Washington Insurance Commissioner Mike Kreidler this month fined Aetna Life Insurance Co. $25,000 for discriminating against policyholders who sought gender-affirming medical treatment.
In June 2019, a Washington consumer filed a complaint with Kreidler’s office that Aetna, a health insurer, denied coverage for breast augmentation as part of the policyholder’s gender-affirming treatment plan. Aetna denied coverage without reviewing for medical necessity, stating the treatment was not covered because it was a cosmetic procedure.
Aetna also treated transgender women differently than they treated transgender men and cisgender women. For example, Aetna covered medically necessary breast reconstruction for cisgender women but did not cover medically necessary breast augmentation, or chest reconstruction, for transgender women, a violation of Washington state law.
During Kreidler’s investigation, Aetna repotedly reversed its decision for the consumer who submitted a complaint. However, it failed to reverse decisions for three other policyholders who sought similar treatment.
Kreidler found that Aetna’s policy was specifically discriminatory to transgender women who sought gender-affirming breast augmentation or construction from 2018 to 2020.
Kreidler issued a $25,000 and suspended $10,000 on the condition that Aetna complete a compliance plan to correct the law violations and conduct audits to ensure no further violations occur.
The Affordable Care Act requires insurers to provide services for transgender policyholders if they cover the services for cisgender policyholders. In addition, Washington state’s mental-health parity laws don’t allow insurers to categorically deny treatment that is medically necessary to treat a mental health condition.
The Washington Legislature passed a law that bans all blanket exclusions of gender-affirming medical treatment effective Jan. 1, 2022. Insurers, including Aetna, previously applied blanket exclusions to certain gender-affirming medical treatments, calling them cosmetic. Kreidler’s office is finalizing rulemaking now to implement the new law in time for the 2022 plan year.
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