Transgender Women File Discrimination Lawsuit Against Aetna

Three transgender women filed a lawsuit on Sept. 10 against CVS Health Corp.-owned Aetna alleging the insurer denied them coverage of gender-affirming facial reconstruction (GAFR) surgeries and procedures in violation of an Affordable Care Act statute. David Kaufman, a lawyer who is not involved in the case, tells AIS Health the plaintiffs made a “pretty persuasive argument” in the lawsuit, although he points out that court proceedings are “often a tedious, drawn-out process” and it remains to be seen whether a judge will certify the case as a class action. 

The plaintiffs — Binah Gordon, Kay Mayers and an individual identified as S.N. — alleged the surgeries and procedures they sought were medically necessary and that Aetna violated “the prohibition on discrimination on the basis of sex in federally funded health programs and activities under Section 1557” of the ACA. Gordon, a 42-year-old Nebraska resident who works as a language curriculum specialist at a community college, was covered under an Aetna plan in the federal employee health benefits program. Mayers, a 52-year-old Alaska resident who works in information technology, and S.N., a 48-year-old physical therapist from Pennsylvania, were enrolled in Aetna employer-sponsored plans.