Aetna Defends Exclusion of Transgender Facial Surgery from Coverage

A transgender plaintiff filed a suit against Aetna for denying payment for facial surgery intended to address gender dysphoria, claiming a breach of Section 1557 of the Affordable Care Act. A district judge previously blocked the insurer's policy, finding it discriminatory, and the matter is now before a three-judge panel of the 2nd Circuit. Aetna maintains that its policy excludes purely cosmetic procedures, even when a patient is distressed about not appearing feminine enough, while it would cover reconstructive surgery after trauma.

Counsel for the insurer highlighted that any medically necessary facial reconstruction, regardless of gender identity, would be covered. The plaintiff's attorney argues the insurer applies a stricter review to transgender patients than to cisgender individuals seeking similar outcomes. The dispute occurs amid ongoing debates about the scope of federal protections for transgender health care, which have shifted between administrations and were highlighted by the Supreme Court's recent Skrmetti decision.