Two transgender men have initiated a lawsuit against the Primary Health Insurance Fund (CPAM), seeking reimbursement.
A 100% Coverage for Healthcare Journey
The CPAM at the center of a scandal. The increasingly publicized struggle of transgender individuals to access healthcare comes with numerous requirements. To receive full coverage, individuals must comply with the demands of the CPAM; otherwise, expenses for surgeries, speech therapy, and hormone injections remain their responsibility. These are significant costs that some individuals cannot afford, forcing them to choose between financial or psychological hardship.
The CPAM of Seine-Saint-Denis is currently facing a lawsuit from two transgender men. On March 10, a trial commenced, pitting the individuals referred to in Démotivateur as Morgan and Michel against the health insurance fund.
Fully aware of the processes involved in gender transition, Morgan complied with all the CPAM’s requirements. After a request was validated in 2020, he was supposed to receive coverage for nursing care, speech therapy, hormone injections, and surgical procedures. However, the expenses related to his bilateral mastectomy (breast removal) were left for him to cover.
The CPAM Retracts, Morgan Strikes Back
This was a significant blow for Morgan, who had to pay €5,428 out of pocket for the operation. The reason for this reversal? The CPAM requested proof of at least one year of follow-up care with an endocrinologist and a psychiatrist, along with supporting documents. Finding this request “illegitimate”, Morgan refused to provide the information, leading to the CPAM’s withdrawal from covering the procedure.
Now, he demands reimbursement for these expenses, as well as coverage for excess fees and travel costs between his home in Seine-Saint-Denis and the clinic in Lyon. Facing the refusal of the CPAM, he has turned to the courts.
A similar situation occurred for Michel, whose request for ALD coverage was denied initially but later accepted retroactively. Nonetheless, he is also demanding €150 from the CPAM that has not yet been paid. The judge is set to deliver a ruling on June 23.
Gender transition: CPAM 93 sued for refusing to cover breast removal
➡️ https://t.co/IoKwjU4bsh pic.twitter.com/JF4ZmCBmN1— Le Parisien (@le_Parisien) March 11, 2025
