A woman from northwest Minnesota is suing her employer and health insurance provider for denying coverage for her teenage child's gender reassignment surgery.
In a lawsuit filed in U.S. District Court this week, Brittany Tovar of Halstad, Minnesota, accuses her employer – Duluth-based Essentia Health – of discrimination for "categorically excluding any coverage" for gender reassignment services/surgery in the employee medical plan run by insurer HealthPartners.
Tovar, who has worked for Essentia as a nurse and family nurse practitioner since September 2010, has a son who in November 2014 was diagnosed with gender dysphoria, identifying as a male, according to the suit.
Since treatment for gender reassignment was excluded under the Essentia health plan, Tovar faces paying the full cost out of her own pocket, or the prospect of her son's condition going untreated, the lawsuit says.
She wrote to her employer explaining the "serious repercussions" for her son if he was not able to access necessary care to medically transition from a female to a male, with gender dysphoria associated with high instances of anxiety, distress and depression (more on the condition below).
Essentia Health told BringMeTheNews it has not yet received the lawsuit, and that it "does not comment on pending litigation."
Mother told medication would cost $9,000
According to the suit, the plan denied coverage for a medication called Lupron, designed to temporarily suspend menstruation, meaning Tovar would have had to pay $9,000 out of pocket. She could not afford this, so her son did not receive the prescribed treatment.
He was then prescribed Androderm, which Tovar paid for after again Essentia denied coverage. It later agreed as a one-off to reimburse her, though it has not changed its policy denying coverage for gender reassignment treatment, the suit says.
She also sought pre-authorization from HealthPartners for her son to have gender reassignment surgery, but was once again told it would not be covered.
Tovar is suing Essentia Health for what she argues is a violation of Title VII of the Civil Rights Act of 1964 and the Minnesota Human Rights Act, and HealthPartners for a violation of the Affordable Care Act.
The Star Tribune reports that Tovar's son, Reid Tovar Olson, had his name changed three weeks ago from Madison Olson as part of his gender transition.
His mother told the newspaper she was "disappointed" with Essentia Health, adding: "It's hard coming to work, and my employer considers my son a second-class citizen."
Gender dysphoria is a recognized condition where someone's physical gender traits is in conflict with the gender they identify with – you can read more about it here.
It is generally treated with mental health counseling, hormone therapy and eventually – if it is determined "medically necessary" – gender reassignment surgery, which coverage for was denied in the Essentia health plan, according to the lawsuit.
Last month we reported how the state of Minnesota is being sued by the American Civil Liberties Union because its public health insurance programs don't cover gender reassignment surgery.
This coverage is denied even though the federal Medicare program covers all medically necessary gender reassignment surgery, while the ACLU says that private insurance plans regulated by Minnesota also offer coverage.
The Huffington Post reported in September that new federal regulations are being pushed that would forbid health insurance companies from excluding gender transition treatments.
They would give transgender people the legal right to make civil rights claims against insurers, doctors and hospitals who deny coverage or necessary care.