ATLANTA — Micah Rich, a staff accountant at the Georgia Department of Audits and Accounts, said it felt like his life was put on hold when his employer refused him the medical care his doctor recommended.

“From the time I first got denied surgery, I was expecting that I was going to have it within a month or two,” he said. “But it was 2 1/2 years before I was actually able to have the procedures that I needed.

“It’s agony. It’s a painful experience, living in a body that doesn’t feel like your own, and essentially, it’s just constant discomfort where you have constant fear of not feeling safe because of the way you look.”

Rich identifies as transgender, and he is part of a group suing the state for denying coverage of transgender-related health care in the Georgia State Health Benefit Plan.

After a yearslong struggle that included canceling several procedures because he couldn’t come up with the money, Rich is doing better, thanks in part to friends who chipped in to pay for his medical bills. He says he wants to make sure nobody else has to experience what he did.

“I almost feel a sense of duty,” he said. “Like, I’m very lucky. I’m very fortunate to have as many people in my life that I do that care for me. And the idea that there are other people out there who might not have as much support or they might not know as many people as I just so happen to that they would never be able to access the care, I don’t want that to happen to anyone else.”

The case was filed Wednesday in federal court in Atlanta on behalf of Rich; Benjamin Johnson, a school media clerk in Bibb County, and an anonymous employee of the Division of Family and Children Services on behalf of her young adult child who is enrolled in the state plan.

The court filing describes the three transgender men’s struggles with gender dysphoria, a feeling of distress caused by the mismatch of one’s gender identity with their physical characteristics. To treat it, the World Professional Association for Transgender Health recommends a transition process that can include social, pharmacological and surgical components.

The lawsuit details several roadblocks the three men said they had to deal with when seeking testosterone treatments and male chest reconstruction surgery.

The state coverage plans exclude operations to change one’s sex and related services even when recommended by a doctor as necessary care, the lawsuit argues. And while treatments such as breast surgery and hormone replacement could be available to members who need them for other conditions, they are not offered to members seeking them as part of transgender-related health care.

That amounts to discrimination against transgender employees, says David Brown, legal director for the Transgender Legal Defense and Education Fund and an attorney for the plaintiffs.

“Time and again, courts have ruled that denying health care to people because they are transgender is not only morally wrong, it’s also illegal,” he said. “In June of this year, TLDEF achieved a landmark victory in federal court on this exact question after we sued Houston County, Georgia, in federal court in Macon for the exact same exclusion in its own employee health benefit plan.”

In that case, a federal judge ruled that a veteran Houston County sheriff’s deputy was wrongfully denied health insurance coverage for gender-affirming care.

The state also has had to settle lawsuits that successfully challenged trans health exclusions in its Medicaid plan and the University System of Georgia employee health plan, Brown added.

“We are confident of success in this case, too,” he said. “There is simply no room for discrimination in Georgia, and we call on the state to quickly settle this lawsuit and to start providing health care coverage fairly to all of their employees and their families.”

This summer, Gov. Brian Kemp signed a law banning transgender children from participating in school sports on the team that matches their gender identity. Other states have been seeking to pass laws banning gender-affirming care for children, as Georgia Congresswoman Marjorie Taylor Greene leads a charge to do the same on a federal level.

A June report from the University of California, Los Angeles estimates that 48,700, or about .6% of Georgians over age 18, identify as transgender. For Georgians between 13 and 17, that number is 1.18%. The state plan covers about 660,000 Georgians, including state employees, retirees and their dependents.

According to the lawsuit, in 2016, United Healthcare told the Georgia Department of Community Health removing a transgender exclusion would bring an incremental cost of about 10 cents per member per month.

But Brown said cost should not be an issue when it comes to the state taking care of its employees.

“The cost of this health care is no different than the cost of any other health care,” he said. “This is not an issue of cost. This is simply an issue of equity that the state of Georgia has an employee health plan for its employees to ensure that they are healthy, they come to work every day, they care for their families, they have that most critical need taken care of.”