Overview
On September 10, 2024, Transgender Legal Defense and Education Fund (TLDEF), now known as Advocates for Trans Equality (A4TE), Wardenski P.C., and Cohen Milstein Sellers & Toll PLLC, filed a federal class action civil rights lawsuit against Aetna Life Insurance Company (Aetna) in the United States District Court for the District of Connecticut on behalf of three transgender women—Binah Gordon, Kay Mayers, and S.N. —denied coverage for medically necessary gender-affirming facial reconstruction procedures.
Plaintiffs claim that Aetna violated Section 1557 of the Affordable Care Act, which prohibits discrimination based on sex in federally funded healthcare programs. The lawsuit seeks a declaratory judgment, injunctive relief to end Aetna’s exclusionary policy, and compensatory damages for all policyholders who have had to pay out of pocket for gender-affirming facial surgery because of Aetna’s discriminatory exclusion.
In 2001, A4TE, then Transgender Legal Defense and Education Fund (TLDEF), and Cohen Milstein worked on behalf of four women denied coverage by Aetna for medically necessary breast augmentation. The insurance company eventually updated their policy and expanded their coverage to include the procedure.
Case Background
Gender-affirming facial surgeries are essential components of the medical treatment for gender dysphoria, a serious medical condition that arises from the incongruence between a person’s gender identity and their physical sex characteristics. Despite covering similar reconstructive surgeries for cisgender patients, Aetna categorically excludes these procedures for transgender people, classifying them as cosmetic, thus violating the Affordable Care Act.
Each of the plaintiffs have been deeply impacted by Aetna’s policy:
- Binah Gordon, a 42-year-old resident of Nebraska, was forced to cover the cost of her facial surgery herself, spending approximately $35,000 after Aetna refused to cover the surgery, causing her to experience a long, painful delay in obtaining this medically necessary care.
- Kay Mayers, a 52-year-old resident of Alaska, has been unable to afford the necessary facial surgery due to Aetna’s refusal to cover the costs. She continues to experience severe gender dysphoria and fear for her safety.
- S.N., a 48-year-old from Pennsylvania, paid nearly $50,000 out of pocket for gender affirming facial and voice surgeries. Her appeals to Aetna were denied, forcing her to bear the financial burden for gender-affirming healthcare that her medical providers had deemed medically necessary.
If you wish to speak with a member of the legal team about this case, please contact Aarushi Phalke via e-mail (aphalke@cohenmilstein.com) or by phone (202-408-3632).