Three transgender women are suing U.S. health insurance giant Aetna, alleging unlawful denial of their claims for gender-affirming facial surgeries. The lawsuit, filed in Connecticut federal court, claims Aetna’s refusal to cover these procedures violates Section 1557 of the Affordable Care Act, which prohibits sex-based discrimination in federally funded healthcare programs. Plaintiffs Binah Gordon, Kay Mayers, and S.N. argue the insurer’s policy categorizes their medically necessary procedures as cosmetic, denying them essential care for their gender dysphoria.
The plaintiffs, represented by Wardenski P.C., Cohen Milstein Sellers & Toll PLLC, and Advocates for Trans Equality (A4TE), are seeking a declaratory judgment, an end to Aetna’s exclusionary policies, and compensatory damages for those forced to pay out of pocket for these surgeries.
Background on the Lawsuit
The plaintiffs’ lawsuit addresses a critical issue within transgender healthcare: access to gender-affirming surgeries deemed medically necessary for treating gender dysphoria. Despite Aetna’s coverage of other gender-affirming treatments, the company has consistently excluded facial reconstruction surgeries for transgender patients. According to Aetna’s policy (CPB 0615), these procedures are classified as cosmetic, not medically necessary, leading to denials of coverage.
All three plaintiffs were diagnosed with gender dysphoria and had previously received other types of gender-affirming care. However, their claims for facial surgeries were rejected. Their lawsuit argues that denying coverage violates federal law and directly harms transgender individuals by preventing them from receiving vital medical care.
The Plaintiffs’ Stories
Each plaintiff’s experience highlights the personal and financial toll of Aetna’s policies:
- Binah Gordon, 42, from Nebraska, paid approximately $35,000 out of pocket for her facial surgery after Aetna’s denial. She endured a painful delay in obtaining the necessary care, which exacerbated her gender dysphoria.
- Kay Mayers, 52, of Alaska, could not afford the surgery after Aetna refused coverage. She continues to struggle with severe gender dysphoria and fears for her safety in public settings where her appearance makes her a target of discrimination.
- S.N., a 48-year-old from Pennsylvania, paid nearly $50,000 for facial and voice surgeries. Despite appeals, Aetna refused to cover her procedures, leaving her financially burdened by healthcare costs that her providers deemed necessary.
The lawsuit seeks to rectify these issues by obtaining injunctive relief, which would stop Aetna’s practice of denying coverage for medically necessary facial surgeries. Additionally, the plaintiffs seek compensation for the financial costs transgender individuals have faced due to the exclusionary policy.
Aetna’s History with Gender-Affirming Care
This lawsuit is the latest in a series of legal actions against Aetna over its transgender healthcare policies. In 2021, Aetna settled a similar case involving breast augmentation surgeries for transgender women. Aetna updated its policies to include coverage for these procedures as a result of that case, which Cohen Milstein was also the lead attorney in. However, the insurer did not extend the same coverage to facial surgeries, which has led to the current legal battle.
The case against Aetna comes at a time when the insurance company has faced numerous lawsuits over its handling of medical coverage. In October 2023, Aetna was served with 21 separate lawsuits from breast cancer survivors who claimed the company refused to cover their reconstructive surgeries. Earlier this year, Aetna settled another lawsuit related to discrimination against LGBTQ+ families seeking fertility treatments, creating a $2 million reimbursement fund for those affected.
Gender Dysphoria and the Importance of Facial Reconstruction
Gender-affirming facial surgeries are considered a critical part of treatment for gender dysphoria, a condition resulting from the incongruence between a person’s gender identity and their physical sex characteristics. According to experts and healthcare providers, facial surgeries can significantly improve the mental health and well-being of transgender individuals, as they help align a person’s appearance with their gender identity.
According to a 2020 study by the Williams Institute at UCLA, transgender people who undergo gender-affirming surgeries—including facial reconstruction—report significant improvements in their mental health and quality of life. For transgender women, facial surgeries are frequently necessary to relieve their gender dysphoria’s distress and lower their risk of harassment or violence in public places.
“Gender-affirming facial surgeries are not about vanity or appearance—they provide lifesaving medical care that enables transgender women to live authentic lives and reduce distress caused by gender dysphoria,” said Gabriel Arkles, Co-Interim Legal Director at Advocates for Trans Equality (A4TE), in a press release announcing the lawsuit.
Arkles emphasized that Aetna’s refusal to cover these surgeries forces transgender women to suffer unnecessarily. “Aetna’s policies compel many to continue struggling with untreated dysphoria, while others are forced to bear the financial burden of paying out-of-pocket for essential care,” Arkles added.
Aetna’s Defense
In a statement to Axios, Aetna spokesperson Alex Kepnes said the company could not comment on pending litigation. However, Kepnes highlighted Aetna’s “strong track record of supporting the LGBTQ+ community” and reaffirmed the insurer’s commitment to meeting the healthcare needs of all its members.
Despite this public stance, the lawsuit challenges Aetna’s continued exclusion of facial surgeries for transgender individuals, calling it discriminatory and inconsistent with medical consensus on the necessity of these procedures for treating gender dysphoria.
Broader Implications for Transgender Healthcare
The outcome of this case could have significant ramifications for transgender individuals seeking gender-affirming care. If successful, the lawsuit could set a precedent for broader coverage of facial surgeries by private insurers, removing a major financial barrier for transgender people. The lawsuit also reflects the growing legal push to ensure that insurance companies comply with anti-discrimination laws under the Affordable Care Act, particularly for marginalized groups like transgender individuals.
Joseph Wardenski, Principal of Wardenski P.C. and lead attorney for the plaintiffs, expressed hope that this lawsuit would lead to meaningful changes in how insurers approach transgender healthcare. “Aetna has ignored the medical consensus and wrongly treated this critical healthcare as ‘cosmetic.’ This lawsuit is a crucial step toward ensuring that transgender individuals receive the care they need without facing additional barriers based solely on their gender identity,” Wardenski said.
The Bottom Line
For the transgender community, the fight for equitable healthcare continues. Many transgender individuals and their allies are closely watching the case, hoping it will lead to long-term changes in how insurers classify and cover gender-affirming treatments.
“I spent years living in fear and anxiety about how my appearance would put me in danger, especially while traveling for work,” said plaintiff Binah Gordon. “When I finally got the gender-affirming surgeries I needed, it was like my life began again. No one should have to go through what I did.”
The plaintiffs’ experiences echo the broader challenges transgender individuals face in accessing gender-affirming care. The lawsuit against Aetna highlights the urgent need for reforms in health insurance policies to ensure that transgender individuals receive the care they require to live healthy, fulfilling lives.
As this case unfolds, it underscores the importance of access to gender-affirming care for transgender individuals. For many, these procedures are not cosmetic but essential medical treatments that improve mental health, safety, and overall well-being. The outcome of the lawsuit could set a powerful precedent for the transgender community and lead to meaningful changes in the healthcare landscape.
