A transgender man from Western Massachusetts who says he was repeatedly denied insurance coverage for a gender-affirming surgery filed a complaint last week with the state’s commission against discrimination, according to his lawyer.
Alexander Pangborn, 41, said he had previously been approved for blood work to monitor his testosterone levels. So when Pangborn, a nurse at Ascend Hospice, learned in January that he wasn’t eligible for the gender dysphoria-related surgery, he said, he appealed the decision to the Aetna Life Insurance Co. — twice.
That’s when Pangborn found out Ascend’s parent company, New Jersey-based CareOne Management, lists “sex change” as a general exclusion under its self-funded employee health benefits plan, he said.
According to CareOne’s plan, any treatment that changes “sex or sexual characteristics” — including surgical procedures, hormone therapies, and prosthetic devices — isn’t covered.
“Honestly, it was very crushing,” Pangborn, of Haydenville, said in a phone interview last week. “My co-workers, we all pay into the same system to receive health care, and you are saying my medically necessary care isn’t necessary. That makes you feel devalued as an employee and also as a person.”
Once Pangborn realized self-advocacy wasn’t enough, he enlisted legal aid, he said. On Thursday, Pangborn and his lawyer said they had filed a discrimination complaint — at both the state and federal level — against Ascend Hospice, CareOne Management, and Aetna.
Pangborn, though “assigned female at birth,” has lived as a man for more than 20 years, according to the complaint.
Self-funded plans are customizable across companies, meaning employers can decide which health services to cover and exclude. According to an Aetna clinical policy bulletin dated Jan. 11, 2019, the insurance provider generally does consider “gender reassignment surgery medically necessary,” as long as certain criteria – such as a mental-health referral letter and documentation of gender dysphoria – are established.
But when an organization, like CareOne – and a third-party health administrator, like Aetna in this instance – delineates benefits based on sex, the policy is considered discriminatory, said Chris Erchull, the lawyer who is representing Pangborn.
“It is unlawful to single out transgender employees and to essentially give them a lesser employee benefit package than all other employees,” said Erchull, of GLBTQ Legal Advocates and Defenders.
An Aetna spokeswoman said she required extensive personal information about Pangborn before she could directly address his complaint.
“When we administer a self-funded plan, we have an obligation to administer the terms of the plan, which may include coverage exclusions for specific procedures,” the Aetna spokeswoman said in a statement Friday.
Kameika Watson, a human resources representative at CareOne Management, declined to comment on Pangborn’s case, citing privacy concerns.
“Ascend Hospice provides its employees with access to competitive health benefits that in many cases are better than those offered by similarly-situated competitors in our industry,” Watson said in a statement Thursday. “Our health benefits meet or exceed all legal requirements imposed on plans of our kind.”
CareOne has more than 15,000 employees, with about 70 care centers scattered across nine states, according to its LinkedIn page.
In late February, Pangborn had e-mailed CareOne’s corporate offices, asking if the “sex change” exclusion could be removed. It was a “horrible feeling,” Pangborn said, to so publicly air his private health needs – especially when medical doctors and mental health professionals had already approved the surgery.
Two days later, on March 1, Pangborn said he received a reply e-mail stating that there was “no current intention” to remove the exclusion.
Erchull said the case could trigger national shockwaves, as other self-funded employers are forced to grapple with possible allegations of bias in their own health plans.
Federal claims of discrimination, Erchull said, were also cross-filed with the Equal Employment Opportunity Commission. Pangborn’s complaint alleges that specific mentions of sex, transgender status, gender identity, and disability violate clauses in the Civil Rights Act of 1964 and the Americans with Disabilities Act.
Erchull said CareOne Management has two options for addressing the Massachusetts Commission Against Discrimination: Immediately revise its insurance policy or engage in a lengthy court battle.
“As far as we’re concerned, the law is clear,” Erchull said. “I hope it’s resolved with Ascend. The ball is in their court.”
A liaison from the state commission declined to comment on the status of the complaint filing, citing MCAD’s policy on open investigations.
An EEOC spokeswoman on Friday said all potential complaints are “strictly confidential” under federal law, which prohibits the commission from “even confirming or denying the existence of such a charge.”
For now, Pangborn said he has no other recourse than to wait.
The father of a 5-year-old, Pangborn doesn’t intend to uproot his family’s life by finding a new employer with more comprehensive insurance coverage.
He remains committed to Ascend and the job he’s held since July 2017.
“I love my team – I love the people that I work with,” he said. “I feel like I found a company that was a really good fit in many ways, which makes this even more disappointing.”
Alison Kuznitz can be reached at firstname.lastname@example.org. Follow her on Twitter at @AlisonKuznitz.