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Benefits April 24, 2003
Insurer Fights Sex Change Coverage Order
April 24, 2003 (PLANSPONSOR.com) - A
California-based managed-care health company has taken state
officials to court over an order for it to pay for a
sex-change operation.
Reported by Fred Schneyer
By filing suit against the California Department of Health Services in Los Angeles Superior Court, Health Net Inc. seeks to overturn a January 2003 ruling by an administrative law judge that the operation was medically necessary and should be covered, according to a Los Angeles Times report. The agency later adopted the administrative law judge’s ruling.
A Health Net medical group denied coverage for the operation for a woman identified only as “P.M.” after contending that its medical necessity hadn’t been demonstrated.
Health Net argued that private health plans routinely exclude coverage for sex change operations. “Medical professionals have raised serious issues about the medical necessity related to this case,” Health Net spokesman Brad Kiefer, told the Times. “Under these circumstances, we think it right and appropriate for us to seek a reconsideration.”
A spokesman for the Health Services Department declined to comment on the lawsuit to the Times.