ATLANTA — A panel of appeals court judges found the Houston County Sheriff's Office discriminated against a transgender employee in its health insurance plan, the 11th Circuit Court of Appeals ruled on Monday.
They found that Anna Lange, a transgender employee for the sheriff's office, was discriminated against since they denied her coverage for "medically necessary" gender affirmation surgery solely because she was transgender.
"By drawing a line between gender-affirming surgery and other operations, the plan intentionally carves out an exclusion based on one's transgender status," the federal appeals court found. "Lange's sex is inextricably tied to the denial of coverage for gender-affirming coverage."
Lange had previously been awarded $60,000 in damages by the U.S. Middle District of Georgia in 2022, but the sheriff's office then appealed to the 11th Circuit Court of Appeals.
Lange has worked for the sheriff's office since 2006. However, when Lange transitioned in 2017, she encountered problems with the county's insurance.
Her doctors recommended "medically necessary" gender reassignment surgery, but the sheriff's office health insurance policy stated that "services and supplies for a sex change and/or reversal of a sex change" and "drugs for sex change surgery" were not covered.
According to the U.S. Department of Justice, Lange had previously paid out of pocket for hormone replacement therapy and chest surgery because she knew it wouldn't be covered under the county's insurance policy.
While Lange put off gender reassignment surgery — which would have cost $20,000 — her endocrinologist, two psychologists and a surgeon recommended the procedure. So, she sought out the surgery and requested the county's health insurance cover it.
The county's health insurance provider, BlueCross BlueShield, originally approved the surgery since it was "medically necessary" under the insurance company's guidance, according to the DOJ. But, once the county pointed out the provision about not covering gender reassignment surgery, they then denied coverage for Lange's surgery.
In the federal appeals court's decision, they found the Houston County Sheriff's Office policy was "facially discriminatory" since it treated coverage for transgender issues differently from other medically necessary treatment.
In the DOJ's filing in the 11th Circuit Court of Appeals, they note the county's health care provider, Anthem Blue Cross Blue Shield, had previously recommended the county remove the exclusion, but the county rejected their recommendation.
The Department of Justice joined the case against the Houston County Sheriff's Office as an "amicus curiae," or friend of the court, since they had a vested interest in the proper enforcement of federal anti-discrimination laws.
In the DOJ's filings, they say many procedures used as part of gender-affirming care are covered in other medically necessary contexts, like hormone replacement therapy for menopause.
"Thus, given the 'undisputed' fact that the challenged provisions of the plan deny coverage 'only for transgender members,' the court held that the plan facially discriminates based on sex," the DOJ wrote.
The 11th Circuit Court of Appeals agreed, upholding the previous court's decision and finding Houston County cannot enforce its ban on covering gender-affirming care.
"Because transgender persons are the only plan participants who qualify for gender-affirming surgery, the plan denies health care coverage based on transgender status," the federal appeals court ruled.
Lange's lawyer has previously said that the county has spent over a million dollars fighting this case. Right now, it is unclear whether or not the county will appeal the 11th Circuit Court of Appeal's decision to the U.S. Supreme Court — or whether the high court would hear the case.