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Boyden v. Conlin

United States District Court, W.D. Wisconsin

November 20, 2017

ALINA BOYDEN and SHANNON ANDREWS, Plaintiffs,
v.
ROBERT J. CONLIN, BOARD OF REGENTS OF THE UNIVERSITY OF WISCONSIN SYSTEM, RAYMOND W. CROSS, REBECCA M. BLANK, UNIVERSITY OF WISCONSIN SCHOOL OF MEDICINE AND PUBLIC HEALTH, ROBERT N. GOLDEN, STATE OF WISCONSIN DEPARTMENT OF EMPLOYEE TRUST FUNDS, STATE OF WISCONSIN GROUP INSURANCE BOARD, and DEAN HEALTH PLAN, INC., Defendants.

          OPINION AND ORDER

          WILLIAM M. CONLEY, District Judge

         In this civil action, plaintiffs Alina Boyden and Shannon Andrews assert Title VII equal protection and Affordable Care Act claims against defendants for the denial of healthcare coverage related to treatment for gender transition. Before the court is the motion of defendant Dean Health Plan, Inc., to dismiss plaintiff Alina Boyden's Title VII claim against it for failure to state a claim under Federal Rule of Civil Procedure 12(b)(6). (Dkt. #30.) Because Dean is neither Boyden's employer nor an agent of Boyden's employer under Title VII, the court will grant that motion.

         STATEMENT OF FACTS[1]

         A. Overview of the Relevant Parties

         Plaintiff Alina Boyden is a transgender individual who was assigned male gender at birth, but identifies as female. As a result, Boyden suffers from gender dysphoria, “the medical diagnosis for the feeling of incongruence between one's gender identity and one's sex assigned at birth, and the resulting stress from that incongruence.” (Am. Compl. (dkt. #27) ¶ 31.) Boyden is an employee of defendants University of Wisconsin-Madison and the Board of Regents of the University of Wisconsin System.

         Defendant Dean Health Plan, Inc., is a health insurance administrator that offers insurance plans to Wisconsin state employees, including Boyden, through the Wisconsin Department of Employee Trust Funds (“ETF”). The State of Wisconsin Group Insurance Board (“GIB”) “sets ETF policy” and “oversees the administration of the group health insurance plans for state employees” with the ETF Secretary's assistance. (Id. at ¶ 21.) Boyden alleges that Dean discriminated against her on the basis of sex by denying coverage for gender dysphoria treatment in violation of Title VII. Particularly material to the present motion, Boyden claims that Dean is an agent of her employer and, as such, can be held liable under Title VII.

         B. Denials of Coverage

         In their amended complaint, plaintiffs allege that ETF “determines the requirements for health insurance plans offered to state employees.” (Id. at ¶ 20.) Moreover, ETF/GIB health insurance plans expressly exclude coverage of “procedures, services, and supplies related to surgery and sex hormones associated with gender reassignment.” (Id. at ¶ 8.) Boyden participated in the health insurance plans offered by ETF/GIB as a result of her employment. Having chosen health insurance coverage through Dean, it was responsible for administering her health plan.

         On or around May 17, 2016, Boyden requested pre-approval from Dean for surgical treatment for her gender dysphoria or Gender Conformation Surgery (“GCS”).[2] Boyden's primary care physician wrote a letter supporting her request, recommending GCS as “the best way for her to keep her testosterone levels at goal.” (Id. at ¶ 47.) On May 20, 2016, Dean denied the request. Boyden then initiated a grievance with Dean, requesting reconsideration of its denial of coverage. Dean upheld the denial on July 8, 2016, citing the ETF/GIB health insurance plan's unambiguous exclusion of GCS coverage.

         About one week later, ETF/GIB amended their health insurance plans to provide coverage for transition-related care effective January of 2017. This amendment prompted Boyden to make a second request for pre-approval from Dean for GCS. Dean denied this request as well, stating that coverage for this service would not begin until January of 2017.

         On December 30, 2016, however, GIB again “took action, ” this time to reinstate the exclusion of coverage for gender transition treatments as soon as four contingencies were met. (Id. at ¶ 39.) This action was apparently prompted by an August 2016 directive from the Wisconsin Department of Justice opining that GIB should reinstate the transition-related care exclusion, because the change in coverage was based on a misreading of the law and that denial of coverage for transition-related care is not discriminatory because such treatment “is never medically necessary.” (Id. at ¶ 38.)

         As instructed, on January 3, 2017, Boyden's healthcare provider submitted a request to Dean for pre-approval for Boyden's GCS. In a letter dated January 10, 2017, Dean denied this third request. Boyden then initiated a grievance and also requested the medical professionals she was seeing to seek peer-to-peer reviews of Dean's decisions. In the interim, GIB found that the four contingencies were met on January 30, 2017, and reinstated the exclusion effective February 1, 2017. Boyden met in person with Dean representatives on February 15, 2017, to discuss her grievance. In a letter dated February 21, 2017, Dean again upheld its denial, citing the reinstatement of the exclusion and an external review conducted by a Board Certified Plastic Surgeon.

         Boyden's healthcare providers have referred her to a surgeon for medically necessary GCS, but because she does not have sufficient funds to pay for the procedure out-of-pocket, she has not yet undergone the surgery. Boyden received ...


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