Sellers & Toll PLLC, and the Transgender Legal Defense and Education Fund, now known as Advocates for Trans Equality.

The plaintiffs are looking to end Aetna's exclusionary policy and have the company compensate damages to all policyholders who have had to pay out of pocket for gender-affirming facial surgery because of the exclusion.

In a statement to the Record-Journal, Alex Kepness, executive director of communications at Aetna, said that the company can't comment on pending litigation, but noted that it has a "strong track record of supporting the LGBTQ+ community and is committed to meeting the health care needs of all our members."