BREMERTON, Wash. — A transgender teen from Bremerton is suing his health insurance company for discrimination in violation of the Affordable Care Act.
In a federal lawsuit, the teen said Blue Cross Blue Shield of Illinois is denying him access to gender-affirming care.
“Early on we knew maybe there was something there,” said Nolle Pritchard.
Like all parents, Pritchard and his wife, Pattie, just want their kids to be happy.
“It was really important to us to just be supportive. And just kind of have him tell us who he is,” Pattie added.
They followed the lead of their son who was born biologically female.
“In 2015, it was about the summer leading into middle school, and when he clearly stated at that time he wanted to go into middle school as a boy,” Pattie recalled.
It was unfamiliar territory. Making the transition even harder? Their son having to fight for his health care.
“It’s been a battle since then,” Nolle said.
In a lawsuit filed against Blue Cross Blue Shield of Illinois, their son is identified by the initials C.P.
Mom Pattie works at St. Michael Medical Center in Bremerton, formerly known as Harrison Medical Center. Through work, she and her son receive “health care coverage through the Catholic Health Initiatives Medical Plan (‘Plan’),” which is administered by Blue Cross Blue Shield of Illinois (“BCBSIL”).
Documents show the self-funded health care plan states a blanket exclusion: “Benefits shall not be provided for treatment, drugs, medicines, therapy, counseling services and supplies for, or leading to, sex reassignment surgery.”
By following through, lawyers say the insurance company is violating the Affordable Care Act and Washington state law.
“They have an independent duty to not only not adopt, but not administer or enforce plans that contain such discriminatory terms,” said lawyer Omar Gonzales-Pagan. “They also are not a religious entity and would not be able to raise any defenses no matter how unmeritorious they may be with regards to religious belief.”
Some services were covered. In 2016 the company preapproved C.P.’s Vantas implant, which delays female puberty. Months later, the coverage was denied “...because ‘treatment for transgender services were allowed incorrectly’” but it “…would not ‘clawback’ the payments already made…”
“The lack of clarity that happened in the Pritchards’ case is a sign of confusion within the insurance company as to what laws does it have to follow here,” said lawyer Ele Hamburger.
C.P.’s parents have paid $15,000 out of pocket. They even had to take out a loan so he could get a mastectomy and chest reconstruction.
“We didn’t have a choice. It had to happen,” said Pattie.
Their lawsuit is part of a growing number of transgender health care disputes involving Catholic providers claiming religious exemptions.
Back in 2017, transgender teen Pax Enstad in Bellingham sued his mom’s employer PeaceHealth.
“Existing in a body that didn’t feel like mine because of my gender was unbearable for me. The pain and anxiety I felt because my gender identity didn’t match the sex I was designated at birth,” Enstad said during a 2017 news conference.
PeaceHealth ended up settling with Enstad for an undisclosed amount.
As for C.P.’s parents, they say they know they’re doing the right thing. They say providing him with support and treatment has led to a happier kid.
And they hope their fight leads to meaningful change that will help other families.
“It’s important to say that gender inclusive care is health care. That’s all it is. It’s health care that’s necessary, and trans people are entitled to gender inclusive care,” Pattie said.
Blue Cross Blue Shield of Illinois said it doesn’t comment on pending litigation.