Press Release: Infertility / Insurance Case

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FOR IMMEDIATE RELEASE
June 29, 2006
PROFESSOR SUES BLUE CROSS OVER FAILURE TO OFFER
GROUP COVERAGE FOR INFERTILITY TREATMENTS

 

A California college professor has sued Blue Cross of California in a class action over the health plan’s failure to offer infertility coverage under her employer’s group health plan. Plaintiff Deborah Dunn-Yeager filed the suit on behalf of California Blue Cross members in government and religious institution employee plans whose employers were denied the opportunity to purchase infertility benefits when the plans were issued or renewed.
Dunn-Yeager asked Blue Cross to pay for diagnosis and treatment of her infertility, but the insurer denied her claim, asserting that infertility benefits were excluded.

 

She later learned that her college had not been offered group coverage for infertility treatment when it purchased the Blue Cross plan, despite a state law requiring health plans to offer it. That law, Health & Safety Code Section 1374.55, also mandates that “every plan shall communicate the availability of that coverage to all group contractholders and to all prospective group contractholders with whom they are negotiating.”

 

Dunn-Yeager’s attorney, Mark Didak of Los Angeles, explained that “When the California Legislature passed the law requiring health plans to offer this coverage in 1989, they found that infertility ‘affects millions of Californians.’” Further, Didak said, “The Legislature found that ‘[i]f properly treated, successful pregnancies can result in 70 percent of [infertility] cases,’ but that ‘[i]nsurance coverage for infertility is uneven, inconsistent, and frequently subject to arbitrary decisions which are not based on legitimate medical considerations.’” As many as one in seven couples of child-bearing age experience problems conceiving, a condition that can often be treated with relatively inexpensive methods.

 

Didak noted that because Blue Cross never offered the coverage until after his client complained, the college she works for had no opportunity to evaluate the need for it before buying its Blue Cross group plan. Changing benefits mid-term can cause administrative problems for an employer. The employer has no opportunity to budget for a possible increase in the cost of the health plan at that point. It also cannot get advice from employee benefit committees about the effect adding infertility coverage may have on the overall structure of the health plan’s benefits. As a result, Didak argued, Dunn-Yeager’s employer, and others finding themselves in similar situations, would rarely be able to actually buy infertility coverage if the insurer only offered to sell it belatedly.

 

However, if infertility coverage were always offered during negotiations as the law requires, it would be sold more often, solving the availability problems the Legislature was trying to address and driving down the cost of coverage as more groups opt to buy it. “Blue Cross should no longer be able to deny necessary medical treatment to people who want the chance to start a family or have another child,” Didak concluded. “It’s one of the most fundamental rights any person has.”

 

The case, Dunn-Yeager v. Blue Cross, case no. BC 353402, was filed in Los Angeles Superior Court on June 2, 2006. It has been assigned to Judge Victoria Chaney. Plaintiff is represented by attorney Mark F. Didak, (310) 689-7022. Please contact him for more information.

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