A transgender woman in Oregon has sued her employer and her insurance companies for refusing to pay for facial surgery to make her look more feminine.
Christina Ketcham, a 59-year-old longtime Clatsop County employee, has already undergone sex reassignment surgery and hormone replacement therapy. She has also worked with a voice coach and changed her name, clothes and hairstyle to match her gender identity.
Ketcham’s doctors advised that “facial feminization surgery” was the “medically necessary” next step. But Citycounty Insurance Services and Regence BlueCross BlueShield of Oregon, which handle insurance for Clatsop County employees, have refused to cover the cost of the surgery, the lawsuit says.
The procedure could cost as much as $40,000 and include rhinoplasty, reduction of facial bones, a face lift and an eyelid lift, Asaf Orr, one of Ketcham’s lawyers, told The Oregonian.
According to the $375,000 suit, Regence has denied Ketcham’s coverage requests since 2016 because of “animus toward, or an intent to discriminate against” transgender people. It says that the company covers similar surgeries for reasons other than gender dysphoria, including ingrown eyelashes or jaw deformities.
Christina Ketcham is tired of being called “sir,” “mister” or “he-she”
The suit ― filed on July 18 in Multnomah County Circuit Court ― asks a judge to permanently order the defendants to stop categorically denying facial feminization surgery as a treatment for gender dysphoria.
While waiting for her insurance to fund her facial surgery, Ketcham has suffered ongoing distress due to being treated like a man, the suit says.
“Ms. Ketcham continues to be perceived by others as male,” according to the suit. “Her facial features and the shape of her face frequently lead others to call Ms. Ketcham ‘sir,’ ‘mister’ or ‘he-she,’ and to treat her as a man.”
A spokesperson for Regence told The Oregonian that his company could not discuss the pending litigation but supports “our members with comprehensive, medically necessary transgender services.”
According to the suit, doctors diagnosed Ketcham with gender dysphoria four years ago, but she has experienced the condition since childhood.
“As a young person, Ms. Ketcham’s family and community did not provide any support or options for her to live as a woman consistent with her gender identity,” the suit says. “As a result, she spent most of her life trying to conform to male stereotypes and living outwardly as a man, despite the severe emotional distress this caused her.”
The suit notes that facial feminization surgery, along with other gender confirming procedures, are not considered to be “cosmetic” or “elective” by major health professional organizations.
The next frontier for transgender rights
Orr told The Oregonian that suits like Ketcham’s are rare and he knows of no other active litigation of the sort in the United States. Last year, the National Center for Lesbian Rights helped to push the Oregon Health Plan to cover a facial feminization surgery for a transgender woman, Orr said.
Having won widespread coverage of gender reassignment surgery, Orr said, transgender rights advocates have shifted their focus to winning coverage of facial feminization or facial masculinization surgeries.
Even as activists have continued to fight for what they see as transgender people’s human rights, critics have warned that society can only go so far to accommodate their demands. A recent example that crossed the line for many was the case of a Canadian transgender woman who is suing a number of waxing businesses for refusing to service her scrotum as though it were a vagina.