Metro Weekly

Insurance giant Aetna sued for allegedly denying coverage for fertility treatments to LGBTQ couples

Lawsuit claims policy requiring LGBTQ couples to pay out-of-pocket for up to a year before gaining coverage is discriminatory.

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Photo: Cassidy Rowell, via Unsplash

Health insurance giant Aetna, Inc. is being sued for allegedly discriminating against same-sex and LGBTQ couples by requiring them to pay more out of pocket for fertility treatments. 

In a proposed class-action lawsuit filed Monday in the U.S. District Court for the Southern District of New York, Emma Goidel, a 31-year-old Manhattan resident who received health insurance through her spouse’s insurance plan as a Columbia University student, alleges that Aetna’s policy unfairly discriminates against same-sex spouses or LGBTQ couples seeking to conceive.

Aetna’s plan for Columbia University students provides coverage for fertility treatments, including intrauterine insemination (IUI) and in vitro fertilization (IVF), without any out-of-pocket costs, to individuals who say they have not been able to conceive after having “frequent, unprotected heterosexual sexual intercourse” for 12 months, or, in cases where the female partner is 35 years of age or older, for 6 months.

However, the policy requires individuals who cannot conceive through intercourse due to their sexual orientation or gender identity to pay out-of-pocket costs for 12 cycles of IUI (or 6 cycles, if the gestational mother-to-be is older than 35) before they can receive coverage for fertility treatments under the plan reports Reuters.

In her lawsuit, Goidel claims she and her spouse were forced to spend nearly $45,000 for fertility treatments as a result of the policy’s additional burden placed on same-sex couples, as compared to opposite-sex couples. That included the cost of four unsuccessful IUI cycles, and one unsuccessful IVF cycle, before becoming pregnant through a fifth IUI cycle — all of which Aetna refused to cover.

Goidel says she chose IUI to get pregnant despite previous failures, in part, because of the higher cost of IVF.

“Ms. Goidel has endured great emotional distress in having to choose a course of treatment based on cost, rather than based on her personal and medical circumstances in consultation with her doctor,” the complaint reads. 

“Aetna’s discriminatory policy is an illegal tax on LGBTQ individuals that denies the equal rights of LGBTQ individuals to have children,” the complaint continues. “At best, these individuals incur great costs due to Aetna’s policy language. At worst, these exorbitant costs are prohibitive and entirely prevent people who are unable to shoulder them — disproportionately LGBTQ people of color — from becoming pregnant and starting a family.”

Related: New York Gov. Andrew Cuomo orders health insurers to cover fertility treatments for same-sex couples

The lawsuit also claims that Aetna is deliberately discriminating against LGBTQ couples, in violation of prohibitions on sex-based discrimination contained in Section 1557 of the Affordable Care Act, as well as in violation of New York State and New York City’s respective civil rights laws, which prohibit discrimination based on sexual orientation and gender identity.

The National Women’s Law Center, which is representing Goidel in her lawsuit, wrote a blog post about its involvement in the case and the refusal of insurers in most states to offer or cover fertility services.

“Today, only 17 states have laws requiring insurance companies to either cover or offer fertility services. Emma is fortunate to live in New York, the only state in the country that both mandates coverage of fertility services and, as of this year, made clear that state law requires insurers to cover these services equally for LGBTQ+ individuals,” the organization wrote in a statement on its website.

“We must protect access to health care, including fertility services, for all people. Aetna’s policy flies in the face of Section 1557 and state nondiscrimination law by relying on an outdated view of infertility that excludes LGBTQ+ people from equal coverage for fertility services,” the statement continues. “We are challenging Aetna in court to change this policy in New York, and to send a message to insurance companies around the country that these discriminatory policies are illegal and must end.”

A spokesperson for Aetna told Reuters it was still investigating the specific facts of Goidel’s case.

“Aetna is committed to equal access to infertility coverage and reproductive health coverage for all its members, and we will continue to strive toward improving access to services for our entire membership,” the spokesperson said in a statement.

See also:

Republican lawmaker who allegedly kicked student in balls during anti-gay tirade avoids jail time

LGBTQ ally Gov. Gavin Newsom defeats recall attempt in California

Republican Senate candidate J.D. Vance questions the existence of two-spirit people

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