Anthem Sued by Transgender Librarian Over Surgery Coverage

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By Patrick Dorrian

Sept. 26 — A transgender public library worker in Cincinnati is asking a federal court to order her employer and its health insurer to cover the cost of her upcoming sex transformation surgery ( Dovel v. Pub. Library of Cincinnati and Hamilton Cty. , S.D. Ohio, No. 1:16-cv-00955, complaint filed 9/26/16 ).

Rachel Dovel alleges that the Public Library of Cincinnati and Hamilton County’s policy with Community Insurance Co., doing business as Anthem Blue Cross and Blue Shield, unlawfully excludes coverage for the sex transformation surgery required to treat her gender dysphoria—an intense and persistent discomfort with the characteristics of one’s birth sex. Dovel says the library’s board of trustees has continually refused her calls to change the policy, forcing her to advance the costs of her scheduled November 2016 surgery and incur high-interest debt and depleted savings.

The lawsuit is notable because it’s similar to one filed in June by the American Civil Liberties Union against Dignity Health. The Equal Employment Opportunity Commission enforces federal job rights laws and has ruled administratively and otherwise publicly taken the position that discrimination based on gender identity is discrimination based on sex under Title VII of the 1964 Civil Rights Act. The EEOC in August filed an amicus brief supporting the plaintiff in the case against Dignity.

Dovel’s lawsuit has the backing of the National Center for Lesbian Rights in San Francisco. Amy Whelan, a senior staff attorney with NCLR told Bloomberg BNA that Dovel’s complaint and the case against Dignity are part of a group of lawsuits challenging employer-provided health plans that don’t provide coverage to transgender workers for sex reassignment surgery.

Employers and insurers “should be aware of the importance of providing medically necessary care to employees without discriminating on the basis of sex,” she said Sept. 26. They need to get rid of policies that exclude coverage for sex transformation surgery and related treatment “in order to comply with Title VII and the nondiscrimination provisions of the Affordable Care Act,” Whelan said.

Surgery Is Accepted Standard of Care, Complaints Says

According to her complaint, Dovel is an electronic line assistant in the library’s catalog and processing department. She was hired in 2005 after graduating from college and “climbed her way up the ladder at the Library” after beginning her employment as a shelver.

Dovel was male at birth but was diagnosed in March 2014 with gender dysphoria—previously termed gender identity disorder. She says her diagnosis came “after years of suffering as a result of the intense discordance between her body and her perception as male by others and her female gender identity.”

Following her diagnosis, she legally changed her name, grew out her hair, began wearing women’s clothing and took other steps toward transitioning to the female sex. That included hormone therapy, which was covered under the library’s policy with Anthem.

However, she was denied insurance coverage for sex reconstructive surgery, which is expressly excluded under the library’s policy with Anthem, despite meeting the required medical guidelines, including the determination of her health-care providers that surgery was necessary for her, Dovel says. Moreover, the library’s board of trustees since August 2015 has refused her repeated calls to change the library’s coverage regarding transition-related care, she asserts.

Sex transformation surgery is within the standard of care for gender dysphoria set by the World Professional Association for Transgender Health, which has been endorsed by major medical organizations, including the American Medical Association, Dovel alleges.

“When left untreated, gender dysphoria can result in significant clinical distress, debilitating depression, and, often, suicidality,” the complaint says. Although each transgender person’s medical needs may vary, surgery is one of the three main components of the gender transition process, along with social transition and pharmacological transition, according to the complaint.

Suit Filed Under Title VII, Constitution, ACA

By denying Dovel coverage for sex transformation surgery, the library and Anthem have forced her to use her own money, violating her rights under Title VII, the equal protection clause of the U.S. Constitution and the ACA, the complaint charges.

Dovel seeks an injunction against the library’s continued maintenance of employee health insurance that excludes gender transition-related care as well as an injunction against Anthem’s continued sale of health insurance plans excluding such coverage.

She also seeks an order requiring the library to provide insurance coverage for her sex reassignment surgery and other care related to her condition, along with compensatory damages, attorneys’ fees and other equitable relief.

The library’s marketing manager, Chris Rice, told Bloomberg BNA Sept. 26 that the library hasn’t yet been served with a copy of the complaint. The library doesn’t comment on open legal matters, he added.

Anthem didn’t respond Sept. 26 to Bloomberg BNA’s request for comment.

Gerhardstein & Branch Co. LPA and Scott Knox Attorney at Law also represent Dovel. No attorney has filed an appearance yet for the library or the insurer.

To contact the reporter on this story: Patrick Dorrian in Washington at

To contact the editor responsible for this story: Susan J. McGolrick at

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