GRAND RAPIDS, Mich. (WOOD) — Spectrum Health and the insurance company it owns, Priority Health, are being sued by a Caledonia resident undergoing gender transition.
The woman says the hospital stopped paying for her medical services this year after paying for it previously.
After the Affordable Care Act became law, the medical portion of gender reassignment was covered.
But this year, the health system started denying coverage based on a case out of a federal district court in Texas.
But Cadence Morton, a 14-year Spectrum employee, claims this is discrimination.
“So basically, in 2017, they were not discriminating against her based on her gender identity, then they in 2018, all of a sudden, decided to discriminate by taking that coverage away,” said attorney Christine Yared.
Cadence Morton, who works in information services at Spectrum, was born male but said she always identified a female. In 2011, she was diagnosed with gender dysphoria, which is the condition of being uncomfortable with one’s birth gender.
“It is a legitimate medical issue, it’s been recognized for a long time now as a necessary medical issue,” Yared said.
Morton began the transition nearly seven years ago which includes hormones and surgery.
According to the suit, Morton racked up more than $41,000 in bills between 2011 and 2015.
In 2017, following the Affordable Care Act mandate, the medical care was covered.
“I know other insurance carriers, Blue Care Network, Aetna and others, that apply in this area are covering it,” Yared said.
But in January of this year, Morton was notified that her “Priority Health Plan will no longer cover Gender Reassignment Surgery.”
Priority cited a December 2016 Texas federal court ruling where a judge there ordered an injunction allowing the health insurer in that case to deny coverage.
“The Texas district court has no jurisdiction over courts in the 6th Circuit,” Yared said.
The suit claims negligence, fraud, misrepresentation and discrimination.
“They do cover other similar types of things,” Yared said. “You can’t just pick out this one group of people and say that we won’t provide surgery for, in her case, a medically necessary…it’s not considered cosmetic.”
Morton is seeking to have any ongoing medical treatment for her gender reassignment covered and also repayment for the more than $41,000 she has already spent, punitive damages and attorney fees.
“They’re trying to say that they’re very fair and that they don’t discriminate against people based on their gender identity, and yet, now they are, they clearly are,” Yared said.
Representatives of Spectrum Health would not go on camera, saying they do not comment on active litigation, but in an email they said they “strive to maintain a diverse and inclusive workplace that is an open and accepting environment for all employees.”