A transgender man who was hit with a $30,000 bill after his insurance plan refused to cover medically necessary gender confirmation surgery has filed a discrimination complaint against his former employer with the Colorado Civil Rights Commission.
Dashir Moore moved to Colorado from Georgia in October 2017 to get a fresh start in life, hoping that he would be able to complete his transition in a state with LGBTQ protections.
After arriving, Moore updated his driver’s license to reflect his correct gender identity, without incident. He also took a job with InnoSource Inc., a staffing agency, as a customer service representative, which came with a health insurance package from United Healthcare.
A few months after starting his job, Moore made the decision to pursue gender confirmation surgery with the help of transgender health care specialists at Denver Health. In May 2018, he called UMR, the company that processed his health claims, twice, and was told both times by representatives that insurance would cover 70% of the procedure’s cost, and that preauthorization would not be required.
But while he was recovering from the surgery, he learned that UMR had contacted Denver Health to notify them — while Moore was in the midst of surgery — that they wouldn’t be footing the bill.
Angry and upset at this news, Moore began investigating and requested a copy of his summary plan description. He then discovered that his insurance plan contained an exclusion prohibiting coverage for “treatment, drugs, medicines, services, and supplies for, or leading to, gender transition surgery,” saddling him with the full cost of surgery and recovery and leaving him unable to pay for other expenses.
“Doctors had found three lumps in my left breast, but I skipped my post-op appointment because I couldn’t afford to pay,” Moore wrote in a recent op-ed in The Denver Post. “The next week, my dog — a sweet English bulldog who had been my biggest support — got sick. He needed a $1,400 surgery. I should have been able to afford that, but I had just made a big payment toward my surgery; I had nothing. I asked family and friends to contribute and set up a GoFundMe page, but my dog died a few days later. I was devastated.”
Moore began to receive bills, which he tried to pay. But due to the high price of the surgery, it became too financially burdensome to afford, and those bills were sent to collections, further harming his credit. As a result, he began experiencing anxiety attacks, and eventually resigned from his job at InnoSource Inc.
“The fact that InnoSource refused to cover any medical treatment for transition-related care made it clear to me that the company that I was working for believed that as a transgender person I was not worthy of equal treatment,” Moore said in a statement. “I no longer felt valued or that the company really cared about me or my success.”
Enlisting the help of the American Civil Liberties Union and the ACLU of Colorado, Moore then filed a complaint with the Colorado Civil Rights Commission arguing that the insurance exclusion in InnoSources’ employee health care plan was discriminatory. His lawyer argue that coverage for the surgery would have been provided had Moore been a cisgender woman whose doctor recommended a mastectomy.
“InnoSource’s denial of coverage for medically necessary care for the treatment of gender dysphoria illegally discriminates against transgender people, Sara Neel, a staff attorney with the ACLU of Colorado, said in a statement. “The idea that Mr. Moore paid for health insurance and is still being denied coverage for medically necessary treatment is outrageous.”
Ria Tabacco Mar, a senior staff attorney with the American Civil Liberties Union’s LGBT & HIV Project, and one of Moore’s lawyers, says there are a number of options for Moore to seek relief if the Colorado Civil Rights Commission concludes that he was the victim of discrimination.
“Certainly, the parties could come together and try to resolve this issue, short of litigation. Obviously, Dashir is looking for a commitment that this won’t happen to anyone else, so we are looking for the company to remove the discriminatory exclusion,” Mar tells Metro Weekly. “If that’s not possible, the Civil Rights Commission itself could choose to pursue this against InnoSource, or Dashir could pursue it himself.
Mar notes that the ACLU has previously sued on behalf of four transgender plaintiffs, all state employees, who were forced to pay out-of-pocket expenses or forego surgery after their employer-sponsored health insurance plans refused to cover the costs.
In October, a Wisconsin jury awarded $780,000 to two transgender women researchers at the University of Wisconsin-Madison. Last week, a jury in Iowa awarded $120,000 to a transgender corrections employee who was barred from the men’s bathroom, in addition to having his insurance refuse to pay for his transition-related care.
The organization has also filed a class-action lawsuit on behalf of Russell Toomey, a University of Arizona professor who argues that the exclusion on transition-related care in the university’s health insurance plan is discriminatory.
“We are seeing courts recognize that these exclusions are discriminatory, we’re seeing juries recognize that they’re not only discriminatory but harmful, and yet we’re still seeing these kinds of exclusions in cases like Dashir’s and in the Toomey case, which is why we’re continuing to fight,” Mar says.
She adds that there are a number of myths associated with the costs of transition-related health care, often based on outdated understandings or misperceptions about the transgender community.
“In many cases, companies adopted these exclusions at some time in the past when they were less familiar with what it means to be transgender,” Mar says. “The most benign explanation would be that they haven’t revisited these exclusions since then. Obviously, that, in and of itself, is problematic and discriminatory.”
Mar says that one of the chief myths about transgender surgery is the contention that it is so prohibitively expensive that it will lead to increases in premiums for other employees. In fact, even the expert witness called by the state of Wisconsin arguing in favor of an exclusion estimated that the cost of such surgeries was an increase of about 4 to 10 cents per insured person.
“There is also a myth that this kind of surgery is somehow optional or not medically necessary,” adds Mar. “Of course, these surgeries are subject to the same standard of medical necessity as any other medical care. The reality is that for some transgender people, these surgeries can be medically necessary treatment for gender dypshoria. So I think there’s this myth that the care isn’t needed, when in fact, it can be life-saving.”
Another myth involves the extent to which insurers can pick and choose which services to provide, meaning they are within their rights to refuse to provide transition-related care. But Mar notes that a mastectomy, which is given to transgender men undergoing “top surgery,” is the same procedure recommended for cisgender women with breast cancer or mutations in the BRCA gene (which puts a person at a higher risk of breast cancer). As such, the only difference between cases where a doctor might recommend a mastectomy is who is receiving the treatment.
“To the extent insurers can pick and choose what they cover, they can’t deny those same services to some people just because they’re transgender,” she says.