Victory! Empire Blue Cross Blue Shield Reverses Coverage Denial for Transgender Man’s Medically Necessary Gynecological Care Following TLDEF’s Intervention

Empire Blue Cross LogoWe are thrilled to announce that Empire Blue Cross Blue Shield of New York has reversed its coverage denial for a transgender man’s medically necessary gynecological care after we intervened on his behalf. John Doe, who wishes to remain anonymous, began his transition during his teenage years. He underwent medical care as part of his gender transition. He changed his name and updated his social security records, passport and driver’s license to reflect that he is male. In 2013, he purchased a health insurance plan from Empire Blue Cross Blue Shield (Empire). He was listed as male on the health care plan.

Because he has reproductive organs traditionally associated with women, he needs routine gynecological care. He sought that care last fall. When he complained of abdominal pain during his gynecological exam, he was referred for an ultrasound screening. He was diagnosed with a fibroid.

His providers submitted three claims related to this gynecological care to Empire. Empire denied the claims on the grounds that “[t]he procedure or diagnosis billed is not valid for the patient’s gender.” In short, Empire refused to pay for his gynecological care because he is a transgender man.

Our client protested to no avail. He told Empire that he is transgender and asked the insurance company to make a note of this in its system. Empire stated that it could not do that and continued to refuse to pay for his care.

On April 29, TLDEF appealed Empire’s coverage denial. On July 29, 2015, Empire reversed its decision and provided the coverage he is entitled to.

“Transgender men need routine medical care, including gynecological care,” said TLDEF Executive Director Michael Silverman. “Many do not seek care because of concerns about discrimination related to revealing that they are transgender. Our client’s experience highlights the significant challenges that transgender people face in getting the care that they need. We expect Empire to treat transgender policyholders fairly moving forward.”

“Empire initially denied my claims because I am transgender,” Mr. Doe said. “No one should be denied healthcare coverage just because of who they are. Every day transgender people struggle to get basic health care. I hope my case has shined a light on the discrimination that transgender people face and will help bring it to an end.”

TLDEF represented Mr. Doe with pro bono co-counsel Debevoise & Plimpton LLP, including partner Robert D. Goodman, associate David Sandler, and associate Bryn Paslawski.