Some Insurers Refuse To Cover Contraceptives, Despite Health Law Requirement
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How much leeway do employers and insurers have in deciding whether theyll cover contraceptives without charge and in determining which methods make the cut?
Not much, as it turns out, but that hasnt stopped some from trying.
The NuvaRing (Photo by Sandy Huffaker/Getty Images)
Kaiser Health News readers still write in regularly describing battles theyre waging to get the birth control coverage theyre entitled to.
In one of those messages recently, a woman said her insurer denied free coverage for the NuvaRing. This small plastic device, which is inserted into the vagina, works for three weeks at a time by releasing hormones similar to those used by birth control pills. She said her insurer told her she would be responsible for her contraceptive expenses unless she chooses an oral generic birth control pill. The NuvaRing costs between $15 and $80 a month, .
Under the health law, health plans have to cover the full range of FDA-approved birth control methods , unless the plan falls into a limited number of categories that are excluded, either because its grandfathered under the law or its for is a religious employer or house of worship. in the Hobby Lobby case, some private employers that have religious objections to providing birth control coverage as a free preventive benefit will also be excused from the requirement.
In addition, the federal government has given plans some flexibility by allowing them touse “reasonable medical management techniques” to keep their costs under control. So if there is both a generic and a brand-name version of a birth-control pill available, for example, a plan could decide to cover only the generic version without cost to the patient.
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As for the NuvaRing, even though they may use the same hormones, the pill and the ring are different methods of birth control. As an official from the federal Department of Health and Human Services said in an email, “The pill, the ring and the patch are different types of hormonal methods It is not permissible to cover only the pill, but not the ring or the patch.”
Guidance from the federal government that the full range of FDA-approved methods of birth control must be covered as a preventive benefit without cost sharing. That includes birth control pills, the ring or patch, intrauterine devices and sterilization, among others.
But despite federal guidance, weve seen this happen, plenty, says Adam Sonfield, a senior public policy associate at the Guttmacher Institute, a reproductive health research and education organization. Clearly insurance companies think things are ambiguous enough that they can get away with it.
If you are denied coverage, your defense is to appeal the decision, and get your state insurance department involved.
The state has the right and responsibility to enforce this law, says Sonfield.
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