Carefirst BlueChoice Coverage for IVF Embryo Thawing Maryland Class Action

If Carefirst BlueChoice, Inc. insurance policies in Maryland must cover in-vitro fertilizations (IVF), what aspects of this procedure must they pay for? The complaint for this class action alleges that Carefirst is refusing to cover embryo thawing, which the complaint calls “an essential component of most IVF cycles.”

The class is all individuals in Maryland who, between April 27, 2017 and April 27, 2021, were refused coverage for embryo thawing but not other IVF expenses under a Carefirst health insurance policy in Maryland that covers “pregnancy-related benefits.”

Plaintiffs Matthew and Jamie Skipper live in Maryland. They are among the 3.4 million parties in Maryland, the District of Columbia, and Northern Virginia to whom Carefirst provides health insurance.

The complaint quotes the Maryland insurance code, which says that health insurance companies “that provide[] pregnancy-related benefits may not exclude benefits for all outpatient expenses arising from in vitro fertilization procedures performed on a policyholder or subscriber or on the dependent spouse of a policyholder or subscriber.”

Specifically, the policy covers “[a]ssisted reproductive technologies” which include IVF, the complaint says, “where less costly methods have failed.”

The complaint refers to a report from the Centers for Disease Control and Prevention as saying that nearly three-quarters of 2018’s more than 100,000 embryo transfer cycles involved frozen embryo transfers.

Since 2010, the Skippers had been undergoing treatment for female infertility. They first tried several times to do intrauterine insemination, then moved on to egg retrieval. These were paid for at first by another insurer, and later by the couple themselves. Each of these, the complaint alleges, cost either the insurer or the Skippers $10,000.

In each retrieval cycle, the complaint says, multiple eggs were collected and multiple embryos were created. The Skippers tried to transfer one in what the complaint says was its “fresh” state, but that failed. The other embryos were frozen. One transfer of a frozen embryo succeeded in 2015.

According to the complaint, in September 2018, the Skippers “secured prior authorization from Carefirst to proceed with a transfer cycle for one of the remaining frozen embryos.” Carefirst was therefore not asked to pay for the egg retrievals or for creating the embryos, because that had already been done. Had they had to do that, the complaint alleges, the costs to Carefirst would have been even higher.

The complaint claims that thawing is a necessary step in the process, because embryos cannot be transferred without thawing. However, Carefirst denied coverage for the process. The Skippers appealed the denial, but Carefirst still refused. In November 2021, the Skippers filed a complaint with the Maryland Insurance Administration.

Article Type: Lawsuit
Topic: Insurance
Tags: Health Insurance, Incomplete payment of benefits due, Insurance, Pregnancy