Aetna accused of refusing fertility treatment coverage for LGBTQ + policyholders

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Without coverage, 12 cycles of fertility treatments can cost tens of thousands of dollars out of pocket, according to the complaint. (Photo: Shutterstock)

The National Women’s Law Center has filed a one-of-a-kind lawsuit against an insurance company alleging that Aetna discriminates against LGBTQ policyholders in its coverage of fertility treatments.

The class action lawsuit, filed in federal court in the Southern District of New York on Monday, claims that Aetna’s policy covers people with “infertility,” defined as those who, after 12 months, have not become pregnant after having had unprotected sex or after receiving “therapeutic donor insemination”. LGBTQ people, however, cannot conceive through sex, relying instead on fertility treatments such as intrauterine insemination (IUI) or in vitro fertilization (IVF).

Without coverage, 12 cycles of fertility treatments can cost tens of thousands of dollars out of pocket, according to the complaint. The plaintiff in this case, Emma Goidel, a 31-year-old woman who is insured by Aetna through her spouse’s student health plan at Columbia University, spent nearly $ 45,000 on seven separate treatments to obtain a successful pregnancy.

“We understand that there have been no other lawsuits like this against insurance companies disputing their fertility allowance. We believe this is the first such trial, ”said Noel Leòn, of Emery Celli Brinckerhoff Abady Ward & Maazel of New York, who has partnered with the National Women’s Law Center to bring the case forward. “It’s really a tax on same-sex couples and policyholders. “

The lawsuit was filed on behalf of two classes of New Yorkers: those who have been denied coverage by Aetna’s student health plan, and those who will be denied, “because of their sexual orientation or their gender identity ”.

The complaint says student health plans with “identical language” to Aetna’s exist at Barnard College of Columbia University, Brooklyn Law School, Cornell University, Fashion Institute of Technology, Hofstra University, Icahn School of Medicine, Manhattanville College, New York Film Academy. , New York Institute of Technology, Pratt Institute, Rochester Institute of Technology, Syracuse University, SUNY Maritime College and Purchase College, University of Rochester and several schools of Touro College & University System.

“We’re dropping it off for a class, looking for other people who paid out of pocket or completely prevented from getting pregnant because of their sexual orientation or gender identity in that type of provision of a plan health care, ”Leòn said. .

A spokesperson for Connecticut-based Aetna released an emailed statement: “We only learned of this lawsuit this morning and we are still actively investigating the facts. Aetna is committed to ensuring equal access to infertility and reproductive health coverage for all of its members, and we will continue to strive to improve access to services for all of our members. .

The lawsuit seeks an injunction to change Aetna’s policies, as well as damages. He claims that Aetna’s policy violates the anti-discrimination provisions of the Patient Protection and Affordable Care Act and the human rights laws of the City and State of New York.

“Aetna therefore imposes significant reimbursable fees on these LGBTQ people that it does not impose on others before allowing LGBTQ people to qualify for Aetna’s insurance coverage for fertility treatments,” the complaint states. “At worst, these exorbitant costs are prohibitive and completely prevent those unable to afford them – disproportionately LGBTQ people of color – from getting pregnant and starting a family. “

The complaint also claims that the New York City Department of Financial Services, which regulates health insurance companies, issued a bulletin in February this year indicating that policies requiring LGBTQ + people to pay out of pocket before getting coverage for fertility treatment constitutes illegal discrimination on the basis of gender identity and sexual orientation.

“Aetna’s discrimination is willful,” says the complaint.

Leòn is the former Acting Director of State Abortion Access and Senior Counsel at the National Women’s Law Center, located in Washington DC. Zoe Salzman, a partner at Emery Celli who is also involved in the case, represented one of the women interviewed as part of the New York Attorney General’s investigation into the sexual harassment allegations against the former governor of New York Andrew Cuomo.

This the costume has surfaced by BenefitsPRO’s sister site, Law.com Radar, a source of high-speed legal news and litigation updates tailored to your practice. Law.com Radar posts daily updates on newly filed federal cases like this one. Click here to get started and be the first to hear about new suits in your region, practice area or client area.


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