A proposed class action in the U.S. District Court for the Northern District of Illinois alleges that Blue Cross Blue Shield of Illinois unlawfully denied full coverage for fertility treatments to LBGTQ members.
The complaint filed May 19 alleges the plaintiff, her partner and other LGBTQ members are being forced by BCBSIL 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 immediate coverage and no out-of-pocket costs if they have not conceived after unprotected sexual intercourse for 12 months.
Because the plaintiff has had to pay $19,000 for a successful pregnancy, the lawsuit describes the payer's policy as "an illegal tax on LGBTQ individuals that denies the equal rights of LGBTQ individuals to have children."
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.
The case argues that LGBTQ members can only meet BCBS' definition of "infertility" if they pay for 12 months of procedures such as intrauterine insemination or other "medically based and supervised methods of conception."
Under Illinois law, an insurance policy "may [not] impose any exclusions, limitations, or other restrictions on coverage of any fertility services based on a covered individual's participation in fertility services provided by or to a third party," and it cannot impose any other limitations on coverage for the diagnosis of infertility, treatment for infertility and standard fertility preservation services.
The case looks to represent all individuals covered under a BCBSIL policy and who have been or will be denied coverage for fertility treatments because they cannot meet the payer's prerequisite of a diagnosis or treatment of "infertility" based upon the inability to conceive after 12 months of unprotected sexual intercourse.