Ex-employee sues MultiCare, alleging denial of gender-affirming care coverage
A transgender Tacoma woman and former MultiCare bereavement counselor has sued the MultiCare Health System for discrimination after she was denied coverage for gender-affirming surgeries under MultiCare’s employee health plan.
Francis Faye Oak filed a lawsuit in late September in Pierce County Superior Court claiming that MultiCare’s policy of excluding select treatment for gender dysphoria needed by transgender employees was unlawful discrimination based on sex. Oak said she was denied coverage by MultiCare in 2024, despite being under the impression when she was hired that her facial-feminization surgery would be covered. That year she contends she paid $71,000 out of pocket for the surgery, a significant financial hardship.
There is a court date scheduled for Jan. 16, 2026, according to court records. Oak is being represented by the Seattle-based law firm Sirianni Youtz Spoonemore Hamburger PLLC.
When asked about Oak’s case, MultiCare said in an email to The News Tribune on Oct. 9 that it does not comment on pending litigation.
“MultiCare complies with all applicable federal, state and local laws and does not discriminate,” media relations manager Scott Thompson said.
On Oct. 9, attorneys for MultiCare filed a notice to remove the case to U.S. District Court from Pierce County Superior Court, according to court records, arguing that Oak’s complaint raises questions of federal law.
‘Life-changing and life-saving’ care
Oak, who is 44, told The News Tribune on Oct. 9 that she started transitioning when she was about 40 years old. In late 2023, she said, she felt physically and emotionally prepared to undergo facial-feminization surgery, a series of plastic-surgery procedures designed to create a more feminine appearance. She had discussed the option with her medical team for years and in 2024 had a surgery date on the calendar (which had also taken more than a year to schedule).
When she was hired in late 2023, Oak said, MultiCare assured her its employee health plan was robust and included care for transgender employees.
As part of its benefits package, MultiCare provides workers with “health care coverage through a self-funded plan, the MultiCare Health System Flexible Benefits Program, MultiCare MyConnected Care Plan administered by MultiCare,” according to Oak’s lawsuit. “A ‘self-funded plan’ is a plan that is designed and funded by the employer, while administered by a third-party, commonly referred to as a ‘third-party administrator’ or ‘TPA.’ The Plan is not health insurance under Washington law.”
“I was pointed to their rating with the Human Rights Campaign and how much work they have done with the Rainbow Center locally as really evidence of their support of transgender caregivers in their company. And so, with all of that, I accepted the position,” Oak said.
It wasn’t until she was denied the pre-authorization for the surgery in early 2024 “when all the sort-of fiasco started,” Oak said.
At first, Oak thought the denial was an oversight. Once she began appealing the decision and made her case to MultiCare leadership, it became clear “they were not going to cover anything that they felt was ‘unnecessary’ or ‘cosmetic,’” she said.
A section of MultiCare’s employee health care plan says transgender employees may receive “gender-affirming surgery” and “plastic surgery,” but another section deems those services “cosmetic” when sought to treat gender dysphoria and thus not covered, according to the complaint Oak filed in Pierce County Superior Court.
Under the plan, employees have coverage for breast-reduction surgery following a mastectomy for breast cancer “but not when needed for a diagnosis of gender dysphoria,” according to the complaint.
“MultiCare’s ‘Transgender/Gender-Affirming Services’ Exclusion is illegal facial or proxy discrimination based on sex,” Oak alleges in the lawsuit. “On the face of the MultiCare Plan, certain clinically effective surgeries that are the standard of care for treatment of gender dysphoria are expressly singled out and excluded from coverage precisely because they treat transgender people.”
Oak said she went on medical leave because of her distress with the situation and was administratively discharged from MultiCare in June 2025 when the parties could not come to a resolution over the accommodations she requested.
“[These surgeries were] life-changing and life-saving. It’s life-giving to be able to align my appearance with my gender. Not only does it give me life and fill me with a sense of congruence in the world, it also makes me safe,” Oak said. “I can walk in the world and not be picked out as easily, and thus not be picked on as easily. It has made all the difference for me in that regard.”
Oak is seeking “injunctive relief requiring MultiCare to stop its facially discriminatory policy, actual damages resulting from the enforcement of the Transgender Exclusion, emotional distress damages, attorney fees and all other appropriate remedies permitted under RCW 49.60.030,” per the complaint.
“I feel very reticent to work in health care ever again, because of this experience. To be a health care provider and not be given appropriate, adequate health care by the largest employer in our county, and one of the largest health care systems in the state of Washington, and one of the most powerful companies on the West Coast — it has dramatically shifted my life,” Oak said.
‘Have science be the guiding light’
Melissa Chubbuck, who was the medical director for MultiCare’s Home Health and Hospice department, resigned after she became “dispirited” with leadership’s handling of Oak’s case. MultiCare did not respond to multiple requests for comment about Chubbuck’s resignation or allegations.
Chubbuck, who uses she/they pronouns, told The News Tribune that Oak came to her for help after she was denied coverage. When Chubbuck inquired up the leadership chain, she said, she encountered more resistance than she expected. Health professionals should be following the evidence-based guidance of associations like the World Professional Association for Transgender Health (WPATH) when treating conditions like gender dysphoria and offering gender-affirming care, she said.
“They include facial-feminization surgery as a surgery that should be covered by insurers based on the demonstrated mental health benefits,” Chubbuck said. “It really is not experimental [care]. It’s widely performed, widely covered by insurance. It’s covered by Washington Medicaid. It’s actually required to be covered by the Washington state insurance commissioner because they are basing their requirements on the WPATH guidelines.”
Chubbuck said she could not get a clear answer from MultiCare leadership as to why Oak’s care was denied, and she resigned “because I’m not willing to work for an organization that discriminates against trans people.”
“Clinical excellence entails following clinical guidelines. You don’t get to wing it based on what is most politically expedient or even financially expedient,” she said. “I do not blame them for not wanting to sort of come out and take a political stand overtly. I don’t necessarily think that needs to be a healthcare system’s role in order for them to be behaving in a way that’s ethical and clinically appropriate. But what they do need to do, if they want to be apolitical, is then just have science be the guiding light.”
