The parents of a transgender teen are suing the state of New York after her insurance provider refused to cover her gender-affirming surgery.
The 16-year-old, identified in court documents as LD, was denied a “medically necessary vaginoplasty procedure” under her fully-funded health insurance plan with Cigna because she is under 18.
As LD’s dysphoria intensified her parents were forced to pay nearly $60,000 out of pocket for a procedure which should have been covered, according to a petition filed in Albany County Supreme Court on 21 May.
“The idea of waiting until she is 18 years old is inconceivable,” LD’s parents told the court. “One can only tread water for so long. You either drown, or must start swimming to land.
“Without gender-affirming surgery, [LD] will drown… We fear she will take her life and we will lose our precious daughter before she can fully blossom into the beautiful young woman we know she is.”
Cigna covers all medically necessary treatment for gender dysphoria but limits certain procedures, including vaginoplasty, to members who are 18 years or older.
The policy is founded on “outdated” guidance stating that gender-affirming treatment for under-18s “is not recommended by professional societies” – guidance that has since been withdrawn and replaced with no recommendations for age-based restrictions.
Despite this, Cigna’s determination was based solely on the “arbitrary and discriminatory factor” of the trans teen’s age, ignoring recommendations for flexibility and case-by-case treatment.
It failed to acknowledge “clinically recorded history of profound gender dysphoria, depression, and self-mutilation,” according to the petition, as well as “statements of self-loathing and painful tucking by LD herself and her parent’s earnest concern about death by suicide were she not able to obtain this surgery soon”.
“This incongruence with her anatomy and her intrinsic knowledge about her gender is not a choice. She would not wish this struggle on anyone,” LD’s parents stated.
“[She] has resorted to self-harm when the feelings are overwhelming, and we fear for how far such behaviours will go without aligning her body with who she is on the inside.”
In its review the insurer reportedly made several omissions and errors regarding her care, including the fact that LD met all other prerequisites for the surgery besides her age.
Cigna’s report also failed to identify several key members of her medical team, such as her psychiatrist, endocrinologist and paediatric nurse.
The claimants are arguing that LD’s treatment constitutes a violation of state human rights law, the New York state constitution and state insurance law, which stipulates that health insurance plans regulated by the state must provide fair and non-discriminatory coverage for medically necessary treatments.
They claim Cigna’s categorical age-based restriction “creates an arbitrary and erroneous non-rebuttable presumption of non-medical necessity” for all trans youth, regardless of any other unique factors or the professional opinions of medical and mental health providers.
The case continues.