A transgender male from Pennsylvania has filed a lawsuit against his insurance provider after being denied coverage for what he claims is a medically necessary device related to gender-affirmation surgery — an $11,000 erectile pump.
The legal case, filed Jan. 25, was brought by a plaintiff identified only as John Doe before the U.S. District Court for the Eastern District of Pennsylvania. Keystone First, Keystone Family Health Plan, Vista Health Plan, and Blue Cross and Blue Shield Association are named as defendants in the case, represented by attorney Justin Robinette.
“Plaintiff is substantially limited in the major life activities of working, interacting with others, social functioning and caring for himself,” the suit claims, according to the Pennsylvania Record.
The plaintiff, suffering from gender dysphoria—a condition characterized by distress from the dissonance between one’s experienced gender and the sex assigned at birth—claims that the denial of coverage has significantly impacted his ability to work and socialize, thus severely affecting his overall well-being.
John Doe, who began his surgical transition in 2018, has cited a history of disputes with Keystone regarding coverage of various procedures related to his transition. He alleges that the refusal to pay for treatments such as arm hair removal, testicular implantation, and, most recently, the replacement of an erectile pump constitutes illegal discrimination.
In 2021, complications arose with an existing erectile pump, which was not functioning properly and was causing significant discomfort and sometimes pain due to its improper placement. This issue necessitated the planned replacement surgery for a new pump, which Keystone declined to cover, saying the surgery was deemed not to be covered by the plan.
By not having a functioning penis, the plaintiff expresses that he is being forced to maintain physical characteristics that are inconsistent with his gender identity, perpetuating his severe emotional distress. The complaint further details John Doe’s financial challenges, illuminated by this recent coverage denial and continued healthcare needs related to his gender-affirmation surgeries.
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