Press Release: Class Action Law Suit Filed Against Blue Cross Blue Shield of California
October 26, 2007
[For Immediate Release]
A lawsuit charging Blue Cross of California with failing to offer infertility benefits required by California law was certified as a class action on Tuesday. This will allow the class representative and her attorneys to seek an injunction directing Blue Cross to offer much broader infertility coverage to group health plans covering employees of governmental entities and many religious institutions. Blue Cross currently offers only a limited benefit of $2,500 a year, and requires plan members to pay 50% co-pays.
According to attorney Mark F. Didak of Los Angeles, who represents the class, California Health & Safety Code and Insurance Code require health plans to offer infertility coverage on the same terms as they cover other health conditions, without lower coverage limits or higher co-pays. “The benefit should cover all infertility diagnosis and treatment services ‘consistent with established medical practices,’” Didak said, “except that health plan providers are not required to offer coverage for the actual laboratory procedures involved in in vitro fertilization.” The last part is important, says Didak, because health insurers typically refuse to pay for anything associated with in vitro fertilization, which can cost anywhere from $10,000 to $25,000 per cycle. “The law only allows them to not offer coverage for the lab procedures, which usually cost between a few hundred dollars and $1,500.” Didak hopes to persuade the court to issue an injunction that might serve as an example to the health insurance industry by clarifying what infertility benefits must be offered and which ones they can choose not to offer.
The lawsuit was filed in 2006 by plaintiff Deborah Dunn Yeager and is pending before Judge Victoria Chaney of the Los Angeles Superior Court. Prof. Dunn Yeager, who teaches communications at Westmont College in Santa Barbara, enrolled in a Blue Cross plan at work believing it covered infertility problems, only to have her benefits claim denied. Her college, she discovered, had not been offered infertility coverage on the terms required byCalifornia law. The statutes, Health & Safety Code section 1374.55 and Insurance Code section 10119.6, also mandate 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.”
Up to 15% of all couples of child-bearing age suffer problems conceiving. The problems are often treatable, many times with relatively inexpensive methods. “When the California Legislature passed the law requiring health plans to offer this coverage in 1989, they found that infertility ‘affects millions of Californians,’” said Mr. Didak. “The Legislature also 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.’”
Mr. Didak continued, “what’s clear is that if infertility coverage is always offered as the law requires, it will be sold more often, solving the problems the Legislature was trying to address. It will also bring the price of coverage down as more and more groups purchase it. Blue Cross will no longer be able to deny necessary medical treatment to people who want the chance to start a family or have another child. It’s one of the most fundamental rights any person has.”
[For more information, please contact class counsel Mark F. Didak at (310) 689-7022 or firstname.lastname@example.org.]