“IGNA prohibits health plans from discriminating against individuals because of the individual’s gender, including gender identity or gender expression,” the agency noted in its directive, issued April 9, 2013. “This prohibition extends to the availability of health coverage and the provision of benefits.”
The directive orders health plans to “Ensure that individuals are not denied access to medically necessary care because of the individual’s gender, gender identity or gender expression,” and to review and revise health plan documents to ensure they are compliant with IGNA, including removing exclusions related to gender transition services. According to the directive, exclusions or limitations that are prohibited are those that exclude coverage of “transsexual surgery” and/or “transgender or gender dysphoria conditions.”
Under the directive, patients who are denied coverage have the ability to appeal the decision to the Department.
Meanwhile, a doctor in California won a lawsuit against Anthem Blue Cross, after he alleged his application to join the insurance company’s preferred provider network was unfairly denied. Anthem Blue Cross said the doctor was rejected because the company did not need another general practitioner, but Jeffrey Nordella alleged he was denied because when he was in their network previously, he advocated for patients who had their insurance claims denied.
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The verdict means that insurers may have to work harder to prove a decision to exclude or terminate a doctor from a network is based on reasonable business decisions. It may also mean physicians who believe they were rejected because of patient advocacy are more likely to file lawsuits of their own.
The lawsuit is Nordella v. Anthem Blue Cross, Los Angeles Superior Court, No. BC444364.