Sex

Dignity Health Sued Over Refusal to Offer Insurance Coverage for Transition-Related Care

“I was shocked when Dignity, which is supposed to be in the business of healing and holds itself out to the public as a bastion of ‘human kindness,’ told me they would not authorize insurance coverage for my doctor-prescribed treatment,” Joe Robinson said in a statement released by his attorneys at the American Civil Liberties Union (ACLU).

Because Dignity Health, the fifth-largest health-care network in the country, excludes health insurance coverage for gender dysphoria—or "sex transformation surgery," as the insurance policy states—Joe Robinson has borne the cost of his transition treatment himself. Shutterstock

Joe Robinson, a transgender man and operating room nurse at a Dignity Health medical center in Arizona, has alleged in a lawsuit filed Monday that his employer’s insurance policy of depriving coverage for gender dysphoria is discrimination on the basis of sex, in violation of Title VII of the 1964 Civil Rights Act.

Because Dignity Health, which operates the fifth-largest health-care system in the country, excludes insurance coverage for gender dysphoria—or “sex transformation surgery,” as the insurance policy states—Robinson has borne the cost of his transition treatment. This included hormonal therapy and a double mastectomy. According to Robinson’s complaint, he requested coverage for phalloplasty, but his claim was denied; he says he cannot afford to pay for that surgery out of pocket.

“I was shocked when Dignity, which is supposed to be in the business of healing and holds itself out to the public as a bastion of ‘human kindness,’ told me they would not authorize insurance coverage for my doctor-prescribed treatment,” Robinson said in a statement released by his attorneys at the American Civil Liberties Union (ACLU).

“All I want is the same health benefits other, non-transgender Dignity employees receive, which is coverage for medically necessary treatments,” he continued.

On May 16, the Equal Employment Opportunity Commission (EEOC), the federal agency tasked with enforcing workplace anti-discrimination laws, determined that Robinson could proceed with a lawsuit against Dignity Health. That lawsuit, which was filed in federal court in California, alleges that Dignity Health’s policy singles out transgender employees employees for unequal treatment.

In response to Robinson’s original EEOC complaint, Dignity Health claimed that its policy was not discriminatory because “health benefits under the Dignity plan are not provided for any personality disorders, including sexual/gender identity disorders and behavior and impulse control disorders.”

Robinson counters that the medical community does not consider gender dysphoria to be a “personality disorder.” His complaint notes that insurance companies have previously excluded coverage for transition-related care based on the erroneous assumption that such treatments were cosmetic and experimental—assumptions, he says, that have no basis in medical science today.

The World Professional Association for Transgender Health has published standards of care for gender dysphoria that have been recognized as authoritative by leading medical organizations, the U.S. Department of Health and Human Services, and federal courts, according to the complaint. Under those standards, it reads, medically necessary treatment for gender dysphoria “may include hormone therapy, surgery (sometimes called ‘sex reassignment surgery’) and other medical services that align individuals’ bodies with their gender identities.”

In September of last year, Robinson’s fiancée, who also works at Dignity Health, emailed Dignity Health’s CEO, Lloyd Dean, to ask him to remove the “sex transformation” exclusion from the company’s health plan so that Robinson could receive coverage for his medically necessary care, according to the complaint.

Nearly two months later, the complaint continues, Dignity Health’s chief human resources officer informed Robinson’s fiancée that Dignity Health had found no evidence of discriminatory practice in the administration of its health plan.

Robinson’s lawsuit comes at a crucial time in the legal battle for transgender rights. The primary focus of that battle has been on bathrooms, with states and school boards across the country rushing to propose discriminatory legislation that prohibits transgender people from using the bathroom that aligns with their gender identity.

Eleven states and state officials in late May filed a joint lawsuit challenging the Obama administration’s “Dear Colleague” letter sent to public schools nationwide, arguing that the letter, which says Title VII and related statutes protect transgender people from discrimination under the federal definition of “sex,” is beyond the scope of the administration’s authority.

North Carolina, meanwhile, is embroiled in a pair of lawsuits with the Department of Justice over HB 2, the recently enacted legislation that forces transgender North Carolinians to use the bathroom that does not align with their gender identity in public buildings and schools. Gov. Pat McCrory (R) sued the Obama administration for its “radical reinterpretation of Title VII of the Civil Rights Act of 1964 which would prevent plaintiffs from protecting the bodily privacy rights of state employees while accommodating the needs of transgendered [sic] state employees.”

Also in North Carolina, Joaquín Carcano has sued the state, alleging that HB 2 discriminates against him and all transgender people on the basis of sex in violation of Title VII and Title IX of the U.S. Education Amendments of 1972.

Robinson’s attorneys see his lawsuit as complementing the ongoing lawsuits regarding bathroom discrimination.

“Transgender people continue to face discrimination in a wide array of contexts, including employment, housing, education, healthcare and more,” ACLU staff attorney Joshua Block wrote to Rewire in an email. “In each of these contexts, as courts are recognizing that discrimination against transgender people is discrimination on the basis of ‘sex,’ transgender people are finally able to fight this discrimination as a violation of our civil rights laws.”