Court upholds Blue Cross limit on infertility treatment

July 21st, 2009

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LOS ANGELES—Blue Cross of California complied with state law when it offered only $2,000 in annual coverage for fertility treatments and was not obligated to cover the entire cost, a California appellate court ruled. At issue in Wednesday’s ruling by the state appellate court in Los Angeles was a renewal package offered by Thousand Oaks, Calif.-based Blue Cross of California to Santa Barbara, Calif.-based Westmont College. The offer included paying a maximum of $2,000 a year for half of the cost of treating a group member for infertility, which complied with a state mandate that obligates insurers to offer infertility coverage, according to the ruling in Deborah Dunn Yeager vs. Blue Cross of California.

Westmont refused to buy the coverage, in part because of its high cost. Ms. Yeager, a Westmont employee, was unable to become pregnant without medical assistance and could afford only limited infertility treatment, which proved ineffective, according to the decision.

She sued Blue Cross in 2006, alleging unfair competition and false advertising. Ms. Yeager sought recovery for her out-of-pocket expenses for the infertility treatment above Blue Cross’s $2,000 annual limit and “for her pain and suffering from losing her chance to bear a child.”