In the past year, we’ve made great progress in fighting discrimination in health care against transgender people in Washington. And we are excited to announce another victory for our client V.J.!
V.J. is a transgender woman in her early 20s. After years of counseling and hormone therapy, her health care providers agreed that gender-affirming surgery was a medically necessary treatment. But when she sought coverage for the surgery under her health plan from Sound Health & Wellness Trust, she was denied on the grounds that it was “cosmetic.”
We agreed to represent V.J. in challenging her insurer’s denial. When the insurer continued to refuse coverage after we sent them a demand letter, we requested an external review of the denial of coverage by an independent review organization (IRO) as permitted under the terms of the health plan. We’re pleased to report that the IRO recently decided in V.J.’s favor. The IRO found that the requested surgery is medically necessary and reversed the insurer’s denial of coverage. Because the IRO’s decision is binding on the insurer, V.J. will now be able to have the gender-affirming surgery she needs.
We’re thrilled for V.J., but we know many transgender people continue to be denied medically necessary care. Legal Voice will continue working as a member of the Coalition for Inclusive Healthcare to ensure all transgender people in Washington receive the care they need, without discrimination.
Special thanks to Denise Diskin of Teller & Associates for serving as Legal Voice’s cooperating counsel in V.J.’s case.
