Same-Sex Couples Face Insurance Discrimination for Fertility Treatments

fertility clinic illo

Verywell Health / Theresa Chiechi

Key Takeaways

  • A class-action lawsuit was filed against Aetna for discriminating against same-sex couples who seek fertility treatments.
  • Same-sex couples who cannot prove infertility by the insurance policy standards must pay for six to 12 cycles of treatment out-of-pocket before they're eligible for insurance coverage.
  • Aetna is not the only insurance company that denies fertility coverage for same-sex couples.

When Emma Goidel and her spouse Ilana decided to start a family, they knew it would come at a steep price.

Major insurance companies like Aetna, Cigna, and United Healthcare cover fertility treatments for heterosexual couples who cannot get pregnant after about a year of unprotected sex. But they don’t always offer the same benefits to same-sex couples. In Goidel’s case, she was forced to pay for fertility treatments out of pocket.

Same-sex couples are often asked to show receipt of multiple failed rounds of fertility treatments to qualify for insurance coverage.

According to Goidel, she and her spouse spent $8,500 on two rounds of intrauterine insemination (IUI) before giving birth to their first daughter in 2019. These treatment fees felt discriminatory, she said, like a kind of “queer tax.” But at the time, they also felt like it was the societal norm. Fertility clinics have coached some of Goidel’s queer friends to lie about having sex with men in order to gain access to health benefits, she added.

After giving birth, she decided it was a societal norm she wanted to change. 

“I thought a lot more about what it takes for queer people to become parents,” Goidel told Verywell. “Something that I had accepted the status quo years ago is no longer acceptable to me.”

Intrauterine Insemination (IUI)

IUI is a process that uses artificial insemination, where sperm is injected into a person’s uterus around the time of ovulation.

Goidel applied for fertility coverage through Aetna’s health insurance plan for Columbia University students, but her request and appeal were both denied. She then filed a class-action lawsuit with lawyer Noel León against the company for sex-based discrimination.

Aetna defines infertility as being unable to become pregnant after “frequent, unprotected heterosexual sexual intercourse” for at least six months to a year, depending on age. Same-sex partners, however, must pay out-of-pocket for six or 12 cycles of fertility treatments with a donor sperm, with the exact number of cycles being determined by their age.

“We believe that this is the first lawsuit challenging insurance companies' coverage policies around fertility treatment for LGBTQIA people,'' León told Verywell.

The suit alleges that Aetna’s New York policy violates the non-discrimination provision in the Affordable Care Act. More women have joined the lawsuit since Goidel filed her complaint in September.

More About IUI

IUI has a success rate of up to 17% for people younger than 40 when combined with medications that induce ovulation. Each treatment costs about $1,000 without medication. People who do get pregnant from IUI require two to three cycles on average.

In New York, insurance providers are mandated to cover fertility treatments. 14 other states mandate coverage of fertility treatments.

León said their goal is for Aetna to stop requiring LGBTQ+ people to pay out-of-pocket for fertility treatments, and to offer them the same benefits as straight and cisgender people.

“There may be an assumption among LGBTQ+ people that this kind of treatment is ‘just the norm’ and there's nothing they can do about it,” León said. “We hope that this lawsuit can show folks that it is in fact illegal and discriminatory and we don't have to simply sit back and pay out of pocket—that you can potentially argue for your equal treatment and coverage.”

What About In Vitro Fertilization (IVF)?

Instead of IUI, some couples opt for in vitro fertilization (IVF), which has higher pregnancy success rates. IVF is more invasive and expensive than IUI, but its effectiveness could potentially lower overall expenses. The average cost of IVF is around $19,000 per cycle without medication and has a success rate of about 25–55% for people under 40. You can fill out a form on the CDC website to answer questions about your health and pregnancy history and get an estimate of your likely IVF success based on available data from fertility clinics.

It's a Widespread Problem

Since Aetna’s policy requires same-sex couples to undergo up to 12 rounds of treatment before receiving coverage, they may become pregnant without ever becoming eligible. They may also decide to halt the process early because of financial burdens or exhaustion.

Although this suit targets Aetna’s New York policy, LGBTQ+ people face barriers to fertility coverage in other insurance carriers and states.

Alison Tanner, a lawyer from the National Women’s Law Center who is representing the class-action lawsuit along with León, told Verywell that the problem is widespread, but hard to quantify. It’s challenging to locate people who were intimidated by the costs that they never sought fertility treatments in the first place, she said.

“This is a big reason why we filed this as a class-action because we want to change the policy in order to help those people who are prevented from forming families in the first place by inequality,” Tanner added.

Goidel is joined by three other plaintiffs on the complaint, all of whom are in same-sex relationships and have been denied fertility coverage from Aetna. 

“It's very upsetting that this is the case in 2021,” Lesley Brown, another plaintiff on the complaint, told Verywell. “It's saying that a heterosexual couple who can't get pregnant is worthy of fertility treatment, whereas a same-sex couple who can't get pregnant at home is not.”

Goidel, who spent nearly $45,000 on fertility treatments for her second pregnancy, said she feels hopeful that the law is on her side. 

“I'm able to talk about this experience and to pursue this lawsuit because I did get pregnant,” Goidel said. “It's helpful to be able to make my negative experiences useful for other people.”

What This Means For You

When it comes to funding fertility treatments, many insurance carriers require members to first prove infertility. But for LGBTQ+ couples who do not have heterosexual intercourse or may not be infertile to begin with, this is not always possible. Now, a class-action suit has been filed against Aetna for sex-based discrimination.

5 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Aetna. Infertility.

  2. Starosta A, Gordon CE, Hornstein MD. Predictive factors for intrauterine insemination outcomes: a review. Fertil Res Pract. 6(1):23. doi:10.1186/s40738-020-00092-1

  3. National Conference of State Legislatures. State laws related to insurance coverage for infertility treatment.

  4. Wu AK, Odisho AY, Washington SL 3rd, Katz PP, Smith JF. Out-of-pocket fertility patient expense: data from a multicenter prospective infertility cohort. J Urol. 191(2):427-432. doi:10.1016/j.juro.2013.08.083

  5. Society for Assisted Reproductive Technology. Final national summary report for 2018.

By Claire Wolters
Claire Wolters is a staff reporter covering health news for Verywell. She is most passionate about stories that cover real issues and spark change.