Mom sues after Minnesota teen denied coverage for gender reassignment

Jan. 28--A northwestern Minnesota woman is suing her employer, Essentia Health, and her medical insurance provider, HealthPartners, alleging that her 17-year-old was denied coverage for medication and surgery to help him transition from a female to a male.

The suit filed in federal court in St. Paul by Brittany Tovar, who works as a family nurse practitioner for Essentia's hospital in Ada, said her teen was found in November 2014 to have gender dysphoria, meaning his gender identity was different from what was assigned at birth.

"I was really disappointed with my employer," Tovar said in a telephone interview Wednesday. "It's hard coming to work [when] my employer considers my son a second-class citizen."

The suit alleges that Tovar's insurance plan for herself and her family "contains a categorical exclusion ... for services and/or surgery for gender reassignment, regardless of medical necessity."

The teen was prescribed Lupron, which suppresses menstruation, and Androderm, a form of testosterone. The cost for Lupron was roughly $9,000, according to the suit. "This was unaffordable for her," the suit read, so the teen did not get the drug.

The mother paid for the Androderm herself, and Essentia later decided to cover that expense "as a one-time exception," the suit continued, but it did not yield on the overall merits of the coverage denial.

In December, Tovar sought preauthorization for her teen's gender-reassignment surgery but was denied, according to the suit.

Private insurance coverage for transition-related surgeries varies in Minnesota. OutFront Minnesota, which advocates for the rights of lesbian, gay, bisexual and transgender individuals, says that insurance plans usually include a requirement, particularly regarding surgeries, that the services be considered "medically necessary."

State law forbids state medical-assistance programs from paying for such procedures if strictly for gender reassignment.

Tovar has suffered from stress and migraines in connection with the dispute over her teen's medical needs, the suit claims.

The suit asks Essentia to change its policies regarding coverage for gender-reassignment services and surgery.

"It's not even about the money," Tovar said. "I'm trying to change [the coverage] and make access to health care for transgender [people] as it should be. To have a blanket exclusion for transgender is against the law. It's discriminatory."

The U.S. Equal Employment Opportunity Commission (EEOC) said Wednesday that it found that Tovar had "reasonable cause" to pursue the legal action, said EEOC spokeswoman Julie Schmid. In May, Tovar had pursued the discrimination claim through the federal agency.

Representatives of Fargo-based Essentia and HealthPartners said they could not comment on the suit.

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