Health Net Sues Over Sex Change
Health Net Inc. has sued the California Department of Health Services in hopes of overturning an order requiring it to pay for a sex change operation.
The suit, filed Monday in Los Angeles Superior Court, seeks a new hearing by state officials in a medical case involving a patient identified in court papers as a woman with the initials “P.M.”
Last year Woodland Hills-based Health Net, one of the state’s largest managed-care health companies, upheld a medical group’s decision to deny the sex change operation because it was not medically necessary.
But the patient, who is enrolled in the Medi-Cal program, appealed the decision to the state. In January, an administrative law judge agreed with P.M.’s doctor that the surgery was medically necessary.
In February, the Department of Health Services adopted the administrative law judge’s decision granting the patient the right to medical coverage for the operation.
Health Net contends that private health plans routinely exclude coverage for sex change operations.
“Medical professionals have raised serious issues about the medical necessity related to this case,” said Health Net spokesman Brad Kiefer. “Under these circumstances, we think it right and appropriate for us to seek a reconsideration.”
A spokesman for the Health Services Department declined to comment on the lawsuit.
