On Wednesday, a federal court in Georgia heard oral arguments in the case of a transgender University of Georgia employee who sued the university after he was denied insurance coverage for medically necessary care.

Lawyers representing Skyler Jay (whose last name has been redacted to protect his identity), a 31-year-old trans man who works as Catering and Banquets Manager at the university’s Athens campus, sued the university in July after being forced to pay out of pocket for gender confirmation surgery because his the university’s health care plan all contained exclusions that would not cover transition-related expenses.

Skyler, a lifelong resident of Georgia, argues that his medical care should have been covered because the surgery is a necessary part of his treatment for severe gender dysphoria, which had previously forced him to take two medical leaves of absence since first starting as an undergraduate student at UGA in 2008. In 2012, he withdrew from school just three courses shy of his degree.

“A decade of binding my chest had wreaked havoc on my body, so not only was I in deep mental and emotional pain but also in serious physical pain,” Skyler said in a statement. “The agony of dysphoria was always present in my mind. It made it difficult to focus on anything else.”

Skyler was eventually hired by UGA in 2013, becoming a full-time employee with benefits in 2015. When he was choosing a health plan, he asked whether any would help cover the costs of treatment for gender dysphoria, and was told that no matter which plan he chose, he would be denied coverage for any transition-related care. He reached out to Monica Fenton, the director of system benefits, asking that the exclusion be removed. He received no response. 

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The university’s human resources department then informed Skyler that his short-term disability insurance would not provide coverage for surgery to treat gender dysphoria, so he would have to amass personal vacation and sick leave time to ensure he’d still be paid and not risk losing his job in the days and weeks when he’d be recovering from the surgery. He would also be ineligible for short-term disability benefits, even though he participates in the university’s disability insurance plan.

Skyler eventually underwent gender confirmation surgery in spring 2017, and, following his recovery, was able to return to school and complete his degree in December 2018.

Unfortunately, when he tried to get his insurance to reimburse him for his surgical expenses, which included a mastectomy, he was denied. He appealed the denial, but his insurance provider, Blue Cross Blue Shield refused the appeal, stating that because the plan is self-insured, it had “no flexibility” to override the plan exclusion — even though Blue Cross Blue Shield typically recognizes gender confirmation surgery as necessary to treat gender dysphoria.

Skyler was also forced to raise $6,000 from community supporters to help defray the cost of his surgery — something that was highlighted when he appeared on Episode 5 of the most recent season of Queer Eye, with the episode centering around his transition. But Skyler says the denial of care has not only forced him to take on a large amount of medical debt, but has also caused him stress, anguish, and humiliation.

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“My quality of life during those years was so poor, it’s honestly a miracle to me that I am still here today,” Skyler said. “This denial of care and discrimination is something I hope no one else has to endure.”

Enlisting the help of Transcend Legal, the nation’s only transgender-led legal organization focused on securing health insurance coverage for all trans people, Skyler sued UGA, alleging that the denial of medically necessary care based on a particular diagnosis constitutes discrimination based on both sex and disability. The lawsuit is the first of its type filed in the South, though similar lawsuits have been filed and litigated in states like Wisconsin and Iowa.

Specifically, Skyler’s lawyers say the denial of care violates Title VII of the Civil Rights Act, which prohibits sex-based discrimination; Title IX of the Education Amendments Act of 1972, which explicitly protects employees of educational institutions from discrimination; the Americans with Disabilities Act; Section 504 of the Rehabilitation Act of 1973, which prohibits disability discrimination in programs that receive federal funds; and the Equal Protection Clause of the Fourteenth Amendment to the U.S. Constitution. 

Appearing before Judge Clay D. Land of the U.S. District Court for the Middle District of Georgia, Skyler’s lawyers noted that the university’s health care plan already covers mastectomies and similar surgeries for cisgender females if they are deemed medically necessary. As such, the exclusion only serves to single out Skyler and other transgender people and deny them equal benefits.

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Following oral arguments, one of Skyler’s lawyers, Noah Lewis, of Transcend Legal, praised Land for being “very well-informed about the issues” surrounding transgender health care.

“We were extremely pleased to see we were getting a fair hearing, and we expect the judge to rule that the claims may proceed,” Lewis told Metro Weekly in an interview. “He was suggesting at the end that this might be a case that was ripe for settlement, because he seemed to be flagging, or telegraphing, that we had good claims.”

Lewis hopes that employers would take a lesson away from Skyler’s case, as well as other cases where courts have ruled in favor of transgender plaintiffs.

“In 2019, it is no longer acceptable to have transgender exclusions in employer-provided health plans. That’s where case law is headed, that’s what we saw in the case against the University of Wisconsin, and also in Medicaid cases that have come down recently,” Lewis says. “The trend is clearly moving towards saying these exclusions are discrimination, which is why, when we write letters to private employers informing them that having an exclusion is illegal, the majority of them voluntarily remove it.

“So it’s very much an outlier that we even had to bring a case against the university system of Georgia, and we are hopeful that they will do the right thing and settle before the court orders them to remove the exclusion,” he adds.

Asked about government efforts to rescind various transgender protections in health insurance, Lewis reiterates his belief that Skyler has a strong case.

“Title VII and the ADA are still good law, and have been widely interpreted by the courts to protect trans people,” says Lewis. “So the Trump-Pence administration can say all they want that trans people are not protected under Title VII, but courts are free to rule otherwise, and have consistently been doing so since [the landmark sex discrimination case] Price Waterhouse v. Hopkins.”

Editor’s Note: This story was changed to redact the Skyler Jay’s last name in order to protect his identity.