NORTHAMPTON — On his weekend shifts, Ascend Hospice nurse Alexander Pangborn can be found visiting patients across the Pioneer Valley, from Northampton to Palmer.
When it comes to his own health, though, his company’s insurance policy discriminated against him because he is a transgender man, he alleged in a lawsuit filed earlier this year.
The Haydenville resident spent about a year getting recommendations from a primary care doctor, a surgeon and three mental health professionals for a gender-affirming surgery.
And then, in early 2019, he ran into a problem. “We discovered there was actually an exclusion for trans-related health care,” Pangborn said.
“The Plan expressly excludes ‘[a]ny treatment, drug, service or supply related to changing sex or sexual characteristics,” Sharon Zeigler, vice president of human resource operations for Care One Management, wrote in an affidavit filed in April.
A spokesman for Care One Management — which Ascend Hospice is part of — declined to comment on detailed questions about the case, saying, “we can’t comment on existing litigation.”
A message left with the attorneys listed in lawsuit filings as representing the defendants was not returned.
Pangborn said he asked his company’s human resources department to revise the policy.
“I said, ‘I’d just like to request that this be revised because I can’t access care that my physician is saying is medically necessary,’” he recalled. “The response I got was basically, ‘We don’t have any intention of changing that.’”
Now Pangborn is suing his employer — Care Alternatives of Massachusetts, which does business as Ascend Hospice, and Care One Management — with Boston-based GLBTQ Legal Advocates & Defenders (GLAD). The lawsuit, filed in U.S. District Court in Springfield in January, includes claims of discrimination on the basis of sex and discrimination on the basis of gender identity.
“Having gender-affirming surgery is not optional for me,” Pangborn said. “Every trans person is different. So obviously, my experience is just mine. For me, it’s just not optional. It’s something that needs to happen.”
In his suit, Pangborn is seeking coverage for his medical care along with damages as the court sees fit.
“Transition-related care is medically necessary care,” said Chris Erchull, a GLAD staff attorney who is representing Pangborn. “It’s not just me saying it … It’s all the major medical associations that are in consensus that gender transition-related care is medically necessary care for those experiencing gender dysphoria.”
The American Medical Association defines gender dysphoria as “a condition that is characterized by clinically significant distress and anxiety resulting from the incongruence between an individual’s gender identity and birth-assigned sex.” Pangborn has gender dysphoria, which the lawsuit complaint states.
The AMA wrote in an issue brief that for those experiencing gender dysphoria, medically necessary services can include gender-affirming surgeries.
“Every major medical association in the United States recognizes the medical necessity of transition-related care for improving the physical and mental health of transgender people and has called for health insurance coverage for treatment of gender dysphoria,” the brief reads.
Pangborn’s health insurance plan “excludes coverage for medically necessary treatments for Gender Dysphoria but allows coverage for the same medical procedures or treatments when medically necessary for other medical conditions,” the lawsuit alleges.
“Employers should not be treating their employees differently,” Pangborn said. “The fact that I’m transgender means I can’t access care my provider says is medically necessary. It’s not a good feeling to be singled out in that way.”
He added, “employers shouldn’t be making health care decisions for their employees. My doctor is well aware of the standards of care. Decisions about my health should not be up to my employer — they should be up to myself and my physician.”
His health insurance plan is self-funded, which means the employer funds the health care costs instead of an insurance carrier, and decides what the plan covers.
Under federal law, self-funded plans aren’t subject to state insurance laws, according to a consumer guide to health insurance on the state’s website.
In a landmark decision earlier this month, the Supreme Court decided that the Civil Rights Act of 1964 protects LGBTQ people from employment discrimination. It also concluded that “discrimination based on sexual orientation or gender identity is sex discrimination,” Erchull said. “That does help us … It’s a stronger case for us.”
Days before the Supreme Court ruling, the Trump administration finalized a rule that would reverse Obama-era health care and health insurance discrimination protections for transgender people. A section of the Affordable Care Act prohibits discrimination on the basis of sex, which the Obama administration defined as “male, female, neither, or a combination of male and female,” National Public Radio recently explained. The Trump administration is rolling back that protection and defining sex as either male or female.
“Our court case is poised to challenge that interpretation,” Erchull explained. “The interpretation that’s being advanced by the Trump administration is the same interpretation that we’re already fighting in general court.”
Transgender people are often discriminated against in health care settings, Pangborn said. “I would say that transgender people facing discrimination in health care is an epidemic, honestly. We are fortunate to live in an area where we do have access to a lot of trans-competent providers. But I know many many people who don’t.”
When he goes to get care, Pangborn wonders, “Am I going to get somebody treating me like a person? … Or is this someone who is going to reduce me to by body and make that the focus rather than why I’m seeking help? Even here [in the Valley], I think that’s always kind of in the back of my head.”
When he was denied coverage, he said he thought about leaving his job or purchasing independent insurance.
“I think really what it boils down to was, I love my job,” he said. “I love where I’m working. I love the people that I work with … I didn’t want to change that … As far as purchasing independent insurance, that felt like an easy out — ‘Oh, OK, it’s fine to discriminate against me.’”
Pangborn hopes that his case will help others who may face a similar situation.
“This company operates in multiple states,” he said. “There’s no way I’m the only transgender person who works for this company … What if a future employee needs this? Why should they have to go through the same process I have? In some respects, it wasn’t a hard choice to move forward.”
For Pangborn, the bigger question was whether or not to put his name on the lawsuit. “I thought about it for a long time,” he said. “I am in a position where I can be out, and I often am. Anybody who knows me relatively well is going to know I’m trans — it’s part of my life. But, I felt like there are a lot of people that can’t for whatever reason. I also just feel like [if] people can put an actual person’s face or name to a story, I think sometimes that helps them connect to it better.”