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- UPDATE: The CareFirst complaint has since been amended and expanded. To follow the recent story development, read here.
Insurance provider Carefirst BlueChoice regularly denies in-vitro fertilization (IVF) policy-holders the essential service of embryo thawing, misrepresenting the services it provides, a new class action lawsuit claims.
The class action lawsuit was filed in Maryland on April 27 by lead Plaintiffs Matthew and Jamie Skipper, who allege that the company led them to believe that embryo thawing would be provided in their policy, but were denied coverage when they needed it.
According to the 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.
Matthew and Jamie Skipper, who live in Maryland, started IVF treatment in 2010, with Jamie Skipper undergoing several egg retrieval cycles between 2012 and 2015, according to the class action lawsuit.
The initial retrievals were covered by Aetna, Mrs. Skipper’s prior health insurer, and the couple covered some remaining costs out of pocket. Altogether, the retrievals would have cost more than $10,000.
According to the claim, multiple eggs were collected in each retrieval and were used to create a number of embryos. The couple had one embryo transferred in its “fresh” state, shortly after creation, but the transfer was unsuccessful. The remaining embryos were frozen for later transfer attempts.
In 2015, the couple was successful with one frozen embryo transfer, the claim states.
Then, in 2016, the Skippers got a health insurance policy from Carefirst, which specifically provided for coverage of “Assisted reproductive technologies” including in-IVF, according to the class action lawsuit.
The claim states that to abide by local law, the policy “may not exclude benefits for all outpatient expenses arising from in vitro fertilization procedures performed on a policyholder or subscriber.”
However, in 2018, after the couple had received prior authorization from Carefirst to proceed with a transfer for one of the remaining frozen embryos, the provider denied coverage for the thawing of the embryo. The couple was left to pay $900 out of pocket.
“Thawing an embryo is an essential component of IVF; a frozen embryo cannot be transferred without thawing,” the class action states. Carefirst allegedly provided no explanation for the denial, other than indicating that it was “not a covered benefit/service.”
According to the claim, a Carefirst representative told the Skippers that it routinely denied coverage for embryo thawing, though it recognized thawing as a necessary step for the IVF process.
The couple appealed the denial, and that request was denied by Carefirst. They then filed a complaint with the Maryland Insurance Administration, “alleging lack of good faith and breach of contract and seeking declaratory judgment,” which was referred to the Office of the Attorney General.
Matthew and Jamie Skipper are looking to represent a Class of Maryland residents who were denied coverage for embryo thawing, despite having a Carefirst health insurance policy that purports to cover “pregnancy-related benefits.”
They are suing for 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.
Issues arising from IVF treatment have led to class action lawsuits in the past. In 2018, an Ohio couple lodged a class action lawsuit against the University Hospitals Health System alleging that the facility caused damage to their and others’ frozen eggs and embryos.
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 and Jamie Skipper v. CareFirst BlueChoice, Inc., Case No. 8:21-cv-1022, in the U.S. District Court for the District of Maryland Northern Division.
Read About More Class Action Lawsuits & Class Action Settlements:
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