Aetna’s coverage rules for infertility treatment are biased against LGBTQ patients, who are required to pay tens of thousands of dollars out of pocket even though heterosexual people face no cost sharing for the same care, the National Women’s Law Center alleges in a federal lawsuit filed Monday.
The suit, filed in the Southern District of New York, arises from a series of coverage denials faced by Emma Goidel, a 31-year-old woman covered under a Columbia University student plan administered by Aetna, which is owned by CVS Health.
The Aetna policy covers infertility services for individuals under 35 who fail to conceive after 12 months of “regular, unprotected sex” or via artificial insemination. For people over 35, Aetna covers infertility services for those who fail to conceive after six months. In all cases, Aetna’s definition of failing to conceive from “regular, unprotected sex” applies only to cisgender individuals and excludes LGBTQ people.
“Aetna’s discriminatory policy is an illegal tax on LGBTQ individuals that denies the equal rights of LGBTQ individuals to have children,” the complaint says.
Because Goidel and her partner are unable to have children according to Aetna’s definition of “regular, unprotected sex,” the insurer forces them to pay for at least 12 months of artificial insemination, violating state and federal laws that prohibit insurers from discriminating against enrollees’ sex or gender, the lawsuit says.
Aetna is investigating the facts behind the complaint, a spokespersom wrote in an email. “Aetna is committed to equal access to infertility coverage and reproductive health coverage for all its members,” the spokesperson wrote. “We will continue to strive toward improving access to services for our entire membership.”
The complaint has identified at least 17 other New York-based universities with similar Aetna policies, including the Icahn School of Medicine at Mt. Sinai, New York Medical College and Cornell University. The plaintiff’s attorneys seek to represent more than 150,000 students currently enrolled at these universities, as well as any future students who will be impacted by Aetna’s rules, in a class action.
“At best, these individuals incur great costs due to Aetna’s policy language,” the lawsuit says. “At worst, these exorbitant costs are prohibitive and entirely prevent people who are unable to shoulder them—disproportionately LGBTQ people of color—from becoming pregnant and starting a family.”
In September 2020, Goidel’s physician requested prior authorization for six cycles of intrauterine insemination. The same month, Aetna denied her claim because she did not meet the insurer’s standard for infertility.
Goidel went ahead with the procedures and paid for the out-of-pocket costs, spending more than $20,000 over the course of seven months for five cycles of intrauterine insemination. After her second cycle, Goidel experienced a miscarriage. After her fourth cycle, her doctor recommended in vitro fertilization, a costlier method the physician thought would be more successful. Goidel and her partner decided to try one more round of intrauterine insemination; she failed to get pregnant.
This May, the couple decided to attempt in vitro fertilization and Goidel’s doctor submitted a claim for coverage to Aetna, which the insurer denied because she had not attempted 12 rounds of artificial insemination. Goidel and her partner decided to pay for the nearly $20,500 in vitro fertilization procedures out of pocket and, two months later, Goidel experienced another miscarriage. Later that month, she and her partner decided to try another cycle of intrauterine insemination, which cost them $1,810.
Goidel’s sixth round of intrauterine insemination was successful and, after a year of trying and spending nearly $45,000, Goidel is now seven weeks pregnant. But because she has already experienced two miscarriages, she faces a significantly higher risk of losing another child, the lawsuit says. The couple continue to pay to store Goidel’s eggs for another round of intrauterine insemination.
The lawsuit claims that Aetna’s policy violates the Affordable Care Act rule that health plans receiving federal funding cannot discriminate on the basis of sexual orientation or gender identity. The insurer’s coverage also violates New York laws that prohibit sexual discrimination by providers and sites of public accommodation, according to the suit.
The plaintiff, who is represented by the National Women’s Law Center and the law firm Emery Celli Brinckerhoff Abady Ward & Maazel, aims to force Aetna to retract its policy. Goidel also seeks compensatory damages, punitive damages, reimbursement for attorney’s fees and any other relief the court deems just and equitable.