Health Care Service Corp., the parent company of Blue Cross Blue Shield of Illinois, is facing a potential class action complaint alleging the payer intentionally discriminates against LGBTQ members by imposing out-of-pocket costs in order to qualify for fertility benefits, a federal judge has ruled.
The original complaint filed in May alleges the plaintiff, her partner and other LGBTQ members are being forced by BCBS Illinois to pay out of pocket for one year of medically based and supervised methods of conception before the payer will provide coverage for fertility treatments because they cannot conceive through intercourse. According to the court documents, BCBS provides members with coverage and no out-of-pocket costs if they have not conceived after unprotected sexual intercourse for 12 months.
The Oct. 17 decision in the Northern District of Illinois said "it is reasonable to infer that the policy intentionally discriminates against LGBTQ members by excluding them from a cost-free method of demonstrating they meet the definition of infertility."
The complaint also alleges that the policy is discriminatory based on sex, sexual orientation and/or gender identity and violates LGBTQ members' rights under Section 1557 of the Patient Protection and Affordable Care Act.
BCBS argued that the complaint should be dismissed because the plaintiff filed her claims under an outdated policy from 2010, instead of an updated 2020 policy the payer said is non-discriminatory. BCBS also offers at least six options for any member, regardless of sexual orientation, to qualify for infertility benefits.
"If it were true that a covered individual in a same-sex relationship satisfies the "infertility" definition, Blue Cross should have covered plaintiff's IVF treatment instead of forcing her to pay out-of-pocket," the judge wrote.
BCBS Illinois told Becker's it does not comment on pending litigation.