Actress Hilary Swank has sued the film and television actors' health plan in Los Angeles, alleging she was unfairly denied coverage for treatments tied to recurrent ovarian cysts.
The two-time Oscar winner alleges in the lawsuit filed in Los Angeles federal court that the SAG-AFTRA Health Plan's trustees stopped covering her treatments five years ago after initially allowing her claims.
According to the complaint, Swank has suffered from recurrent malignant ovarian cysts for more than 11 years. Around the same time that her claims were rejected, the actress "was undergoing procedures to preserve her ability to conceive in the future," the lawsuit states.
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"Seizing upon Swank's choice to keep her options open, the trustees pointed to an exclusion in the plan for 'infertility treatment,' relying on the notion that the only purpose of preserving the health of an ovary is to procreate," the complaint, filed late Tuesday, alleges. "Despite Swank's, and her board-certified doctors', insistence that she was not seeking coverage for fertility treatment, but only for treatment for her ovarian cysts, the trustees dug in their heels. The trustees repeatedly said that there was no medically necessary reason to treat or monitor ovarian cysts other than for 'infertility treatment.'"
A representative of the SAG-AFTRA Health Plan could not be immediately reached for comment.
Because of the cysts' recurrence, Swank is frequently required to undergo aspirations of the cysts, sometimes multiple times per year, the lawsuit states.
According to the suit, Swank did not submit claims for any treatments undergone to preserve her ability to conceive and has made a "conscientious effort to distinguish such treatments from treatments for her ovarian cysts."
However, in 2017, the trustees allegedly informed Swank that none of the treatments after the beginning of 2016 would be covered "because they had decided that the treatment was 'infertility related,' and therefore not covered by the plan," according to the lawsuit, which seeks the full amount of all benefits due under the plan and legal fees.
By wrongfully denying Swank payment of benefits, the trustees violated minimum standards for retirement and health plans set by federal law, the lawsuit alleges.