Aetna updates fertility coverage following claims of LGBTQ+ discrimination

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Just two days after a class-action lawsuit claimed Aetna’s fertility treatment policies were discriminatory against the LGBTQ+ community, the health insurer announced it will update its coverage rules.

In a statement shared with Healthcare Finance News, Aetna said it had wrongly denied requests to cover fertility treatments for certain individuals and that it would rectify the mistake.

“Upon further review, certain costs were improperly denied after a change in New York State coverage requirements only weeks earlier,” an Aetna spokesperson said by statement.

“Those costs will be promptly covered, and we’ll review similar cases to ensure coverage decisions were made according to the new requirements. We have a history of support for the LGBTQ community, which we’ll continue to build on.”

WHY THIS MATTERS

The decision to update its policy follows a lawsuit filed by a woman who claimed to have paid nearly $45,000 out of pocket for fertility treatments that Aetna refused to cover.

Previously, Aetna’s policy only covered infertility treatments such as artificial insemination or in vitro fertilization after one year of  members trying to get pregnant, defined by the insurer as “regular, unprotected sexual intercourse or therapeutic donor insemination.”

But because same-sex couples cannot naturally conceive from intercourse, the policy only covered fertility treatments after 12 months of members paying for them upfront.

The suit alleged that the policy caused financial, physical and emotional harm to LGBTQ+ couples enrolled in its health plan. It also claimed that Aetna violated Section 1557 of the Affordable Care Act, New York State Human Rights Law and New York City Human Rights Law with its actions.

Although Aetna says it’s changing its policy, the lawsuit remains active, according to court records from the Southern District of New York. If it continues forward, the plaintiff is seeking a trial by jury that will declare Aetna’s policy as discriminatory, force it to end said practices and award monetary damages.

THE LARGER TREND

In another instance involving coverage, last fall, a group of California lawmakers sent letters to a number of insurers, including Aetna, urging them to fully cover noninvasive prenatal testing for all pregnant women in the state.

Despite its alleged discrimination against LGBTQ+ people in the court case, Aetna did expand its coverage of gender-affirming surgeries earlier this year to include breast augmentation for transfeminine members of most of its commercial plans.

Even with advancements in recent years, people in the LGBTQ+ community continue to face discrimination in their personal lives, in the workplace and the public sphere, and in healthcare, according to a survey by the Center for American Progress. More than one-third of LGBTQ+ Americans experienced discrimination of some kind in 2020, according to survey results.

These prejudices have long-lasting impacts on people’s health, as LGBTQ+ people are at a higher risk for cancer, mental illnesses and other diseases, and are more likely to smoke, drink alcohol, use drugs and engage in other risky behaviors, the Center for American Progress noted.

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