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A class action lawsuit filed against insurance provider CareFirst BlueChoice alleging that the company regularly denies in-vitro fertilization (IVF) policy-holders the essential service of embryo thawing, misrepresenting the services it provides, has been expanded.
The class action lawsuit, first filed in April 2021, now includes a third lead Plaintiff, Sarah Roberts, who alleges that CareFirst denied her “essential” embryo thawing despite having a policy that covers IVF with the company.
According to the amended CareFirst claim, Roberts obtained a health insurance policy from CareFirst in 2013 and in 2017 her and her husband sought fertility treatment.
Their physician advised them to proceed directly with IVF, and the couple created and froze several embryos, with one embryo transferred that same year and resulting in a successful pregnancy. Three additional embryos remained frozen, the claim reads.
In August 2019, one of the remaining frozen embryos was transferred, also resulting in a successful pregnancy.
“Notwithstanding the necessity of a frozen embryo transfer from the previously frozen embryos, upon information and belief, Carefirst represented to SGF’s insurance coverage team that it would not cover embryo thawing,” the CareFirst lawsuit reads.
Because of that, Roberts paid $600 out of pocket for the embryo thawing that was integral to the otherwise-covered embryo transfer process, the CareFirst class action lawsuit says.
Roberts’ claims have been added to the class action lawsuit that includes the original claims of other lead Plaintiffs Matthew and Jamie Skipper, who allege that CareFirst led them to believe that embryo thawing would be provided in their policy, but were denied coverage when they needed it.
According to the CareFirst class action lawsuit, the company’s practice of denying such coverage is widespread.
“Defendant intentionally made these misrepresentations and omissions, knowing that they would mislead reasonable consumers, such as Plaintiffs,” the claim states.
Since the original claim was filed, and three years after first denying the Skippers coverage for the embryo thawing, CareFirst issued a new explanation of benefits to the Skippers, saying it would cover the thawing.
However, CareFirst issued payment directly to the Skippers’ physicians despite the Skippers having already paid out of pocket, the claim reads.
“The Skippers’ policy provides that ‘[i]f the Member has paid a Contracting Provider or Non-Contracting Provider for Covered Services rendered, benefits will be payable to the Member,’” the class action lawsuit explains.
Though CareFirst was aware that the Skippers had already paid for the thawing out of pocket, it did not provide direct reimbursement to the Skippers, and even if the Skippers were to receive reimbursement, either from CareFirst or from their physicians, they have lost the use of those funds for a period of years, the claim adds.
The CareFirst policy holders are suing for breach of contract, negligence, and violation of the Maryland Consumer Protection Act, and are seeking certification of the Class, damages, attorney’s fees, injunctive relief, interest, and a jury trial.
Have you ever had an issue with getting IVF treatment coverage from your insurance provider? Let us know in the comments section!
Matthew and Jamie Skipper are represented by Courtney L. Weiner of Law Office of Courtney Weiner PLLC and Todd D. Lochner and Lochner Law Firm, P.C.
The CareFirst BlueChoice In-Vitro Fertilization Denial Lawsuit is Matthew Skipper, et al. v. CareFirst BlueChoice, Inc., Case No. 8:21-cv-1022, in the U.S. District Court for the District of Maryland Northern Division.
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