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PATIENT STORY

Woman Denied Fertility Benefits Retroactively

Linda DeBenedictis - Norwood, MA
As told by Linda DeBenedictis:

Unfortunately, I had received my health care through my husband's private employer in the mid 1980s. We were unable to conceive a child. I had been covered by the insurance company for invitro fertilization services in the past. But in 1986, invitro fertilization was suddenly listed as an excluded benefit -- only after I applied for a claim. We believe we were the only couple using the benefit and that is why the insurer terminated it.

Through discussions with an employee insurance representative we were led to believe that our coverage would be continued since we had been approved in the past. As it turned out, our future claims were denied. We appealed to the Massachusetts Division of Insurance. After months of frustration and dozens of letters and phone calls, we learned about the ERISA law which allowed my husband's employer to legally stop paying for our treatment retroactively. We had absolutely no remedy under the law.

In 1988, Massachusetts passed a law mandating fertility coverage. We were still excluded, because self-insured ERISA plans don't have to comply with state mandates. The Massachusetts Division of Insurance wrote us a letter stating that "the plan is not subject to any of Massachusetts mandated insurance benefits, including infertility benefits."

We learned about ERISA the painful way. It's critical for consumers to understand the limitations, risks, and lack of redress under self-insured ERISA plans. Most of us learn about it after the fact. It's time to stop the abuses and protect consumers by reforming the ERISA law.




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