Judge dismisses lawsuit on insurance coverage for gender reassignment

A federal judge has dismissed a northwestern Minnesota woman's lawsuit alleging that her teenage son was denied coverage for medication and surgery to help him transition from a female to a male.

In January, Brittany Tovar sued her employer, Essentia Health, and the administrator of the company health plan, HealthPartners, alleging they violated state and federal law by excluding coverage for gender reassignment services or surgery.

In the lawsuit, filed in the U.S. District Court of Minnesota, Tovar argued that her son was diagnosed in November 2014 with gender dysphoria, a condition arising when an individual's gender identity differs from the gender assigned at birth.

In an order issued this week, Judge Richard Kyle granted motions to dismiss by Essentia and HealthPartners, saying that HealthPartners is the wrong defendant and that discrimination protections apply to employees.

"There is no dispute that Tovar is an employee and her son is not," the judge wrote. "Accordingly, Tovar must be the individual to have suffered the discrimination — and this is where her claim falters."

Lisa Stratton, one of Tovar's attorneys in the case, said she was disappointed in the ruling, adding that the plaintiff is "considering our appeal options."

A spokeswoman for Essentia Health, which is a Duluth-based operator of hospitals and clinics, said the health system is "pleased with the decision."

HealthPartners, a Bloomington-based health insurer, did not comment.

Symptoms of gender dysphoria can be relieved by social and legal transition to the gender an individual identifies with, Tovar said in her complaint, as well as by medical treatments such as counseling, hormone therapy and gender reassignment surgery.

But the employer's health plan includes a categorical exclusion barring any insurance coverage for gender reassignment surgery or services, Tovar said in her lawsuit. She is a family nurse practitioner at Essentia.

In his ruling, Kyle wrote that the employer plan was amended as of Jan. 1 to remove the exclusion for gender-reassignment services and surgery. In the lawsuit, Tovar says her son was harmed by delaying medication treatment for his condition, because the family could not afford the $9,000 cost for a medication that can help some people with gender dysphoria.

Tovar alleged that because her son could not obtain necessary medical services, she suffered from stress, worry, anger, disappointment and sleepless nights. She said she experienced an increase in migraines, and ultimately reduced her hours at work.

"Tovar and her family continue to suffer financial and emotional harm due to the plan's discriminatory exclusion of coverage for medical care needed by Tovar's son," the lawsuit states.

Kyle's order was issued Wednesday.

The U.S. Department of Health and Human Services finalized a rule Friday mandating that insurers provide health services for patients regardless of their gender identity as part of the Affordable Care Act, the second time in a single day that the administration has framed transgender rights as a central civil-rights issue.

The rule, known as Section 1557, says that any health insurance company that participates in the federal health care exchange cannot deny individuals health care or coverage based on their gender identity, and that they "must be treated consistent with their gender identity, including in access to facilities."

The Washington Post contributed to this report.

Christopher Snowbeck • 612-673-4744

Twitter: @chrissnowbeck