Premera Blue Cross Faces Class Action Over Gender Affirming Care Age Discrimination

In a recent lawsuit filed against Premera Blue Cross, plaintiffs A.B., L.B., and M.B. allege that the health insurance company has engaged in discriminatory practices. The plaintiffs, represented by Lambda Legal Defense and Education Fund and Q Law Foundation of Washington, claim that Premera has discriminated based on sex and age by excluding coverage of gender-affirming surgical care for transgender youth under the age of 18. This policy, the plaintiffs argue, is inconsistent with medical practice guidelines and has caused both financial hardship and emotional distress.

What Laws Are Allegedly Being Violated?

The lawsuit is brought under Section 1557 of the Affordable Care Act (ACA), which prohibits discrimination on the basis of sex and age in health care. As a recipient of federal financial assistance, Premera is considered a covered entity under this law. The plaintiffs argue that Premera's policy of excluding coverage for gender-affirming surgical care for transgender individuals under 18 amounts to discrimination based on both age and sex.

"Premera's exclusion of coverage for gender-affirming surgical care for transgender youth is not consistent with medical practice guidelines and is discriminatory," the lawsuit states. The plaintiffs are seeking a court declaration of Premera's violation of Section 1557, along with an injunction preventing the company from enforcing the exclusion.

What Led to the Filing of the Lawsuit?

The plaintiffs' journey to this lawsuit began when A.B., a transgender boy, was denied coverage for his medically necessary chest surgery and reconstruction. According to the lawsuit, Premera denied the coverage on the grounds that A.B. was under 18. A.B. and his parents appealed the decision, but the appeal was denied.

The denial of coverage, the plaintiffs allege, has caused significant financial hardship for A.B. and his family. Moreover, they claim that the denial has resulted in emotional distress, as A.B. has been unable to receive the necessary medical care due to the financial burden.

Who Are the Class Members?

The proposed class in this lawsuit includes all individuals who have been, are, or will be denied coverage for gender-affirming surgical care due to their age and transgender status. This includes not only A.B., but also potentially many other transgender individuals under the age of 18 who have been denied coverage for these necessary medical procedures.

What Damages Are the Plaintiffs Seeking?

The plaintiffs are seeking a variety of damages in this lawsuit. These include compensatory damages for out-of-pocket expenses, consequential damages, and nominal damages. The exact dollar amount of these damages is not specified in the lawsuit, but it is clear that the plaintiffs believe they have suffered significant financial harm as a result of Premera's alleged discriminatory practices.

What Could Be the Next Steps in the Case?

As the lawsuit progresses, the plaintiffs will likely seek class certification. If the class is certified, the lawsuit could potentially affect a large number of individuals who have been denied coverage for gender-affirming surgical care due to their age and transgender status. The court will also need to rule on the plaintiffs' request for a declaration of Premera's violation of Section 1557 and an injunction preventing the company from enforcing the exclusion.