Same-Sex Couples Face Insurance Discrimination for Fertility Treatments

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.”

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.

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.”

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.”