Trans women tussle with Aetna over gender-affirming care at Second Circuit

MANHATTAN (CN) — Health insurance giant Aetna asked the Second Circuit on Wednesday for permission to continue denying gender-affirming care in the form of facial feminization surgeries for transgender women. A group of trans women brought a class action in Connecticut federal court in 2024, claiming Aetna improperly categorized their facial feminization surgeries — structural bone modifications and readaptation of the overlying soft tissues as part of gender-affirming surgery — as excluded “cosmetic surgeries” and refused to cover the cost of the procedures.

District Judge Victor Bolden determined the insurer’s blanket refusal to pay for facial feminization surgery to treat transgender patients’ gender dysphoria was a violation of the Affordable Care Act’s prohibitions against discrimination based on sex in federally funded healthcare programs. In a preliminary injunction, the Barack Obama appointee ordered Aetna to conduct individualized medical reviews for the trans women. Appealing that ruling to the Second Circuit, Aetna — a subsidiary of CVS Health Corporation and the nation’s second-largest health insurance company — argues the ruling should be overturned because the plaintiffs’ claimed injuries are traceable to their employers’ plan choices, not to Aetna’s advisory guidelines.