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Blue Cross Blue Shield Illinois May Not Exclude Gender-Affirming Care

U.S. District Court ruling applies to all BCBSIL health plans across the country.

In a groundbreaking decision, U.S. District Court Judge Robert Bryan has ordered Blue Cross Blue Shield of Illinois (BCBSIL) to stop excluding gender-affirming care from all of its health plans across the United States. The court’s ruling prohibits BCBSIL from imposing these discriminatory exclusions even when requested to do so by an employer, with no exception for religious employers.

The court also mandated that BCBSIL reprocess claims for gender-affirming care that it previously denied dating back to October 30, 2014. This is the first time a third-party administrator, like BCBSIL, has been instructed to refrain from administering discriminatory exclusions at the request of employers.

This significant decision comes as a result of the class action lawsuit, C.P. et al., v. Blue Cross Blue Shield of Illinois, filed by Lambda Legal and Sirianni Youtz Spoonemore Hamburger PLLC in the U.S. District Court for the Western District of Washington in Tacoma. The case was initially initiated by C.P., an 18-year-old transgender young man, and his parents. The plaintiffs were later joined by S.L., a 12-year-old transgender girl, and Emmett Jones, a transgender man. The lawsuit alleged that BCBSIL’s administration of exclusions for gender-affirming care violated Section 1557 of the Affordable Care Act, which prohibits health discrimination.

In December 2022, the court found that BCBSIL discriminated against transgender enrollees by enforcing categorical exclusions of gender-affirming care, even in self-funded plans designed by employers. Despite this ruling, BCBSIL continued to apply these exclusions throughout 2023. In response, the C.P. plaintiffs sought a permanent injunction and reprocessing of denied claims to ensure BCBSIL adhered to the court’s decision.

Omar Gonzalez-Pagan, Counsel and Health Care Strategist for Lambda Legal, celebrated the court’s decision, stating, “Thousands of transgender people in BCBSIL-administered health plans will have access to the health care they need.” He emphasized that the court made it clear that BCBSIL must not administer any categorical exclusions for gender-affirming care in the future and must reprocess all unlawfully denied claims. BCBSIL is now required to notify all class members of the ruling, cease enforcing exclusions, and process or reprocess claims accordingly.

Eleanor Hamburger of Sirianni Youtz Spoonemore Hamburger noted that BCBSIL is not unique in implementing discriminatory exclusions and warned other health insurers and third-party administrators that they too may face consequences for engaging in such discrimination. She emphasized that health companies governed by the Affordable Care Act cannot discriminate, even when requested to do so by an employer.

Pattie Pritchard, C.P.’s mother, expressed her joy at the court’s decision, stating, “We are thrilled that BCBSIL has been told, definitively, that it cannot discriminate against my son or anyone else just because they are transgender.” She hopes that other health companies take note of the court’s order and understand that no one should be denied necessary medical care based on their gender.

In his decision, U.S. District Judge Robert J. Bryan made it clear that BCBSIL violated Section 1557 and discriminated against the plaintiffs by denying them access to gender-affirming health care. He stated that classwide declaratory and injunctive relief is necessary to ensure that all class members can have their claims for gender-affirming care adjudicated without discrimination. This decision sets a precedent for other health insurers and third-party administrators, sending a warning that discrimination will not be tolerated under the Affordable Care Act.

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