Illinois Blue Cross must pay for transgender care, court rules

Blue Cross and Blue Shield of Illinois violated the Affordable Care Act’s anti-discrimination provisions by refusing to pay for a transgender teen’s sex-determined care through employer plans they manage, a federal judge ruled Monday.

The health insurer, which is owned by Health Care Service Corp., is required to cover this care even though, as a third-party administrator, the company has carried out directives of the employer client in denying the lead plaintiff, Judge Robert Bryan of the United States District Court for the Western District of Washington decided in a summary judgment. The employer, Catholic Health Initiatives in Englewood, Colorado, opposes these services on religious grounds. The health system, part of Chicago-based CommonSpirit Health, has the legal right to withhold payment for medical care that is inconsistent with its religious beliefs and is not a party to the lawsuit. .

Bryan ruled that despite a business relationship with a religious organization, Blue Cross and Blue Shield of Illinois are not exempt from federal laws and regulations that prohibit discrimination based on sex. The court will then determine the appropriate relief for the family that initiated the lawsuit and for the 370 employers included in the class action.

Bryan instructed Blue Cross to reprocess the claims, end the definitive denial of sex-determined care, and reimburse the main plaintiff’s family for medical expenses they had out-of-pocketed.

Jenny Pusher, chief legal officer of Lambda Legal, which represents patients suing the nonprofit insurance company, said Bryan’s ruling sets a legal precedent that could significantly increase potential liability. hidden by third-party administrators under the anti-discrimination provisions of the Affordable Care Act.

“Third-party administrators need to follow the law. That shouldn’t come as a big surprise to anyone,” Pusher said. “It’s very clear and easy to understand. We are applying the words of the statute simply, as Congress intended, but we are addressing a longstanding discriminatory practice. This is a very important precedent and an important precedent there.”

Blue Cross and Blue Shield of Illinois and Catholic Health Initiatives declined to comment.

Patricia and Nolle Pritchard of Washington state sued two years ago after Blue Cross and Blue Shield of Illinois refused to pay for hormone therapy and breast reconstruction surgery for their son, identified as CP, contrary to doctor’s recommendation. The family ended up paying more than $12,000 for out-of-pocket procedures for CP, now 17.

Pritchards alleges the insurer violated section 1557 of the Affordable Care Act, which states that institutions receiving federal funding cannot discriminate on the basis of gender. Last month, Bryan one-class certification of transgender people who work at employers that contract with insurance companies to manage their health benefits and do not pay for sex-identified care.

In court filings, Blue Cross argued that the medical community had failed to agree on the appropriateness of gender affirmation care and that, because its third-party administrators do not directly collect federal money, it is not subject to ACA rules. The company’s Medicaid, Medicare, and exchange operations receive federal payments.

The insurer also points to federal laws and regulations it maintains that support its arguments, such as the 1974 Employee Retirement Income Guarantee, which Blue Cross and Blue Shield of Illinois argued for allowing insurance companies to make policies for religious customers that would otherwise be classified as discriminatory. . The insurance company further argued that it was covered by Religious Freedom Restoration Act 1993Allows employers to claim religious exemptions for certain federal laws.

Blue Cross also asserts that Department of Health and Human Services rules do not protect LGBTQ people from discrimination based on gender. The Supreme Court has previously ruled that the sexist protections in the Civil Rights Act of 1964 apply to LGBTQ individuals.

Administration of President Barack Obama announced regulations including transgender people under the ACA’s anti-discrimination provisions, but the administration of President Donald Trump cancel it. This August, HHS proposes recover Obama-era standards.


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