Couple Claims Insurer Must Cover the Cost of Creating a Donor Child

     PROVIDENCE, R.I. (CN) – A Massachusetts couple sued their health insurer, claiming it must cover in vitro fertilization to ensure conception of a disease-free child, so that their daughter, who suffers from a rare blood disorder, will have a matching blood donor.
Jean Ho-Rath and her husband Bunsan Ho-Rath sued the Tufts Health Plan in Federal Court.
The Ho-Raths have family health insurance through Bunsan’s employer. They claim the plan includes provisions for infertility services and pre-implantation genetic determination, which are among the services they are seeking.
The Ho-Raths say their young daughter suffers from Alpha Thalassemia Hemoglobin H Constant, a genetic blood disorder she was diagnosed with when she was 5 years old.
The disorder requires lifelong blood transfusions as often as twice a month, “which can lead to severe iron overload, resulting in liver and endocrine complications, heart failure, and premature death,” according to the complaint.
Since both parents carry the Alpha Thalassemia trait, their daughter’s physicians “recommend that the only curative option for [the child] is for plaintiffs Jean and Bunsan Ho-Rath to have another child through in vitro fertilization (IVF) with intracytoplasmic sperm injection (ICSI) and pre-implantation genetic diagnosis (PGD) to ensure a disease-free, 100% HLA-matched sibling cord blood donor.” (Parentheses in complaint.)
The Ho-Raths say Tufts denied them coverage in September 2011. They appealed the denial twice in November and were denied both times, according to the complaint.
They claim the denials violate terms of their coverage, and violate the Employee Retirement Income Security Act. They want Tufts ordered to provide coverage for the services they seek, and punitive damages for breach of fiduciary duty.
They are represented by Amato Deluca, with Deluca Weizenbaum.

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