Aetna walks back LGBTQ infertility coverage policy after discrimination lawsuit


Aetna will update its coverage rules for infertility treatment just two days after a woman sued the insurer over its policy that forced LGBTQ individuals to pay tens of thousands of dollars out of pocket for procedures that it offered to heterosexual people with no cost-sharing.

The insurer, which is owned by CVS Health, acknowledged it improperly denied coverage to Emma Goidel, a 31-year-old covered under an Aetna plan for Columbia University students who filed the proposed class-action against the company Monday.

“Upon further review, certain costs were improperly denied after a change in New York state coverage requirements only weeks earlier,” an Aetna spokesperson wrote in an email. “Those costs will be promptly covered, and we’ll review similar cases to ensure coverage decisions were made according to new requirements. We have a history of support for the LGBTQ community, which we’ll continue to build on.”

The National Women’s Law Center, which represents Goidel, is looking forward to hearing from Aetna about how it planned to remedy the situation for Goidel and other LGBTQ patients harmed by the policy, a spokesperson wrote in an email. “We are pleased to learn that there is interest in resolving the matter,” the spokesperson said.

Aetna could not immediately respond to an inquiry about whether the policy would be modified nationwide. The insurer has 44.6 million members.

Under Aetna’s coverage rules at the time the company denied coverage for Goidel’s infertility treatments, policyholders could only access that benefit if they failed to conceive after a period of “regular, unprotected sex” or via artificial insemination. Patients under 35 had to try for 12 months and old patients for six months. By definition, this excluded LGBTQ people.

As a consequence, Goidel and her partner were forced to pay nearly $45,000 out of pocket trying to get pregnant. Goidel experienced two miscarriages during that time. She currently is pregnant but faces higher risks of complications because of the previous miscarriages.

Goidel’s suit accused Aetna of violating the Affordable Care Act’s rule that health plans receiving federal funding cannot discriminate on the basis of sexual orientation or gender identity. The lawsuit further claims Aetna’s rules were against New York laws prohibiting sexual discrimination by providers and sites of public accommodation.

The attorney representing Goidel seeks class-action status for the lawsuit. The class would include more than 150,000 students at 17 universities in New York who are covered by similar Aetna policies.

A waiver of the service for summons for the case was filed in the Southern District of New York on Wednesday. This allows Aetna to later object to the jurisdiction of the court or to the location where the lawsuit was filed.


Source: modernhealthcare.com

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