Bloomberg Law
Nov. 23, 2020, 10:19 PM

Blue Cross Illinois Affiliate Sued Over Gender Surgery Exclusion

Ayanna Alexander
Ayanna Alexander

Blue Cross Blue Shield of Illinois was sued in federal court on Monday by the parents of a 15-year-old who allege the insurer’s policies deny transgender individuals of “coverage for medically-necessary treatment of gender dysphoria.”

The plaintiff, Patricia Pritchard, receives health coverage through the Catholic Health Initiatives Medical Plan, administered by BCBSIL, with her son, “C.P.,” a dependent. The suit, brought on behalf of the parents by civil rights group Lambda Legal, was filed in the U.S. District Court for the Western District of Washington, and alleges BCBSIL denied coverage for C.P.’s gender dysphoria.

BCBSIL covered some of C.P.’s treatments, including testosterone injections and mental health counseling, but later denied coverage, according to the suit. In Oct. 2016, BCBSIL initially approved C.P.’s request for preauthorization for a Vantas implant to delay the onset of female puberty. C.P. received the implant in Nov. 2016 and BCBSIL made payment for the treatment, the complaint says.

In April 2017, C.P.’s mother received a letter from the insurer claiming coverage would be denied because “treatment for transgender services were allowed incorrectly under the medical plan.”

The plan didn’t specifically exclude coverage for gender-reassignment or gender dysphoria treatments in 2017, the suit alleges, with BCBSIL only adding an exclusion starting on Jan. 1, 2018.

“Benefits shall not be provided for treatment, drugs, medicines, therapy, counseling services and supplies for, or leading to, gender reassignment surgery,” the policy states, according to the complaint.

“Other Plan enrollees who are not transgender do not face a categorical exclusion barring coverage for health care that is medically necessary for them based on their sex and receive coverage for the same care that is denied to transgender enrollees,” the complaint adds.

The lawsuit alleges the “sweeping exclusion” violates the nondiscrimination provisions under Section 1557 of the Affordable Care Act.

“Section 1557 of the ACA expressly prohibits categorical bans on gender-affirming care because it is discrimination on the basis of sex, plain and simple,” Omar Gonzalez-Pagan, senior attorney and health care strategist for Lambda Legal, said in a statement Monday.

The suit seeks damages and an order enjoining BCBSIL from excluding coverage for gender dysphoria treatments.

Cause of Action: Section 1557 of the Affordable Care Act.

Relief: Order enjoining BCBSIL from “administering or enforcing health plans that exclude coverage for gender-affirming health care,” damages, attorney fees and costs.

Response: Blue Cross Blue Shield of Illinois did not immediately respond to a request for comment.

Attorneys: Lambda Legal and Sirianni Youtz Spoonemore Hamburger PLLC are representing the plantiffs.

The case is P. et al v. Blue Cross Blue Shield of Ill., W.D. Wash., No. 3:20-cv-06145, Complaint filed 11/23/20.

To contact the reporter on this story: Ayanna Alexander in Washington at

To contact the editor responsible for this story: Meghashyam Mali at