Aetna said Wednesday it will now cover costs for fertility treatment after a federal discrimination lawsuit by a woman in a same-sex marriage.
“Upon further review, certain costs were improperly denied after a change in New York state coverage requirements only weeks earlier,” the Hartford insurer said in an emailed statement. “Those costs will be promptly covered and we’ll review similar cases to ensure coverage decisions were made according to the new requirements.”
“We have a history of support for the LGBTQ community, which we’ll continue to build on,” said Aetna, a subsidiary of CVS Health Corp.
Emma Goidel, who became pregnant on her sixth try, accused Aetna in a federal lawsuit of discrimination by requiring out-of-pocket payments by LGBTQ couples for fertility treatment before coverage applies while providing immediate payment for heterosexual couples.
She and her spouse are enrolled in Aetna’s Student Health Plan for Columbia University. Goidel’s lawsuit says the policy provides broad coverage for intrauterine insemination, or IUI, and in vitro fertilization, or IVF.
The National Women’s Law Center and a New York law firm that represent Goidel did not immediately return calls seeking comment.
In her lawsuit filed this week in U.S. District Court in New York, Goidel said she paid nearly $45,000 for one successful pregnancy after a half-dozen attempts. The legal action blames Aetna’s “discriminatory policy” for forcing Goidel and her partner to choose the less expensive IUI over IVF.
She submitted a claim for IVF coverage to Aetna in May, but was denied because she did not meet the requirement “for a member under 35 years of age” of being “unable to conceive or produce conception after at least one year despite frequent, unprotected heterosexual sexual intercourse, or at least 12 cycles of donor insemination if there is no male partner.”
She claimed “great emotional distress” by being forced to choose a course of treatment based on cost, rather than her personal and medical circumstances in consultation with her doctor.
Goidel cited a directive from the New York state Department of Financial Services that regulates insurers. The agency said in a bulletin in February 2021 that an insurance policy requiring LGBTQ individuals to pay out of pocket as a precondition for fertility treatments is considered discrimination under state law, according to the lawsuit.
To prevent discrimination, the Department of Financial Services directive ordered insurers to provide immediate coverage for basic infertility treatments available to individuals covered under an insurance policy or contract who are unable to conceive due to their sexual orientation or gender identity, the lawsuit said.
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