Aetna Drops LGBTQ Infertility Coverage Policy Following Discrimination Lawsuit

Aetna will update its infertility treatment coverage rules just two days after a woman sued the insurer over a policy that forced LGBTQ people to pay tens of thousands of dollars out of their own pockets for procedures it offered heterosexuals without cost sharing.

The insurance company, which is owned by CVS Health, admitted that it improperly denied coverage to Emma Goidel, a 31-year-old in Aetna’s Columbia University student plan, who filed a proposed class action lawsuit against the company on Monday.

“On further consideration, some expenses were wrongly rejected after changing the coverage requirements of New York State just weeks before,” an Aetna spokesperson wrote in an email. “These costs will be covered immediately and we will look at similar cases to make sure that coverage decisions are made in line with the new requirements. We have a history of support for the LGBT community, which we will continue to develop. “

The National Women’s Rights Center, which represents Goidel, is eagerly awaiting a response from Aetna on how it plans to remedy the situation for Goidel and other LGBT patients affected by politics, the spokesperson wrote in an email. “We are pleased to know that there is interest in resolving this issue,” the spokesman said.

Aetna was unable to immediately answer the question of whether the policy would be changed nationwide. The insurer has 44.6 million members.

Under Aetna’s coverage rules, at the time the company denied coverage for Goidel fertility treatment, policyholders could only access this benefit if they were unable to conceive after a period of “regular unprotected sex” or through artificial insemination. Patients younger than 35 were required to try for 12 months, while older patients had to try 6 months. By definition, this excluded LGBTQ.

As a consequence, Goidel and her partner were forced to pay almost $ 45,000 out of pocket while trying to get pregnant. During this time, Goidel experienced two miscarriages. She is currently pregnant but faces an increased risk of complications from previous miscarriages.

Goidel’s lawsuit accuses Aetna of violating an Affordable Care Act rule that federal-funded health insurance plans cannot discriminate on the basis of sexual orientation or gender identity. The lawsuit also alleges that Aetna’s rules conflict with New York City laws that prohibit gender discrimination by service providers and public spaces.

A lawyer representing Goidel is seeking class action status in the action. The class will include over 150,000 students from 17 New York universities, subject to similar Aetna rules.

A waiver in the case was filed in the Southern District of New York on Wednesday. This allows Aetna to later challenge the jurisdiction of the court or the place where the claim was filed.