Aetnas Fertility Benefits Discriminate On The Basis Of Sex So We Sued
Content warning: this post discusses infertility.
Emma Goidel has reached her limit. In the fall of 2020, she and her partner decided to add to their family through pregnancy. To do so, Emmaa queer womanneeded fertility services like intrauterine insemination or in vitro fertilization . But Emma encountered a problem all too common for LBGTQ+ people seeking fertility services: her insurance company Aetna refused to cover her treatment.
Aetnas reason for the denial was not that they dont cover these fertility servicesthey have generous fertility benefits, including IUI and IVF. Instead, Aetnas reason was that coverage is limited to people who are infertile, defined as the inability to conceive after 12 months of heterosexual sex or, if there is no male partner, 12 months of donor insemination. Because Emma does not have a male partner, Aetna required her to undergo 12 months of IUIon her own dimebefore they would begin covering any treatments.
Does Insurance Cover Ivf Questions For Your Insurance Company Or Employer
We understand the important role that insurance plays in your fertility treatment. After your initial physician consultation, we give every patient an opportunity to speak with an Aspire HFI financial counselor who will be available to you throughout your treatment with us. For patients who prefer to speak to their insurance company directly, weve provided a list of questions that are important to ask when directly contacting your employer or insurance company:
- Explain my benefits for diagnostic testing for infertility.
- Are there any age restrictions for infertility treatment?
- Do we need any type of prior authorization or a referral to see a specialist?
- Are there plan limitations, such as lifetime maximums or set limits, for intrauterine insemination , in vitro fertilization , or intracytoplasmic sperm injection ?
- Are there any restrictions on frozen embryo transfer cycles?
- Do I have medication coverage? Is this separate or inclusive of my other limits?
- Are donor sperm and/or donor eggs covered procedures?
- Are there genetic testing benefits?
- Do you require a waiting period before I can start treatment?
- If I have no coverage for an actual procedure, do I have any coverage for related services such as ultrasounds and blood work?
- Can you put these benefits in writing?
Vaginal Sildenafil For The Treatment Of Female Infertility
Check et al examined if sildenafil improves endometrial thickness better than vaginal estradiol in women with a history of thin endometria. Women failing to attain an 8 mm endometrial thickness on either the oocyte retrieval cycle or their 1st frozen embryo transfer despite an oral graduated E2 regimen were treated again with graduated oral E2 and were also randomly assigned to vaginal sildenafil or vaginal E2 therapy. Endometrial thickness was compared between the groups. Neither vaginal E2 nor sildenafil significantly improved endometrial thickness or blood flow in the subsequent frozen ET-cycle. The authors concluded that these data failed to corroborate previous claims that 25-mg sildenafil 4 times daily intra-vaginally can improve endometrial thickness.
Furthermore, an UpToDate review on Overview of treatment of female infertility does not mention sildenafil as a management tool.
Also Check: What Is New Health Insurance Marketplace Coverage
Support Metro Weeklys Journalism
These are challenging times for news organizations. And yet its crucial we stay active and provide vital resources and information to both our local readers and the world. So wont you please take a moment and consider supporting Metro Weekly with a membership? For as little as $5 a month, you can help ensure Metro Weekly magazine and MetroWeekly.com remain free, viable resources as we provide the best, most diverse, culturally-resonant LGBTQ coverage in both the D.C. region and around the world. Memberships come with exclusive perks and discounts, your own personal digital delivery of each weeks magazine , access to our Member’s Lounge when it launches this fall, and exclusive members-only items like Metro Weekly Membership Mugs and Tote Bags! Check out all our membership levels here and please join us today!
State Of Wisconsin Infertility And Ivf Insurance Coverage
Because our Gurnee office is close to the Wisconsin border we have many couples that come down to us for IVF treatment. Unfortunately, Wisconsin does not yet have any state mandate for infertility or IVF services to be covered. Some employers will cover it to some extent, but many provide no coverage at all.
It is fairly common for our Wisconsin patients to have some coverage for diagnostic testing, and much less common to have any coverage for treatment of infertility. About 5% of our patients from Wisconsin have insurance coverage for IVF. Hopefully, health insurance coverage for infertility and IVF in WI will become more common in the future.
Also Check: How Much Is Health Insurance In Florida
Lawsuit Claims Policy Requiring Lgbtq Couples To Pay Out
By John Rileyon September 15, 2021
Health insurance giant Aetna, Inc. is being sued for allegedly discriminating against same-sex and LGBTQ couples by requiring them to pay more out of pocket for fertility treatments.
In a proposed class-action lawsuit filed Monday in the U.S. District Court for the Southern District of New York, Emma Goidel, a 31-year-old Manhattan resident who received health insurance through her spouses insurance plan as a Columbia University student, alleges that Aetnas policy unfairly discriminates against same-sex spouses or LGBTQ couples seeking to conceive.
Aetnas plan for Columbia University students provides coverage for fertility treatments, including intrauterine insemination and in vitro fertilization , without any out-of-pocket costs, to individuals who say they have not been able to conceive after having frequent, unprotected heterosexual sexual intercourse for 12 months, or, in cases where the female partner is 35 years of age or older, for 6 months.
However, the policy requires individuals who cannot conceive through intercourse due to their sexual orientation or gender identity to pay out-of-pocket costs for 12 cycles of IUI before they can receive coverage for fertility treatments under the plan reports Reuters.
Goidel says she chose IUI to get pregnant despite previous failures, in part, because of the higher cost of IVF.
Are Benefits Offered To Transgender Employees
Yes. Transgender employees have the same benefits as all Yale employees.
Transgender employees who are managerial & professional staff, faculty, postdoctoral associates, postdoctoral fellows, clerical and technical, service and maintenance and security are eligible to receive gender affirmative surgery. Aetna and Yale Health follow many of the recommendations of the WPATH standards for care related to gender affirmation surgery.
Contact Yale HEALTH or Aetna for detailed information.
Add information, including a support group can be provided by .
Also Check: Does Colonial Life Offer Health Insurance
How Do I Know If Private Insurance Covers Fertility Services
Seventeen states have laws that require private insurers to cover some forms of infertility services, and other states are in the process of putting through legislation requiring them to cover it. If you live in Arkansas, California, Connecticut, Delaware, Hawaii, Illinois, Louisiana, Maryland, Massachusetts, Montana, New Hampshire, New Jersey, New York, Ohio, Rhode Island, Texas, or West Virginia, your private insurer has to cover some portion of your fertility treatment. Many health insurance plans offer fertility coverage outside those states, as well. To find out if your private insurance covers fertility services, contact your plan administrator.
What Were Doing About It
We must protect access to health care, including fertility services, for all people. Aetnas policy flies in the face of Section 1557 and state nondiscrimination law by relying on an outdated view of infertility that excludes LGBTQ+ people from equal coverage for fertility services. So we filed a class action lawsuit on behalf of Emma and all other similarly situated LGBTQ+ people in New York who are enrolled in Aetnas discriminatory policies. We are challenging Aetna in court to change this policy in New York, and to send a message to insurance companies around the country that these discriminatory policies are illegal and must end.
UPDATE: In November 2021, we amended our complaint to add three additional plaintiffsall of whom, like Emma, were excluded from equal coverage for fertility treatments under Aetnas discriminatory policy.
If your insurance policy unfairly discriminates against LGBTQ+ individuals or couples seeking fertility treatments, you can contact attorneys with more information in three ways:
by email: , or
You May Like: How Much Is Good Health Insurance A Month
Questions To Ask Your Insurance Company
You can get more specific information on infertility coverage by calling Member Services at the insurance company or by visiting its website. To facilitate the inquiry process you should have the following information ready: name of the insured individual, patient/employee ID number or social security number, patients name and date of birth, name of the employer, name of the plan and group number. Remember to get the full name of the person providing the information and the contact phone number . When possible you should get the information in print. Below are the questions to ask:
- Is there coverage for diagnostic testing?
- Is there coverage for treatment of infertility? If yes, which of the following is covered:
- Intrauterine insemination ?
- In vitro fertilization – Number of cycles allowed?
- Embryo freezing?
- Are the fertility drugs covered ?
- Is there a lifetime maximum benefit?
- Is there a maximum benefit per calendar year?
- Is the medication benefit included in the calculation of the lifetime maximum limit?
How Can I Confirm My Medication Coverage
Based upon your insurance plan, you may be required to use a specialty pharmacy, and/or obtain prior authorization. It is essential for you to verify if medication coverage is under your fertility benefit rider, or, your major medical, and if you are required to use a specialty pharmacy. Once your treatment plan is known, someone on your clinical team can provide you with a list of medications, allowing you to confirm coverage with your insurance. SGF also works with a preferred pharmacy, which provides discounts for self-pay patients.
Also Check: Do You Need Health Insurance To Go To Planned Parenthood
The Surrogate Will Also Need Prenatal Care And Coverage For Her Labor And Delivery
Does aetna insurance cover surrogacy. But, with some help from your american surrogacy specialist, you can find a financing solution that works for you. According to the centers for disease control and prevention , about 10 percent of u.s. This may also be covered by the intended parents insurance, but it.
While medicaid can cover a lot of health problems, it does not cover fertility treatments. California does not require insurance companies to provide health insurance coverage, but they must offer the option for infertility benefits. Among their covered fertility services, aetna offers 3 assisted reproductive technology cycles per lifetime.
If they don’t ask how you got pg or what your plans are, don’t tell. This post will mostly cover the insurance for the pregnancy. Both options are fsa/hsa eligible.
Does aetna health insurance cover ivf?. What your insurance will cover depends on your insurance, so that might be nothing, just diagnostic testing , or your entire procedure. It ensures that the surrogate and the pregnancy are protected in case any complications should arise.
Infertility is a common problem. Unfortunately, aetna does not cover anyone over 44 years of age. The insurance experts at ivf1 will make certain that your insurance policys benefits are maximized as a financial source to cover your infertility treatment.
Pay up front with our single pay option, or via easy monthly payments with smilepay with no credit check required.
Centers Of Excellence Network
Aspire Houston Fertility Institute is a proud member of both the OptumHealth Center of Excellence network offered through United Healthcare and the Blue Distinction program offered through Blue Cross Blue Shield. These networks recognize medical centers and programs with proven experience and statistically successful track records.
Don’t Miss: How To Find The Best Private Health Insurance
Blue Cross Blue Shield Ivf Coverage
1310 G Street, NW Washington, DC 20005
The Blue Cross Blue Shield Association stands out as one of the most recognized insurance providers in the U.S. and worldwide. The company covers all aspects of healthcare including infertility treatments such as IVF and IUI for its policyholders.
For IVF services, BCBSA gives coverage to members if only specified in the member contract. The number of services covered are linked to the procedure such as ovulation stimulation and monitoring, oocyte retrieval, and lab studies. Members may also be covered for assessing and transferring embryo as well as any radiology or ultrasound services.
Other services that are received as part of an IVF procedure get the same benefits as the procedure itself. These can include coverage for medication, lab work, and pathology. Associated surgical procedures and radiology services are also included.
In cases where mechanically assisted fertilization such as Zona drilling is involved, Blue Cross Blue Shield members get covered for the procedure as well. Others such as intracytoplasmic sperm injection are also covered.
Some cases of IVF treatment may also use additional associated procedures that get coverage such as:
- Microscopic epididymal sperm aspiration
- Testicular sperm extraction
- Testicular sperm aspiration
This makes it very important to thoroughly go through the Blue Cross Blue Shield members benefit booklet to verify how much coverage you are eligible for.
Aetna Sued Over Fertility Treatment Coverage For Lgbt+ People
Logos of CVS and Aetna are displayed on a monitor above the floor of the New York Stock Exchange shortly after the opening bell in New York, U.S., December 5, 2017. REUTERS/Lucas Jackson
- Related documents
- Insurer required LGBT+ people to pay for treatment out of pocket before being covered, lawsuit says
- Plaintiff seeks to represent statewide class of student health plan beneficiaries
– Health insurer Aetna Inc has been sued for allegedly discriminating against beneficiaries that are lesbian, gay, bisexual, transgender and other gender identity iterations by requiring them to pay more out of pocket for fertility treatments.
In a proposed class action filed Monday in federal court in Manhattan, plaintiff Emma Goidel said she and her spouse were forced to spend nearly $45,000 for fertility treatments as a result of Aetna’s policy, which required same-sex couples to pay for fertility treatment out of pocket before becoming eligible for coverage.
A spokesperson for Aetna, which was acquired by CVS Health Corp in 2018, said We … are still actively investigating the facts. Aetna is committed to equal access to infertility coverage and reproductive health coverage for all its members, and we will continue to strive toward improving access to services for our entire membership.
She said she chose IUI despite previous failures in part because of the higher cost of IVF.
For Aetna: Not immediately available
You May Like: How To Get The Health Insurance
Does Cigna Health Insurance Cover Fertility Treatments
Once an individual meets the definition of infertility as outlined in the benefit plan or as listed above, the following services associated with establishing the etiology of infertility are generally covered under the medical benefits of the infertility plan option when available.
Best Fertility Insurance Companies
- Best for Multiple Rounds of Treatment: Blue Cross Blue Shield
- Best for Additional Resources: Aetna
Why We Chose It: United Healthcare is our overall pick for fertility insurance because of its expansive network, solid reputation, and coverage for infertility services, including ovulation induction, insemination, and Assisted Reproductive Technologies.
Available in all 50 states
A smartphone app that integrates with medical records
Infertility treatments likely limited to 19 mandated states
IVF may not be covered
Not available in some counties
More expensive than some competitors
For couples trying to conceive, having an insurers safety net that covers infertility treatments is invaluable. United Healthcare took our position as the overall fertility insurance choice with their giant provider network, supreme reputation, and coverage for a range of infertility treatments.
United Healthcare has a network of more than 1.3 million doctors and 6,500 hospitals and other facilities nationwide, including in the 19 states with mandated fertility insurance coverage laws. They have an A rating for financial stability from AM Best and are rated 4.0 or better out of a maximum of 5 for six of their health insurance plans in the National Committee for Quality Assurance ratings.
You can find a quote and purchase a plan on United’s online portal or the ACA Marketplace. Offerings begin with the basic bronze plan through to comprehensive platinum level coverage.
Recommended Reading: What Is On Exchange Health Insurance
How Do I Find The Best Private Medical Insurance For Fertility Treatment
Speak to an expert first! We pride ourselves in arranging perfectly tailored insurance cover to our customers, and the best way to ensure you get the most suitable plan for your needs is to speak to us directly.
We understand that this is a sensitive topic, but you can rest assured that youll be in safe hands. We only work with experienced, qualified advisors, and have whole-of-market access to insurance providers covering all niches.
Give us a call on 0808 189 0463 or make an enquiry and well discuss your situation in more detail and advise you on the next steps to take.
+ Does Aetna Insurance Cover Freezing Eggs Images
Least cost medically necessary brands. Does my health insurance plan cover fertility treatments? Before purchasing a health insurance policy, make sure your insurer covers the procedure you want. It may take some work but you should be able to check each of the insurance companies. In order to be eligible for coverage, you must be under age 46 and. Look into the fertility options available to you, and discover which are covered by your health insurance plan.
If youre wondering does aetna cover egg freezing, or if private insurance providers such as blue cross help with the costs, you should know that some insurance companies may share the cost with you if a doctor determines egg freezing is medically necessary for example, if you are undergoing chemotherapy that could impact your. I believe those employees of aetna are heartless. An egg or sperm donor when it has not been deemed medically necessary. Also reimbursement to freeze eggs is provided if there is a medical cause involved like chemotherapy, or some surgery that would get in the way of a natural pregnancy It may take some work but you should be able to check each of the insurance companies. Hmos are required to cover infertility services as part of basic healthcare services.
Recommended Reading: Does Health Insurance Cover Baby Formula