A federal class action lawsuit has forced one of America’s largest health insurers to change how it covers fertility treatments for LGBTQ+ couples — and to pay $2 million to people it left behind. The settlement in Goidel et al. v. Aetna, filed in the U.S. District Court for the Southern District of New York, requires Aetna to give same-sex couples equal access to fertility benefits, ending a policy that made queer families pay tens of thousands of dollars out of pocket before coverage kicked in.
At a glance
- LGBTQ+ fertility coverage: Aetna agreed to modify its clinical policy so that eligible plan members have equal access to fertility treatment regardless of sexual orientation, consistent with guidelines from the American Society of Reproductive Medicine.
- Class action settlement: The $2 million common fund will compensate class members and reimburse out-of-pocket costs for artificial insemination cycles, with Aetna also agreeing to re-process eligible claims up to plan limits.
- Equal benefits standard: Aetna will introduce a new standard health benefit plan that includes artificial insemination for all members and ensures IVF policies are no more burdensome for LGBTQ+ people than for heterosexual couples.
The “queer tax” that started it all
Emma Goidel and Ilana Caplan were covered under Aetna through Columbia University in New York City, where Caplan was completing a Doctorate in Nursing Practice. When they tried to have a second child in 2020 C.E., they discovered a stark gap in their coverage.
Heterosexual couples could access fertility treatment after six to twelve months of unprotected sex. All they had to do was verbally confirm their circumstances and coverage began. For Goidel and Caplan, the bar was different. To qualify as a couple unable to conceive through intercourse — which is simply the reality for same-sex couples — Goidel would have needed to complete up to a full year of fertility treatments at her own expense before insurance would cover anything.
Goidel called it a “queer tax.” Depending on the treatment, that tax could reach $100,000. A single round of in vitro fertilization (IVF) can cost more than $30,000. Intrauterine insemination (IUI), which is cheaper but has a 5–15% success rate per cycle, cost the couple roughly $5,000 plus sperm per round. Goidel and Caplan went through two rounds of IUI, a miscarriage, three more unsuccessful IUI rounds, an attempt at IVF, and finally a successful IUI cycle — all paid from their savings. When Goidel applied for coverage anyway, Aetna denied her specifically because of the nature of her partnership.
How the lawsuit came together
In September 2021 C.E., Goidel filed a federal class action suit against Aetna, a subsidiary of CVS Health, alleging discrimination on the basis of sex and sexual orientation. Her legal team, the National Women’s Law Center alongside co-counsel Emery Celli Brinckerhoff & Abady LLP, connected her with other affected couples. Plaintiffs Ilana Lee, Madeleine Lee, and Lesley Brown joined the suit.
The legal argument rested on Section 1557 of the Affordable Care Act, which bans discrimination in health care on the basis of sex. The plaintiffs argued that the two-tier fertility system — easy access for heterosexual couples, a costly obstacle course for everyone else — was sex discrimination in practice.
On May 3rd, 2024 C.E., the settlement was filed. Aetna denied liability but agreed to the policy changes and the $2 million payout. “We celebrate this significant stride toward achieving justice for LGBTQ+ people who have faced obstacle after obstacle trying to access the health care services they need to build their families,” said Alison Tanner, Senior Litigation Counsel for Reproductive Rights and Health at the National Women’s Law Center.
Why this matters beyond Aetna
The problem is not unique to one insurer. Several large U.S. insurance companies do not automatically cover fertility treatments for same-sex couples. Even as more employers have added fertility benefits as a recruiting strategy, a 2021 C.E. survey by the Business Group on Health found that only 35% of those plans included coverage for LGBTQ+ people, who are often excluded under standard definitions of infertility that assume conception through heterosexual intercourse.
The settlement creates a template. It shows that existing civil rights law — already on the books — can be used to challenge discriminatory fertility policies. Advocates hope other insurers will review their own coverage without waiting for litigation.
“This settlement is a big win for queer families,” Goidel said. “We hope other insurance companies will follow Aetna’s example and review their policies to make sure everyone has equal access to fertility care.”
Still, legal settlements bind only the defendant. Aetna’s policy change does not automatically reach the millions of LGBTQ+ people covered by other insurers, self-funded employer plans, or Medicaid programs in states that still use narrow infertility definitions. Broader change will require either legislative action or more lawsuits — and probably both.
A door opened
What Goidel and Caplan started in 2020 C.E. as a fight for their own family has become a legal precedent with national implications. The American College of Obstetricians and Gynecologists and the American Society of Reproductive Medicine have both called for equitable fertility care regardless of sexual orientation. This settlement brings policy one step closer to that standard — and gives future plaintiffs a clear path to follow.
For the families who went through the same financial and emotional toll as Goidel and Caplan, the reimbursements in this settlement are at least partial recognition of a wrong. For families who come after them, the changed policy means fewer people will face that toll at all.
As RESOLVE: The National Infertility Association has long argued, access to fertility care is a matter of health equity. This case puts that principle into practice.
Read more
For more on this story, see: LGBTQ Nation
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