Blue Cross and Blue Shield of Illinois violated the non-discrimination provision of the Affordable Care Act by refusing to pay transgender teenagers for gender-affirming care through employer plans they administer, a federal judge said. Judgment was made on Monday.
A health insurance company owned by Health Care Service Corp., as a third-party administrator, was performing an employer’s client’s instructions when it denied lead plaintiff, U.S. Judge Robert Bryan. Nevertheless, this care should be covered. The District Court for the Western District of Washington entered judgment on summary judgment. Our employer, the Catholic Health Initiative of Englewood, Colorado, opposes these services on religious grounds. You have the legal right to refuse payment for medical care that you disagree with and are not a party to in litigation.
Despite business ties with religious groups, Blue Cross and Blue Shield, Illinois, are not exempt from federal laws and regulations prohibiting discrimination based on gender, Brian ruled. A determination will be made at a later date as to appropriate remedies for the families and the 370 employers involved in the class action lawsuit.
Bryan instructed Blue Cross to reprocess the claim, end its categorical denial of gender-affirming care, and reimburse the primary plaintiff’s family for out-of-pocket medical expenses.
Bryan’s ruling sets a precedent that could significantly increase the potential liability of third-party administrators under the Affordable Care Act’s anti-discrimination provisions, citing patients suing nonprofit insurers. said Jenny Pizer, chief legal officer of Lambda Legal, which represents
“Third-party administrators have to obey the law. It shouldn’t come as a big surprise to anyone,” said Pizer. “We have been very clear and straightforward on that point. We are applying the word of the law in a straightforward manner, as Congress intended, and yet we are grappling with long-standing discriminatory practices. This is a very precedent and an important precedent…at that time.”
Blue Cross and Blue Shield in Illinois and the Catholic Health Initiative declined to comment.
Patricia Pritchard and Noll Pritchard of Washington state two years ago Blue Cross and Blue Shield of Illinois refused compensation for hormone therapy and chest reconstructive surgery for their son, identified as CP, against the recommendation of his doctor. That’s why I filed a lawsuit. The family eventually paid her more than $12,000 for her CP surgery, now 17.
Pritchards alleged that the insurance company violated section 1557 of the Affordable Care Act. The law stipulates that federally funded organizations may not discriminate based on gender. Last month, Brian accredited a class of transgender people who contract with insurance companies to administer health insurance and work for employers who do not cover gender-affirming care.
In its court filings, Blue Cross said the medical community had not reached consensus on the adequacy of gender-affirming care, and its third-party management division did not directly raise federal funds, so the ACA rule The company’s Medicaid, Medicare and exchange businesses are paid for by the federal government.
Insurers also point to federal laws and regulations that support claims such as Employee Retirement Income Security of 1974, and Illinois’ Blue Cross and Blue Shield, which insurers would otherwise be classified as discriminatory. It claimed to have admitted to enforcing a policy for deaf and religious customers. The insurance company further claimed that it was protected by the Religious Freedom Restoration Act of 1993.
Blue Cross also argued that Department of Health and Human Services regulations do not protect LGBTQ people from discrimination based on sex. made a judgment that
President Barack Obama’s administration announced regulations to include trans people under the ACA’s anti-discrimination clause, but President Donald Trump’s administration withdrew it. I suggested reviving it.
