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Bobbie Pearson, who was born male and paid out-of-pocket for sex reassignment surgery in Pennsylvania.

Michelle Siu/The Globe and Mail

When it comes to her physical recovery, Bobbie Pearson is doing well.

The 57-year-old is back home in London, Ont., preparing to return to university after travelling last month to Pennsylvania, where she underwent sex reassignment surgery to achieve her lifelong dream of becoming a woman.

When it comes to her financial recovery, on the other hand, Ms. Pearson likely has a long road ahead, one that is scheduled to reach a critical bend when she appears before a quasi-judicial panel in Toronto on Wednesday.

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Ms. Pearson will be asking the Health Services Appeal and Review Board to order the province to reimburse about $20,000 she paid out of pocket for genital surgery, a procedure the Ontario Health Insurance Plan would have covered if she had first obtained approval from the Adult Gender Identity Clinic at Toronto's Centre for Addiction and Mental Health (CAMH), where it takes two years just to secure a first appointment.

"I would like to get my money back," she said. "But there's the bigger picture here: I think this needs to start to get some public traction."

Two months have passed since Ontario Health Minister Eric Hoskins promised to improve the options for transgender people like Ms. Pearson who cannot endure the assessment queue at CAMH – not to mention the wait for surgery.

But the Liberal government has not taken any action.

In the meantime, one transgender man filed a Charter challenge to Ontario's regulation regarding CAMH and OHIP coverage, Caitlyn Jenner's splashy coming-out spread in Vanity Fair made headlines around the world, and the line at the CAMH clinic ballooned from 680 in mid-April to 970 today.

Catherine Zahn, the president and chief executive officer of CAMH, said in an interview Tuesday that the provincial government's interest in fixing the long-standing problem has "ramped up" over the past few months.

(Dr. Hoskins said in an e-mailed statement Tuesday that his ministry continues to look into the issue and he hopes "to announce our plans soon.")

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The regulation that designates CAMH as the sole site allowed to approve sex reassignment surgery candidates for OHIP coverage should "absolutely" be scrapped, Dr. Zahn added.

"Why would a restriction like that be placed on an assessment that, given the right professionals, could take place in any number of venues?"

At Wednesday's hearing, lawyer Susan Ursel plans to make a version of that argument, one rooted in what she sees as internal contradictions in the province's Health Insurance Act.

The act guarantees Ontario patients the right to choose their own doctors and health practitioners. It also guarantees a "uniform" approach to patients across the province. But, separately, a provision in the act's schedule of benefits expressly states that transgender patients who want OHIP coverage for their surgery must first be assessed and approved at CAMH – nowhere else.

"It's a really simple argument," Ms. Ursel said. "The [sex reassignment surgery] requirement requires people to go through the CAMH process. That means right from the beginning, right from the initiation of the search for surgery, they are not allowed to choose their own practitioners or doctors."

Ms. Ursel, a veteran lawyer who has argued gay rights cases before the Supreme Court of Canada, said that if Ms. Pearson is not successful at the Health Services Appeal and Review Board – which hears appeals of OHIP rejections – she plans to take the case to the Ontario Human Rights Tribunal. The tribunal has clear authority to force the government to change its laws and policies.

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For Ms. Pearson, forcing such change would be an important victory after the two tumultuous years that followed her coming out as trans in the spring and summer of 2013. Her three children, now 24, 21 and 19, all vowed to support her transition – "I was just so impressed and proud of how they responded," she said – but other relatives responded coolly to her shoulder-length blonde hair, dresses and makeup.

Her 88-year-old mother wants to keep in touch, but is "embarrassed" about the change. Some of Ms. Pearson's six siblings have stopped speaking to her; others have held her hand through the transition.

As well, calls from clients of her software consulting business dried up after she came out, eventually forcing her to sell her childhood home in Woodstock, Ont., and move to an apartment in London.

Winning the reimbursement of her surgery costs would help put her back on a more stable financial footing, allowing her to pursue chest surgery and seek more help making her voice more feminine.

"I believe and I've always believed that my position is valid," she said.

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