VICTORY: Transgender Boy Denied Gender-Affirming Care to Get His Day in Court

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“The court was unequivocal: C.P. has standing…, and Blue Cross Blue Shield of Illinois will need to defend its denial of medically necessary care in court.”
May 5, 2021

A federal district judge yesterday denied an effort by Blue Cross Blue Shield of Illinois (BCBSIL) to dismiss a lawsuit filed by Lambda Legal and Sirianni Youtz Spoonemore Hamburger PLLC challenging BCBSIL’s administration of a blanket exclusion of gender-affirming care in an employer-provided health insurance plan provided by Catholic Health Initiatives.

The lawsuit was filed in the United States District Court for the Western District of Washington in Tacoma on behalf of a 15-year-old transgender boy, “C.P.,” and his parents, and argued the exclusion is in direct violation of the nondiscrimination provisions of Section 1557 of the Affordable Care Act.

“The court was unequivocal: C.P. has standing to bring this case, and Blue Cross Blue Shield of Illinois will need to defend its denial of medically necessary care in court,” said Omar Gonzalez-Pagan, Senior Attorney and Health Care Strategist for Lambda Legal. “The judge, in a straightforward opinion, summarily rejected BCBSIL’s efforts to confuse the issue, including a baseless claim of that BCBS, a nonreligious entity, was exempt from the ACA’s nondiscrimination mandate based on another entity’s purported religious beliefs. The court saw through it all, and now C.P. and his parents will have their day in court.”

From the opinion:

“Without these defenses, the following allegations remain: (1) BCBS is a healthcare provider that receives federal financial assistance; (2) Plaintiffs were denied healthcare coverage and discriminated against; and (3) the latter occurred because of sex. Plaintiffs provide enough factual support to make these allegations plausible, and therefore, properly state a claim of sex discrimination under Section 1557.”

“All we are asking is that my son receive the medical care he needs to live, be healthy, and to thrive. I’m relieved we will be able to make that case in court, and that BCBSIL will have to justify the obstacles put in our way simply to access the care he needs and is legally entitled to,” said Pattie Pritchard, C.P.’s mother and the primary beneficiary on the employer-provided health benefit plan that BCBSIL administers. “My son and all other transgender youth deserve the ability just to be themselves and to thrive. That’s all we ask.”

BCBSIL is a “covered health entity” under the ACA, which means BCBSIL cannot, and it has represented that it does not, discriminate on the basis of race, national origin, sex, age and disability.  The ACA’s Section 1557, which BCBSIL agrees it must abide by, prohibits discrimination on the basis of sex and gender identity, such as in the provision of gender-affirming health care. As such, BCBSIL cannot administer the discriminatory terms of the health plan provided by Pattie Pritchard’s employer—St. Michael Medical Center in Bremerton, Washington, which is part of the Catholic Health Initiatives Franciscan Health System, now known as CommonSpirit Health.

“BCBSIL cannot hide behind a defense that it was 'just following orders' when Pritchard’s employer told BCBSIL to apply the illegal exclusion,” said Eleanor Hamburger of Sirianni Youtz Spoonemore Hamburger who has worked with C.P. and his parents during the past three years to prepare this case for litigation. “BCBSIL has a separate legal, contractual and fiduciary duty to C.P. and others in the health plans it administers, to comply with the anti-discrimination law."

C.P. is a dependent on his mother’s employer-provided health insurance plan and began receiving medically necessary gender-affirming care three years ago. Recently, however, C.P. and his family were informed that some of his care would not be covered because of an exclusion of any care “for or leading to gender reassignment surgery”, including the same care and medical interventions that other cisgender patients receive without question or problem. C.P.’s family has had to pay out-of-pocket for his care, causing unnecessary financial stress.

The case is C.P. v. Blue Cross Blue Shield of Illinois and is being litigated by Lambda Legal Senior Attorney and Health Care Strategist Omar Gonzalez-Pagan, Law and Policy Director Jennifer C. Pizer and Eleanor Hamburger of Sirianni Youtz Spoonemore Hamburger PLLC, in Seattle, Washington.

Read the decision here:

Learn more about the case here: