Lawsuit against Essentia allowed to proceed
A lawsuit against Essentia Health over denied coverage for gender reassignment treatment in 2015 has been allowed to proceed.
Senior U.S. District Judge Donovan Frank on Thursday issued a mixed ruling in the case of Brittany Tovar and Reid Olson v. Essentia Health and HealthPartners. He partially granted insurer HealthPartners' move to dismiss the complaint but denied Essentia's motion.
Tovar, at the time a nurse practitioner for Essentia West from Ada, Minn., sought pre-authorization for gender reassignment surgery for Olson in 2015 from HealthPartners, which was Essentia's insurer. Olson, Tovar's son, was diagnosed with gender dysphoria the previous November. He was 17 at the time. Gender dysphoria is the term used when an individual's gender identity differs from the gender assigned at birth, Frank explained in his order.
Olson's name was legally changed from Diane Madison Olson to Reid Tovar Olson on Nov. 12, 2015.
The HealthPartners plan excluded coverage for gender reassignment, and Tovar's appeal was denied. That included two medications, Lupron and Androderm. She decided not to purchase Lupron and the insurer later reimbursed her for the cost of Androderm.
"As a result of the denied coverage, Olson and Tovar suffered emotional and financial harm, and Olson suffered delayed access to medically necessary treatment," Frank wrote in his order.
Gender Justice, an advocacy group, represented Olson and Tovar, and argued that failure to cover gender reassignment violated a provision of the Affordable Care Act banning discrimination in health care based on sex.
Christy Hall, the lawyer who represented Tovar and Olson, said on Friday that the portion of the lawsuit against HealthPartners that was dismissed stemmed from the fact that Olson, now 20, was a minor when the suit originally was filed.
The ruling is that Tovar is no longer a party to the lawsuit since her expenses were reimbursed, Hall said. "She feels like her advocacy was successful even though her claim wasn't going forward."
Frank's ruling doesn't resolve the lawsuit. But Hall said she's optimistic a judgment will be issued in favor of her clients within the next several months, or that the issue will be settled out of court. The facts of the case aren't in dispute, she said, and Frank's ruling suggests to her that they are winning the legal question.
"The way that I see it is that it's a total win on the issue that we care about," she said.
In a statement Friday, a representative for Essentia Health said the organization "prefers not to comment on pending litigation matters.".
Frank's order notes Essentia requested HealthPartners remove the gender assignment exclusion from its coverage at the beginning of 2016, and the insurer did so.
"Unfortunately for them, this law went into place in 2010," Hall said. "So they needed to move faster. But they certainly aren't the only ones who had a plan like this. "
HealthPartners sold 200-plus similar plans across the state, she said.
"This case, and Brittany's advocacy for her son, brought this issue to the attention of Essentia, who subsequently has, to their credit, changed their policy," Hall said.