Minnesota Mother sues her employer for insurance coverage of her son

 photo tovar_zpsgn5elx4b.jpgBrittany Tovar works as a nurse practitioner for Essentia Health at Essentia's hospital in Ada, MN. As such, she and her family are supposedly insured under Essentia's medical insurance provider, HealthPartners.

At least that's what she thought until she sought medical care for her transgender son, Reid Tovar Olson.

I was really disappointed with my employer. It's hard coming to work, and my employer considers my son a second-class citizen.

So Tovar has filed suit in federal court.

The suit alleges that Tovar's insurance plan for herself and her family "contains a categorical exclusion … for services and/or surgery for gender reassignment, regardless of medical necessity."

The teen was prescribed Lupron, which suppresses menstruation, and Androderm, a form of testosterone. The cost for Lupron was roughly $9,000, according to the suit.

This was unaffordable for her, and as a result, her son was not able to obtain the medical benefit of Lupron.

The mother paid for the Androderm herself, and Essentia later decided to cover that expense "as a one-time exception," the suit continued, but did not yield on the overall merits of the coverage denial.

In December, Tovar sought pre-authorization for her teen's gender-reassignment surgery but was denied, according to the suit.

Tovar has suffered from stress and migraines in connection with the dispute over her teen's medical needs, the suit alleges.

Olson has a mastectomy scheduled for this spring, his mother said, at a cost of up to $10,000.

I get the bill. But if your kid had cancer, you'd do anything. This is my duty, my job.

--Tovar, who is married with two other teenager sons

The claim against Essentia and HealthPartners alleges discrimination based on gender and is seeking unspecified compensatory and punitive damages. It also asks for Essentia to change its policies regarding coverage for sex-change services and surgery.

It's not even about the money. I'm trying to change [the coverage] and make access to health care for transgender [people] as it should be. To have a blanket exclusion for transgender is against the law. It's discriminatory.

The U.S. Equal Employment Opportunity Commission said Wednesday that it found that Tovar had "reasonable cause" to pursue the legal action, said EEOC spokeswoman Julie Schmid. In May, Tovar pursued the discrimination claim through the federal agency.

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LapsedLawyer's picture

is fine now in the health care industry! Costs are going down* and people are getting coverage**!

Fuck these guys, and fuck the pols who left them still in charge of our health care.

Thanks for bringing this up Robyn. It is awful and inhuman what Reid and his family are going through.

*Unless you're paying premiums -- they've skyrocketed

**Except for about 30 million of the 40 million who were uncovered before, with the added bonus that if you are covered they can still pull shit like this.

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