Same-sex couples are subject to insurance discrimination for fertility treatments

Key takeaways

  • A class action lawsuit was filed against Aetna for discriminating against same-sex couples seeking fertility treatments.
  • Same-sex couples who cannot prove infertility according to the insurance policy standards must pay for six to 12 out-of-pocket treatment cycles before they are eligible for insurance coverage.
  • Aetna is not the only insurance company that denies same-sex fertility coverage.

When Emma Goidel and her husband Ilana decided to start a family, they knew it would come at a high price.

Major insurance companies such as Aetna, Cigna and United Healthcare cover fertility treatments for heterosexual couples who cannot become pregnant after about a year of unprotected sex. But they do not always offer the same benefits to same-sex couples. In Goidel’s case, she was forced to pay for fertility treatments out of her own pocket.

Same-sex couples are often asked to show receipt of multiple failed rounds of fertility treatments to qualify for insurance coverage.

According to Goidel, she and her husband spent $ 8,500 on two rounds of intrauterine insemination (IUI) before giving birth to their first daughter in 2019. These treatment fees felt discriminatory, she said, as a kind of “queer treasure.” But at the time, they also felt it was the norm of society. Fertility clinics have coached some of Goidel’s queer friends to lie about having sex with men in order to access health benefits, she added.

After the birth, she decided it was a societal norm she wanted to change.

“I thought a lot more about what it takes for queer people to become parents,” Goidel told Verywell. “Something that I had accepted the status quo years ago is no longer acceptable to me.”

Intrauterine insemination (IUI)

IUI is a process that uses artificial insemination, in which semen is injected into a person’s uterus around the time of ovulation.

Goidel applied for fertility coverage through Aetna’s health insurance plan for Columbia University students, but her request and appeal were both denied. She then filed a class action lawsuit with lawyer Noel León against the company for gender-based discrimination.

Aetna defines infertility as being unable to conceive after “frequent, unprotected heterosexual intercourse” for at least six months to a year, depending on age. However, same-sex partners must pay for six or 12 cycles of fertility treatment with a donor sperm, where the exact number of cycles is determined by their age.

“We believe this is the first lawsuit that challenges insurers’ coverage policies regarding fertility treatment for LGBTQIA individuals,” León told Verywell.

The case alleges that Aetna’s New York policy violates the provision of non-discrimination in the Affordable Care Act. Several women have joined the lawsuit since Goidel filed his complaint in September.

More on IUI

IUI has a success rate of up to 17% for people under 40 when combined with drugs that induce ovulation. Each treatment costs about $ 1,000 without medication. People who become pregnant by IUI require an average of two to three cycles.

In New York, insurance providers are mandated to cover fertility treatments. 14 other states mandate to cover fertility treatments.

León said their goal is for Aetna to stop demanding that LGBTQ + people pay their own pocket for fertility treatments, and to offer them the same benefits as hetero- and cis-sexes.

“There may be an assumption among LGBTQ + people that this type of treatment is ‘just the norm’ and there is nothing they can do about it,” León said. “We hope this lawsuit can show people that it’s actually illegal and discriminatory, and we do not just have to sit back and pay out of pocket – that you can potentially argue for your equal treatment and coverage.”

What about in vitro fertilization (IVF)?

Instead of IUI, some couples opt for in vitro fertilization (IVF), which has higher pregnancy success rates. IVF is more invasive and more expensive than IUI, but its effectiveness can potentially lower overall costs. The average price for IVF is around $ 19,000 per day. cycle without medication and has a success rate of around 25-55% for people under 40 years. You can fill out a form on the CDC website to answer questions about your health and your pregnancy history and get an estimate of your likely IVF success based on available data from fertility clinics.

It is a widespread problem

Since Aetna’s policy requires same-sex couples to undergo up to 12 rounds of treatment before receiving coverage, they can become pregnant without ever being eligible. They may also decide to stop the process early due to financial burdens or exhaustion.

Although this case is directed at Aetna’s New York policy, LGBTQ + individuals face barriers to fertility coverage in other insurance companies and states.

Alison Tanner, a lawyer from the National Women’s Law Center who represents the class action lawsuit along with León, told Verywell that the problem is widespread but difficult to quantify. It is challenging to locate people who were intimidated by the cost because they never sought fertility treatments in the first place, she said.

“This is a big reason why we brought this as a class action lawsuit because we want to change the policy to help the people who are prevented from starting a family in the first place by inequality,” Tanner added.

Goidel is joined by three other plaintiffs in the complaint, all of whom are of the same sex and have been denied fertility coverage by Aetna.

“It is very outrageous that this is the case in 2021,” Lesley Brown, another plaintiff in the complaint, told Verywell. “It says that a heterosexual couple who cannot get pregnant is worthy of fertility treatment, whereas a same-sex couple who cannot get pregnant at home is not.”

Goidel, who spent nearly $ 45,000 on fertility treatments for her second pregnancy, said she feels hope the law is on her side.

“I’m able to talk about this experience and pursue this lawsuit because I got pregnant,” Goidel said. “It’s helpful to be able to make my negative experiences useful to other people.”

What this means for you

When it comes to financing fertility treatments, many insurance companies require members to prove infertility first. However, for LGBTQ + couples who do not have heterosexual intercourse or may not be infertile to begin with, this is not always possible. A class action lawsuit has now been filed against Aetna for gender-based discrimination.

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