After a lawsuit by a queer mom, insurance giant Aetna has said it improperly denied her fertility coverage and will review similar cases. Whether this means a larger change towards equal treatment of LGBTQ people under their policies remains an open question.
Under Aetna’s policy, there were only two ways to qualify for coverage of (in)fertility treatments: tell Aetna you’ve been having regular, unprotected sexual intercourse for 12 months (or 6 months if the person with the womb is over 35), or have 12 (or 6) months of “therapeutic donor insemination” (intrauterine insemination, or IUI) first, paid for out of pocket, according to the lawsuit filed Monday (PDF). For single people and many LGBTQ people, the only option is the latter. That means that those LGBTQ people have to pay thousands of dollars out of pocket before they can access the same benefits that different-sex couples get simply by stating that they’ve been having regular, unprotected sex.
That’s exactly what happened to Emma Goidel, who was covered by Aetna’s policy for Columbia University through her spouse, a student there. Before she could qualify for Aetna’s fertility coverage, though, Goidel had to pay nearly $45,000 for multiple attempts at IUI and then in vitro fertilization (IVF) when IUI was unsuccessful. She had two miscarriages during this time. She had even delayed trying IVF because it was more expensive, even though her doctor had suggested it as an option based on her medical history. This meant more time trying to get pregnant and more “emotional distress” at having to delay her doctor’s recommended treatment, her lawsuit states. Goidel, 31, is now seven weeks pregnant, but older than she would have been had Aetna not delayed her coverage—and age reduces her ability to get pregnant again, if she either has another miscarriage or wants another child after this one.
Aetna’s policy, Goidel’s lawsuit says, violates a New York law that says “an insurance policy requiring LGBTQ+ individuals to pay out of pocket as a precondition for fertility treatments constitutes discrimination” and violates the Affordable Care Act’s anti-discrimination provisions.
On Thursday, Aetna admitted that “certain costs were improperly denied after a change in New York state coverage requirements only weeks earlier,” reported Modern Healthcare, and “will be promptly covered.” The company will also review similar cases, but as of this writing, it is unclear if it will change its policy nationwide or just in New York.
Goidel’s lawsuit, filed with the help of the National Women’s Law Center and law firm Emery Celli Brinckerhoff Abady Ward & Maazel LLP, is also attempting a class action on behalf of all people covered by Aetna’s student health plans in New York. The schools covered by such plans enroll a total of 150,000 students. It remains to be seen whether Aetna’s actions Thursday are enough for the lawsuit to be dismissed.
As I’ve written before, some companies, such as MassMutual, J.P. Morgan, and others, are not requiring their employees to obtain pre-authorization for (in)fertility benefits in any state. That’s a key step towards truly equal benefits and one that more companies and insurers should follow. HRC’s Corporate Equality Index, which measures LGBTQ-friendly policies and practices, “does not currently evaluate family formation benefits,” according to a spokesperson, who said, however, that they are “considering it for future criteria changes.”
