PHILADELPHIA - A Pennsylvania transgender man has gone to court after his insurer declined to pay for an $11,000 erectile pump as part of gender-affirmation surgery to build him a penis.
A John Doe sued Keystone First, Keystone Family Health Plan, Vista Health Plan, and Blue Cross and Blue Shield Association Jan. 25 in U.S. District Court for the Eastern District of Pennsylvania. His lawyer is Justin Robinette.
John Doe is a transgender man who argues his gender identity has caused him distress due to incongruence with his assigned sex at birth - a condition known as gender dysphoria.
"Plaintiff is substantially limited in the major life activities of working, interacting with others, social functioning and caring for himself," the suit claims.
Affirmation surgeries began in 2018, and Doe notes a history of coverage disputes with Keystone for the costs. Doe claims it was illegal discrimination for Keystone to not pay nonparticipating health care providers for procedures like arm hair removal and testicular implantation.
In 2021, Doe had to cancel a surgery for a new erectile pump. The one he already had was not functioning properly, he said.
The cost for a new pump was $11,000, but Keystone would not pay. Doe called the surgery "medically necessary."
"The pump needs to be replaced in Plaintiff's specific case because the first pump is placed too close to the surface of Plaintiff's skin," the suit says.
"Plaintiff's pubic mound is perpetually pumped up in a way that is extremely uncomfortable and sometimes painful."
With a non-functioning penis, Doe says he is required to maintain "sex characteristics of his sex assigned at birth that are not congruent with his gender identity and which caused and continue to cause severe emotional distress."
Doe details his financial troubles in the rest of the complaint.