Legal Law

Lawsuit: Aetna fertility protection coverage “an unlawful tax” on LGBTQ folks – MedCity Information

Aetna allegedly discriminated against LGBTQ individuals by making them pay thousands of dollars out of pocket for fertility treatments, according to a new class-action lawsuit. But the Hartford, Connecticut-based health insurer claims that a change in New York State coverage requirements led to the claims denial described in the suit.

Filed in the U.S. District Court of the Southern District of New York on Monday, the lawsuit alleges that as a result of Aetna’s policy plaintiff Emma Goidel and her spouse were forced to pay nearly $45,000 out of pocket before becoming eligible for fertility coverage.

Goidel and her spouse are enrolled in Aetna’s Student Health Plan for Columbia University. The couple wants children, and since they are LGBTQ individuals, they cannot conceive through intercourse and require fertility treatments to get pregnant, such as intrauterine insemination and in vitro fertilization, both of which are broadly covered by the plan.

Aetna’s policy defines infertility as the inability to conceive after 12 months of unprotected, heterosexual intercourse. After that time period, coverage for fertility treatment kicks in.

But the insurer “requires individuals who cannot conceive through intercourse due to their sexual orientation or gender identity to pay out of pocket for 12 cycles of [intrauterine insemination] before Aetna will provide them with coverage for fertility treatments,” the suit states.

This allegedly results in LGBTQ individuals being forced to pay tens of thousands of dollars out of pocket that others are not required to pay.

“Aetna’s discriminatory Policy is an illegal tax on LGBTQ individuals that denies the equal rights of LGBTQ individuals to have children,” the lawsuit claims.

Aetna has agreed to cover the costs incurred by the plaintiff and her spouse after their fertility treatment claims were denied.

“Those costs will be promptly covered, and we’ll review similar cases to ensure coverage decisions were made according to the new [New York State coverage] requirements,” said Ethan Slavin, head of national media relations at Aetna, in an email. “We have a history of support for the LGBTQ community, which we’ll continue to build on.”

But the lawsuit goes further than reimbursement for costs incurred by the couple and asks the court to prevent Aetna from implementing and enforcing the policy. The plaintiffs are also demanding a jury trial.

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