Denial of Sterilization Treatment Coverage Found Reasonable

March 19, 2007 ( - Judge Mark Fuller of the U.S. District Court for the Middle District of Alabama ruled in favor of a health plan administrator who denied a female Wal-Mart Stores Inc. employee coverage for a sterilization procedure, finding that the plan clearly excluded all such procedures.

In his opinion, Fuller said that the summary plan description that governs the self-funded health plan administered by Blue Cross Blue Shield of Alabama “excludes charges for ‘sterilization and the tubal ligation is a form of sterilization, an admission even Brown makes in her briefs and a fact affirmed by her doctors, the procedure was not covered by the plan.”

Shawn Brown, a participant in the self-funded health plan administered by Blue Cross Blue Shield of Alabama, was advised by her doctor to undergo tubal ligation after it was discovered she carried a genetic disorder that she passed on to her daughter when the baby was born in February 2001. Brown’s daughter began suffering seizures when she was eight months old, at which point doctors diagnosed her with cellular mitochondria complex one defect.

Health plan administrators denied coverage for the tubal ligation as well as coverage for nutritional supplements called Carnitor prescribed for Brown’s daughter. The court pointed out the SPD also excluded coverage for vitamins, minerals and nutritional supplements.

The case is Brown v. Wal-Mart Stores Inc. Associates Health and Welfare Plan ,  M.D. Ala., No. 1:05-cv-810-MEF (WO), 3/12/07.