United Can’t Duck Same-Sex Couple’s Suit Over IVF Treatment

Employee Benefits News examines legal developments that impact the employee benefits and executive compensation employers provide, including federal and state legislation, rules from federal...

By Carmen Castro-Pagan

United Healthcare can’t escape a lawsuit alleging that it illegally refused to cover in vitro fertilization for a same-sex male couple who wanted to have a child by using a surrogate ( Uddoh v. United Healthcare , 2017 BL 41941, E.D.N.Y., No. 1:16-cv-01002, 2/10/17 ).Judge Brian M. Cogan of the U.S. District Court for the Eastern District of New York dismissed the discrimination lawsuit Feb. 10, which was filed by New York attorney Humphrey O. Uddoh and his partner, Plamen Koev. But the judge granted the couple leave to amend their lawsuit, which alleged that United discriminated against them when it reversed its preapproval of coverage after learning they were a same-sex couple.

Issues over coverage of medical expenses related to surrogacy are starting to become common in the employee benefits world. Last month, third-party administrator EBPA LLC was sued for allegedly violating the Employee Retirement Income Security Act by denying maternity-care coverage to a woman who served as a surrogate mother.

Cogan’s ruling didn’t dig into ERISA because the couple’s plan wasn’t covered by the federal statute. When the couple first applied for insurance benefits, United issued a conditional preapproval, according to the lawsuit. However, the preapproval was based on the mistaken assumption that the couple was heterosexual, the lawsuit said. After reversing the decision, United agreed to pay for medical procedures necessary for the collection of sperm from both Uddoh and Koev, but not for surrogacy procedures.

In reliance on the initial letter, in which the couple thought they were preapproved for surrogacy procedures, Uddoh and Koev allegedly spent $150,000; that amount isn’t covered under the revised approval letter, the court noted.

In his ruling, Cogan held that the Empire Plan and the New York State Health Insurance Program weren’t legal entities susceptible to be sued. Both entities were merely the program name of the various insurance plans offered to New York state employees, the court said.

Cogan further dismissed some of the couple’s claims, including slander and equal protection. He further warned the couple that in filing their amended complaint, they should make their breach of contract and estoppel claims more plausible.

Humphrey O. Uddoh represented himself. Sedgwick LLP represented United.

To contact the reporter on this story: Carmen Castro-Pagan in Washington at ccastro-pagan@bna.com

To contact the editor responsible for this story: Jo-el J. Meyer at jmeyer@bna.com

Copyright © 2017 The Bureau of National Affairs, Inc. All Rights Reserved.

Request Pension & Benefits Daily