Trans women tussle with Aetna over gender-affirming care at Second Circuit

A panel of the Second Circuit heard arguments Wednesday on Aetna's appeal of a district court ruling that found its blanket denial of facial feminization surgery coverage for transgender patients violated the Affordable Care Act's anti-discrimination provisions. The March ruling by Judge Victor Bolden ordered Aetna to conduct individualized medical reviews rather than categorically refusing the procedure as 'cosmetic.'

Aetna's attorney argued the plaintiffs sued the wrong party, since employers technically control plan design even though Aetna administers the exclusion and authored the guidance behind it. Plaintiffs' counsel countered that cisgender patients seeking similar procedures get an individualized medical necessity review while transgender patients face a categorical denial tied specifically to the word 'transition.'

Judges pressed both sides, with one asking whether a cisgender woman seeking the same surgery for feminization would be covered — the answer was potentially yes, with review. The panel did not rule from the bench, leaving the injunction in place for now.

The full dispatch is available from the source below.