06 Feb 2024 LGBTQ Couples Fight for Reproductive Healthcare Benefits
As a growing number of same-sex couples turn to assisted reproductive technology (ART) to create their families, many are disheartened to find disparities in reproductive healthcare benefits provided by employers and insurers compared to their heterosexual counterparts. In many cases, LGBTQ couples are being denied fertility benefits, because they don’t fit into an antiquated mold of traditional male and female gender roles.
The World Health Organization (WHO) defines infertility as a “disease of the male or female reproductive system defined as the failure to achieve a pregnancy after 12 months or more of regular unprotected sexual intercourse.” The Centers for Disease Control and Prevention (CDC) has an almost identical definition. The issue with this outdated definition is that it only pertains to the family dynamics of yesteryear when most households were made up of heterosexual couples and does not reflect the advancement of society and the changing dynamics of families, which now include thousands of LGBTQ individuals and couples.
With state fertility benefit mandates and insurers still using this definition as a qualifier for reproductive healthcare, the entire LGBTQ community is being categorically excluded as they cannot become pregnant from unprotected sex. As we have regularly reported before on this high-interest topic for LGBTQ-intended parents, in the competitive workforce, many employers are now offering reproductive healthcare benefits to recruit and retain talent. Still, many of these benefit policies have disclaimers stating that IVF or other assisted reproductive technologies will only be covered after a couple has not been able to conceive after one year of unprotected intercourse.
States Mandate Reproductive Healthcare Benefits but Leave Out LGBTQ Couples
According to RESOLVE The National Infertility Association, as of September 2023, “21 states plus DC have passed fertility insurance coverage laws, 15 of those laws include IVF coverage, and 17 cover fertility preservation for iatrogenic (medically induced) infertility.” However, of those 21 states, many of the mandates are still exclusionary, and according to USA Today, Arkansas, Hawaii, and Texas even state that couples must use their own eggs and sperm to conceive. Tarun Jain, associate professor of obstetrics and gynecology at Northwestern University, tells USA Today, “There are some populations that still are not getting their fair shake at getting the treatment that they need. The LGBTQ (community) for sure. Some states have very specific language that really excludes that community.”
LGBTQ Female Couples Face Hurdles to Qualify for Fertility Benefits
Emma Goidel and Ilana Caplan tell ABC News that they spent almost $50,000 of their savings to have their one-year-old son Avi. None of their expenses for intrauterine insemination (IUI) and in vitro fertilization (IVF) were covered or reimbursed by their insurance. Goidel tells ABC News, “How is it OK to say if you’re straight and your partner can’t get you pregnant, you come into the doctor, and we’ll cover your treatment, but if you’re a queer and your partner can’t get you pregnant, too bad, you’re going to pay?”
After having their first child in 2020 through self-funded fertility treatments, the couple consulted their newly obtained Aetna health plan about fertility benefits they might be able to use for a second pregnancy. They were shocked to find out that they would have to go through 12 months of self-funded IUI treatments in order to qualify. They go on to tell ABC News that they got pregnant after five IUI attempts and once after one cycle of IVF, both resulting in a miscarriage. Goidel and Caplan brought a class-action lawsuit against Aetna in 2021 citing inequalities in fertility benefits for LGBTQ couples. The case is still pending in federal court.
Although same-sex female couples may have IVF covered after a year of trying IUI, they still have to pay for each IUI during that year, which can cost anywhere from $500 to $4,000 per cycle depending on medication, monitoring, bloodwork, and the actual process of insemination, according to Fertility IQ.
Same-Sex Male Couples Have Even Harder Hurdles to Jump Over for Fertility Benefits
For same-sex male couples who would like to have their own children, the path to parenthood is even more complicated and costly. They must use an egg donor and surrogate in order to have a child. However, the inability to conform to the outdated infertility definitions that many state mandates and insurers base their qualifying coverage for infertility on completely excludes same-sex male couples from any type of reproductive healthcare benefits.
Married couple Corey Briskin and Nicholas Maggipinto tell ABC News that neither of their health insurance plans would cover any fertility treatments involved with a surrogate. Maggipinto says, “There’s just no way that that’s not some form of discrimination.” The couple resides in New York City, and according to The New York Times, the city’s insurance benefits policy states that a person must be deemed infertile to qualify for benefits. Maggipinto goes on to say in ABC News, “The No.1 hurdle that every same-sex couple faces is that they can never meet the definition of fertility, which is the threshold qualifier for covered IVF.” In April of 2022, Briskin and Maggipinto filed a discrimination complaint with the Equal Employment Opportunity Commission (EEOC) seeking a nationwide order that employers must also offer fertility benefits to LGBTQ employees just as they do their heterosexual plan participants, per ABC News.
The financial and medical hurdles are too high for LGBTQ couples or individuals. A single round of IVF can cost well over $12,000 with many intended parents needing more than one round to create their families. This does not include genetic testing or the yearly storage fees to keep any extra embryos in cryopreservation facilities, as we have also reported before. And for same-sex male couples, the price for an egg donor and a surrogate can cost upward of $200,000 with surrogate compensation alone costing around $55,000, per USA Today. Adding into the costly mix, a lack of financial clarity, confusing verbiage in benefit policies, and few choices in insurance policies from employers, same-sex couples face an exorbitant uphill battle when choosing to grow their families compared to heterosexual couples.
It is time to change the definition of infertility to include all intended parents regardless of sexual orientation. Antiquated heteronormative ideals do not reflect our modern society, and state insurance mandates for employers and their insurance policies should not conform to ideals that completely alienate an entire community. At IFLG, we take great pride and care in helping the LGBTQ community. We stay current on state laws regarding ART benefits and how to best navigate changes state by state. Our expert team of fertility law professionals consistently engages with reproductive rights advocates and tracks any new developments for LGBTQ-intended parents. We will continue to report on the progression of LGBTQ fertility rights and answer any questions that may arise during your fertility journey. Please feel free to contact us anytime. We are fierce advocates for the LGBTQ community and are happy to help.
