A Kentucky judge ruled in favor of Anthem BlueCross & BlueShield after a transgender member accused the payer of unjustly denying coverage of gender-affirming facial surgery, according to Bloomberg Law.
TeeAnna Polonczyk, the transgender member who filed the lawsuit, sought facial constructive surgery that would make her appear more feminine. Anthem denied her claim, but Ms. Polonczyk contested that the surgery should be covered as a gender-affirming procedure.
The court ruled Feb. 23 that while gender affirming procedures related to urology or gynecology are covered by the member's plan, facial surgery and other procedures that are deemed cosmetic do not fall under that umbrella because they are not medically necessary.
Ms. Polonczyk also accused the payer of discriminating against her as a transgender individual, which the court called "demonstrably false."
States and health plans have both faced pressure to review their approaches to covering gender-affirming care, and the trend is generally in favor of a more inclusive approach to what constitutes gender-affirming care.