Anyone ever sued insurance company over fertility treatments?

[Anonymous]

to straight PP, The problem is that insurance companies deny fertility coverage to lesbians even if they meet the medical eligibility criteria & that is discrimination...& coverage would be equalling the playing field--not providing coverage "at [your] expense". I met eligibility under medical guidelines (i.e. documented infertility through less expensive treatments, removal of fallopian tube, etc), but could not use my "husband's sperm" as defined in the policy. I did not expect them to pay for any of the cost associated with sperm donation, just the procedure itself.

[Anonymous]

Anonymous wrote:

Anonymous wrote:In honesty, why should insurance companies pay for fertility treatments unless there is a medical issue?

I am perfectly happy to see a gay or lesbian become a parent, but it shouldn't be at my expense.

Yes. I feel the same way about all the straight people who keep popping them out. Why should gay people have to pay for you to have child after child since my insurance is the same rate as a family with 7 or 8 kids would be. I am paying for you to keep breeding and it pisses me off. I shouldn't have to pay for your little snot nosed brats to get well visits just because sperm is free for you and it's an after thought to keep reproducing. Pay for your own expenses and stop ruining our insurance rates.

You realize, of course (though probably not at all), that this is not even close to the same thing. First of all, your children WOULD be covered in the same manner as children of heterosexual couples. You also realize that the average number of children in a straight family is minimal to the average amount of children in a homosexual one. And finally, you realize that I never hinted that your children shouldn't be covered.

The point is that insurance companies do not pay for procedures that are not medically necessary - aka to fix something that is broken. Personally, I do not think that any fertility treatments should be covered. But if they are, I only believe that it should be done when there is a problem with the reproductive organs. I don't think that straight families who get frustrated over not getting pregnant as fast as they want to should qualify. And I don't think that homosexuals with healthy organs should apply.

I am sorry to tell you this, but there is a difference between equal rights and preferential treatment. You are asking for the latter.

[Anonymous]

Anonymous wrote:to straight PP, The problem is that insurance companies deny fertility coverage to lesbians even if they meet the medical eligibility criteria & that is discrimination...& coverage would be equalling the playing field--not providing coverage "at [your] expense". I met eligibility under medical guidelines (i.e. documented infertility through less expensive treatments, removal of fallopian tube, etc), but could not use my "husband's sperm" as defined in the policy. I did not expect them to pay for any of the cost associated with sperm donation, just the procedure itself.

Thank you for clarifying and putting forth an argument in an intelligent and reasonable way (unlike the poster before you). In this case, I would definitely agree that it is an act of discrimination.

[Anonymous]

Anonymous wrote:Has anyone ever heard of a straight couple that had to use donor sperm denied by an insurance company? Many insurance companies have a policy that they won't pay if you use donor sperm. I wonder how strictly they enforce that.

Yes, my friend (a nurse) tried to get her insurance company to pay for IVF using donor sperm because her husband was completely infertile. No dice. She consulted two different lawyers and both told her there were no reasonable grounds to pursue a lawsuit. She and her husband simply paid out of pocket.

[Anonymous]

Just reading these postings about Carefirst BCBS now - are you saying that Carefirst now covers IVF as a matter of policy or that it's possible to fight for it on an individual basis? Does anyone have info on whether there is coverage for IVF deemed medically necessary (using donor sperm and one partner's eggs)? thanks!

[Anonymous]

I would also love to hear more about getting Care First BC/BS to pay fertility treatments. They told me wouldn't pay for IUI unless I was married -- I was a bit naive at time and just couldn't believe it was true. But found out later standard practice and thus very intrigued to hear that someone was able to fight it.

[Anonymous]

We are facing the same issues with Carefirst, we are not married and need IVF treatment, and will be denied. Any suggestions on how to fight back? It seems that it is possible, but time is critial for us. We are in Maryland, and it is darn obvious that it is iligal to deny service on bases of marital status, however, how to start addressing this? An initial letter to Carefrist on our behalf or an attorny?javascript:void(0);

[Anonymous]

Anonymous wrote:We are facing the same issues with Carefirst, we are not married and need IVF treatment, and will be denied. Any suggestions on how to fight back? It seems that it is possible, but time is critial for us. We are in Maryland, and it is darn obvious that it is iligal to deny service on bases of marital status, however, how to start addressing this? An initial letter to Carefrist on our behalf or an attorny?javascript:void(0);

IVF treatment is one of Maryland's mandated health benefits, and its criteria are specified in State law. So that's what an insurer must provide in certain markets. And I believe that limits it to the spouse's sperm and egg (so no donors). Insurance Article 15-810, FYI.

There's definitely a legitimate argument that this discriminates against same-sex couples. It's not an issue I've dealt with at any length, but a cheap way to get some relief "may" be to contact your local State Senator or Delegate (the more the better quite honestly) and see if the law itself can be changed to mandate this benefit for those in domestic partnerships or some other specified criteria. They can't open it up to the general population (i.e., unmarried partners, surrogates, sperm bank donations, etc.) because that would be outrageously expensive and would most likely die before it ever reached committee. But you might have some success based on the State's own anti-discrimination laws, etc., which do cover discrimination based on sexual orientation.

The General Assembly's legislative session starts in January, so if you think you want to try this, start now. It generally takes at least two years for a mandated benefit to be passed or amended. The Maryland Health Care Commission contracts with Mercer to do a cost-benefit analysis of the proposed benefit, and the General Assembly doesn't like to pass these things until they see a definitive cost on paper. Just putting it out there, though, if anyone is interested.

[Anonymous]

Why will companies pay for fertility treatments and not adoption? If you think about it, adopting is much better for the adoptive mother's health b/c she is not going through a pregnancy. Certainly birthing a child costs money, not to mention if a c-section is needed plus all the monthly dr's visits. I'm not trying to be snarky...just a serious question. FWIW, I've adopted a child AND birthed one so I have interests in both camps.

[Anonymous]

Anonymous wrote:Why will companies pay for fertility treatments and not adoption? If you think about it, adopting is much better for the adoptive mother's health b/c she is not going through a pregnancy. Certainly birthing a child costs money, not to mention if a c-section is needed plus all the monthly dr's visits. I'm not trying to be snarky...just a serious question. FWIW, I've adopted a child AND birthed one so I have interests in both camps.

For starters, we are talking about health insurance companies. You purchase health insurance to pay for medical procedures -- originally, medically necessary procedures that were unforeseen and more expensive than you could afford to pay for yourself, but the lines have gotten blurry on that over the years (e.g., what is "medically necessary", most insurers cover routine preventive care (to some degree), etc.).

Anyway, adoption isn't a medical expense, so why would a health insurance company be expected to pay for it? You may equate adoption and fertility treatments/pregnancy/delivery as two different ways to get a child -- but they aren't really equivalent when you are considering the purpose of health coverage.

[Anonymous]

Anonymous wrote:

Anonymous wrote:Why will companies pay for fertility treatments and not adoption? If you think about it, adopting is much better for the adoptive mother's health b/c she is not going through a pregnancy. Certainly birthing a child costs money, not to mention if a c-section is needed plus all the monthly dr's visits. I'm not trying to be snarky...just a serious question. FWIW, I've adopted a child AND birthed one so I have interests in both camps.

For starters, we are talking about health insurance companies. You purchase health insurance to pay for medical procedures -- originally, medically necessary procedures that were unforeseen and more expensive than you could afford to pay for yourself, but the lines have gotten blurry on that over the years (e.g., what is "medically necessary", most insurers cover routine preventive care (to some degree), etc.).

Anyway, adoption isn't a medical expense, so why would a health insurance company be expected to pay for it? You may equate adoption and fertility treatments/pregnancy/delivery as two different ways to get a child -- but they aren't really equivalent when you are considering the purpose of health coverage.

Ah, I understand now. You're right- adoption isn't a medical expense. Thanks!

[Anonymous]

Anonymous wrote:

Anonymous wrote:Why will companies pay for fertility treatments and not adoption? If you think about it, adopting is much better for the adoptive mother's health b/c she is not going through a pregnancy. Certainly birthing a child costs money, not to mention if a c-section is needed plus all the monthly dr's visits. I'm not trying to be snarky...just a serious question. FWIW, I've adopted a child AND birthed one so I have interests in both camps.

For starters, we are talking about health insurance companies. You purchase health insurance to pay for medical procedures -- originally, medically necessary procedures that were unforeseen and more expensive than you could afford to pay for yourself, but the lines have gotten blurry on that over the years (e.g., what is "medically necessary", most insurers cover routine preventive care (to some degree), etc.).

Anyway, adoption isn't a medical expense, so why would a health insurance company be expected to pay for it? You may equate adoption and fertility treatments/pregnancy/delivery as two different ways to get a child -- but they aren't really equivalent when you are considering the purpose of health coverage.

Yes, but for those who are infertile, many insurance companies (mine included) do not cover fertility treatments. I have a medical diagnosis (Endometriosis) which has destroyed my ovaries and fallopian tubes but my insurance company (Anthem BC/BS) won't pay one penny towards IVF treatments - which is the only way I can conceive.

[Anonymous]

Anonymous wrote:In honesty, why should insurance companies pay for fertility treatments unless there is a medical issue?

I am perfectly happy to see a gay or lesbian become a parent, but it shouldn't be at my expense.

There's a thread on another forum about a couple where the husband can't orgasm (with his wife, he's fine manually), and they're being advised to seek infertility treatment. The doctor's and insurance companies simply ask "how long have you been trying?" They don't ask - how many times a month, have you been charting, or does your husband actually send his sperm into your vagina? My guess is a good portion of the "unexplained infertility" diagnoses among straight couples is a result of not having consummated sex at the right time. (And, I say this as someone with this diagnosis who did have sex at the right time.)