“The District Court ruling was thorough and unequivocal: Third-party administrators that accept federal funds cannot discriminate when administering or enforcing employer-sponsored health plans.”
Lambda Legal and Sirianni Youtz Spoonemore Hamburger PLLC today urged the U.S. Court of Appeals for the Ninth Circuit to affirm a lower court ruling finding that Blue Cross Blue Shield of Illinois (BCBSIL) cannot administer categorical coverage exclusions for medically necessary gender-affirming care in the hundreds of employer-provided ERISA health plans it administers.
“The District Court ruling was thorough and unequivocal: third-party administrators (TPAs) that accept federal funds cannot discriminate when administering or enforcing employer-sponsored health plans,” said Omar Gonzalez-Pagan, Senior Counsel and Health Care Strategist for Lambda Legal. “The court’s decision not only established that categorical exclusions for coverage of gender-affirming care are unlawful discrimination, but also that third-party administrators who receive federal funding have an independent duty under Section 1557 to not administer or enforce discriminatory terms in health plans.”
“All we have ever wanted is for our son to receive the medical care he needs to be healthy and to thrive, and am disappointed that BCBSIL continues to throw obstacles in the way to access the care people like our son need and are legally entitled to,” said Pattie Pritchard, C.P.’s mother and the primary beneficiary on one of the employer-provided health benefit plan that BCBSIL administered. “My son and all other transgender people deserve the ability just to be themselves and to thrive. That’s all we ask.”
“When health insurers accept federal funds, they agree not to discriminate in all activities, including when asked to do so by employers,” said Eleanor Hamburger of Sirianni Youtz Spoonemore Hamburger. “BCBSIL broke the law when it denied treatment to more than 1500 transgender enrollees. This must stop.”
In December 2023, a Federal district judge granted class-wide relief declaring BCBSIL’s administration of gender-affirming health care exclusions as a TPA violates Section 1557 of the ACA, prohibiting BCBSIL from administering such exclusions in the future, and ordering the reprocessing of claims improperly denied based on the exclusions, from November 23, 2016, to the present.
That ruling followed the district court’s November 9, 2022, order certifying a class comprised of individuals who were, are, or will be denied pre-authorization or coverage of gender-affirming care as a result of BCBSIL’s administration of categorical exclusions of such care, as well as December 19, 2022 ruling holding that the administrations of discriminatory exclusions in ERISA health plans by a TPA that receives federal funding violates Section 1557 of the Affordable Care Act.
The ruling came in a class action lawsuit filed by Lambda Legal and Sirianni Youtz Spoonemore Hamburger PLLC challenging BCBSIL’s administration of the discriminatory blanket exclusions on behalf of a then-15-year-old transgender young man, C.P., and his parents; S.L., a 13-year-old transgender girl; and Emmet Jones, a transgender man. The lawsuit, filed in the U.S. District Court for the Western District of Washington, argued that BCBSIL’s administration of the exclusions is in direct violation of the health nondiscrimination law enacted as part of the Affordable Care Act, known as Section 1557.
The case is C.P. v. Blue Cross Blue Shield of Illinois and is being litigated by Senior Counsel and Health Care Strategist Omar Gonzalez-Pagan, Chief Legal Officer Jennifer C. Pizer, and Director of Constitutional Law Practice Karen Loewy for Lambda Legal, and Eleanor Hamburger and Daniel Gross of Sirianni Youtz Spoonemore Hamburger PLLC, in Seattle, Washington.
Read the brief to the Court of Appeals for the Ninth Circuit here: https://lambdalegal.org/ legal_document/cp_wa_20240612_plaintiffs-appellees-answering-brief/
Read the court’s summary judgment decision here: https://www.lambdalegal.org/in-court/legal-docs/cp_wa_20221219_order
Read the court’s class certification decision here: https://www.lambdalegal.org/in-court/legal-docs/cp_wa_20221212_amended-order
Learn more about the case here: https://www.lambdalegal.org/in-court/cases/cp-v-bcbsil