A federal judge in Connecticut has refused to pause a court order blocking Aetna from categorically denying coverage for certain gender-affirming facial surgeries for transgender patients, marking another significant development in the ongoing legal fight over insurance coverage for transgender health care in the United States.
The ruling stems from a class-action lawsuit filed against Aetna by several transgender women who argued the insurer unlawfully classified facial feminization procedures as cosmetic rather than medically necessary treatment for gender dysphoria. The lawsuit alleges that Aetna’s policy violated Section 1557 of the Affordable Care Act, which prohibits sex discrimination in federally funded health programs.
Earlier this year, U.S. District Judge Victor Bolden granted a preliminary injunction ordering Aetna to reconsider claims for facial reconstruction surgeries without relying on its blanket exclusion policy. The judge found the plaintiffs were likely to succeed in proving the policy was discriminatory.
In the latest ruling issued Friday, Judge Bolden denied requests from two transgender women seeking emergency enforcement of the injunction, saying the earlier order did not establish a specific compliance deadline. However, the judge also sharply criticized Aetna for failing to move quickly enough to comply with the court’s directive.
According to Bloomberg Law, Bolden wrote that the court’s order was “clear and unambiguous” and stated that Aetna’s failure to comply so far was unacceptable. He also rejected Aetna’s attempt to stay the injunction while litigation continues.
The case is one of several nationwide challenges targeting insurance exclusions related to transgender health care. Advocates argue that facial feminization surgery can be medically necessary for some transgender women experiencing severe gender dysphoria, particularly when facial characteristics contribute to depression, anxiety, social isolation, or safety concerns in public life.
The plaintiffs are represented by Advocates for Trans Equality, along with civil rights law firms Wardenski P.C. and Cohen Milstein. The legal team previously challenged Aetna over exclusions related to breast augmentation coverage for transgender women, resulting in policy changes after a settlement.
While the current injunction directly applies only to specific plaintiffs involved in the case, LGBTQ+ advocates say the ruling could have broader implications for how insurers nationwide classify gender-affirming procedures. Several states already prohibit categorical exclusions for facial feminization surgery, but policies still vary widely across insurers and jurisdictions.
