Oregon Trans Woman Sues Insurance Company for Facial Surgery

After undergoing gender reassignment surgery, Christina Ketcham’s doctors recommended facial feminization surgery so strangers would more intuitively perceive her as female. Her insurance company said no, but she is standing up to them.

Ketchem, 59 has filed a $375,000 lawsuit against her insurance company and her employer, asserting the refusal to pay amounts to discrimination. Ketcham’s suit states she has worked for Clatsop County for almost 30 years, the last 17 years as a fisheries biological aide.

Filed in Multnomah County, the suit names Clatsop County as her employer, Citycounty Insurance Services that provides coverage for Clatsop County employees, and Regence BlueCross Blue Shield of Oregon, which administers the plan.

Ketchem’s suit alleges she has experienced gender dysphoria since childhood, and that she was diagnosed four years ago. She has already undergone gender reassignment surgery, hormone replacement therapy, and had sessions with a voice coach. She also changed her name, clothes, and hairstyle to reflect her gender identity.

Her doctors also believe facial feminization surgery is medically necessary to treat Ketcham’s gender dysphoria. The surgery could include rhinoplasty, reduction of her facial bones, a face lift, and an eyelid lift.

Requests for coverage from 2016 to 2019 were denied. The Oregonian sought comment from Citycounty Insurance Services and Clatsop County; neither responded. Jared Ishkanian, a spokesperson for Regence, told The Oregonian the company couldn’t discuss the pending litigation but supports “our members with comprehensive, medically necessary transgender services.”

The suit alleges, “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.”

The suit states Regence “categorically excludes coverage of facial-feminization procedures” by “wrongly deeming them ‘not medically necessary’” as a treatment for gender dysphoria. The suit also asserts Regence covers eyelid lifts and facial bone reduction surgeries for reasons other than gender dysphoria, and further alleges the denial of coverage is “a reflection of animus toward, or an intent to discriminate against” transgender people.

Beyond a money judgment, the suit seeks a court order requiring the defendants to stop denying facial feminization surgery in gender dysphoria cases.

The Oregonian reports the World Professional Association for Transgender Health states that facial feminization surgery, along with other gender confirming surgeries, “are not ‘cosmetic’ or ‘elective’ or ‘for the mere convenience of the patient.’” Major health professional organizations — including the American Medical Association and the American Psychiatric Association — support that position, according to the association’s website and the lawsuit.

Responsive to The Oregonian, one of Ketchem’s attorneys, Asul Orr said, “Facial feminization surgery is hugely transformative.” He also noted that transgender people once had to fight insurance companies to pay for gender reassignment surgeries, and that the battleground has now shifted to facial feminization and masculinization .