Most of the surgeries sought by Teeanna Polonczyk are procedures to make her facial characteristics appear more feminine, which are deemed cosmetic and medically unnecessary under the terms of her health plan, Judge David L. Bunning of the U.S. District Court for the Eastern District of Kentucky ruled Wednesday. And none of Polonczyk’s requested surgeries fall under the gender reassignment procedures specifically covered by the plan, which include those directed at primary sexual characteristics, he said.
“While Plaintiff may challenge the definition of ‘cosmetic’ under the Plan, unfortunately, the Plan document is clear—gender reassignment surgeries are covered benefits, while surgeries to improve gender specific appearance are not,” Bunning said, dismissing Polonczyk’s claim for plan benefits under the Employee Retirement Income Security Act.
Polonczyk also accused the insurer of unlawful discrimination under the Affordable Care Act, arguing that non-transgender plan participants receive coverage for all of their medically necessary healthcare while transgender participants don’t.
Bunning called this allegation “demonstrably false.”
“Given the Plan’s limited allowance for any cosmetic procedures, regardless of a participant’s status as a transgender or non-transgender individual, it cannot be inferred that by simply denying benefits to Plaintiff, Defendants were intentionally discriminating on the basis of sex,” he said.
O’Hara, Taylor, Sloan, Cassidy, Beck PLLC represents Polonczyk. Vorys, Sater, Seymour & Pease represents Anthem.
The case is Polonczyk v. Anthem BlueCross & BlueShield, 2022 BL 60671, E.D. Ky., No. 2:20-cv-00176, 2/23/22.