Insurance companies don’t cover new birth control methods

Image for article titled Insurance companies give ridiculous reasons for not covering new birth control methods

Photo: SCIENTIFIC PHOTO LIBRARY (Getty Images)

Whitney, an Indiana-based pediatrician who asked her Last name being restrained, had been using a birth control ring called Annovera for nearly a year when she recently changed jobs, and her new insurance provider refused to cover the ring. Before the ring, Whitney used an IUD, knowing that a long-term method of birth control would work better for her. But with no cover for her Annovera ring, she had to switch to an alternative that didn’t work well for her. Besides challenging her insurance company, Whitney says she “has no choice at this time but to use this non-preferred method.”

Stories like Whitney’s are common, according to Dr. Raegan McDonald-Mosley, CEO of the Power to Decide reproductive rights campaign, despite how under the Affordable Care Act insurers are legally required to cover the full range of contraceptive methods, at no cost. It is through this ACA mandate that about 65 million Americans can access birth control without co-payment.

Amid growing attacks on reproductive rights, including a Supreme Court case that could overturn Roe vs. Wade and a pandemic that has created significant logistical barriers to obtain contraception and abortion, McDonald-Mosley points out that patients who try to obtain reproductive care “do not do so as a political act”. Birth control is an integral part of life for people of all ages, faiths and communities. But as the FDA approves more and more forms of birth control, from new patches with fewer hormones to non-hormonal contraceptive gels, many private insurers are doing everything they can to evade the birth control mandate of ACA and avoid covering less traditional methods.

A patient McDonald-Mosley recently worked with concluded that a non-hormonal septic contraceptive gel would work best for her – only to have her insurance company force her to pay $300 out of pocket for just 12 applications of the gel, what she couldn’t afford. Healthcare providers like McDonald-Mosley try to help their patients choose the right contraceptive method for their unique needs, only to have insurance companies “undermine that decision-making, undermine the patient-provider relationship, and weaken overall patient confidence in the medical system,” she says.

It’s a problem that Washington Senator Patty Murray, who chairs the Senate Committee on Health, Education, Labor and Pensions, is well aware of. His office led recent Senate efforts to hold private insurance companies accountable, and has worked closely with patients who say their insurers are not meeting the requirements set by the ACA’s contraceptive mandate.

“A long time ago when we passed the ACA, we made sure it covered the full range of FDA-approved methods, not some, all of them,” Senator Murray told Jezebel. “Now I hear from women telling me that they have to jump through all kinds of hurdles to get their insurers to pay for it, being forced to do crazy things like trying at least five birth control methods and proving that they don’t didn’t work out until the insurer agrees to cover the birth control he wants.

The senator expressed particular concern about how a requirement like this could affect a person’s physical and mental health due to the various side effects they may experience due to the repeated change of control methods. births, just so that his insurer fulfills his legal obligations.

Murray, a longtime leader in advocating for coverage of birth control and reproductive rights in the Senate, recently joined Wisconsin Senator Ron Wyden in calling on the Biden administration to reaffirm the birth control mandate. of the ACA, to monitor private insurance companies and to investigate. patient complaints. A advice from the White House last month essentially warned insurance companies and said they “may take enforcement or other corrective action.”

The guidelines are an important step forward, Murray says, and she hopes next time the Biden administration will build on them by issuing comprehensive guidelines on insurers’ responsibilities for contraceptive coverage, and “take action.” prompt enforcement action against insurers who fail to comply with these responsibilities.”

Dr. McDonald-Mosley says the decision-making power is trying to help the federal government in its oversight of private and public insurers by showing people how report violations to the federal government on its website. Violations for insurers to report include denying coverage even after a health care provider communicates the need for a particular method of contraception for their patient, or requiring people to prove that their contraceptive methods non-preferred don’t work for them until they agree to cover their preferred method. .

Mara Gandal-Powers, director of birth control access and senior counsel at the National Women’s Law Center, says NWLC is investigate the situation and work directly with patients who are required to pay out-of-pocket costs for contraception. The CLFN has a direct line on its website through which individuals can contact the organization for assistance in understanding why they are being charged, and also obtain help appeal a request for contraceptive coverage refused.

Gandal-Powers says the increasing amount of options for birth control methods is an exciting development for people who have long struggled with side effects of more traditional forms of birth control, such as the pill. But if insurers refuse to cover new methods that might suit people betterit is specific health needs, it “simply flies in the face of what the ACA’s birth control benefit is really supposed to do.”

“From an equity perspective, it’s a problem that the only people who can access the new methods are those who can afford the out-of-pocket costs,” Gandal-Powers said. “When you talk to your healthcare provider about birth control that’s right for you, you should be able to take money out of the equation — it should be about your needs.”

BaObstacles to birth control are just one dimension of a growing war on reproductive rights, after 2021 alone has seen a records 106 new state-level abortion restrictions were enacted. “Access to birth control will never be the magic bullet when access to abortion is restricted, because people will always need abortions no matter what,” she said. “But especially knowing what the stakes are for someone who may go through a pregnancy, it’s important that there is good contraceptive coverage at all times, with everything on hold.”

Even as a pediatrician, Whitney says that before she struggled to obtain insurance coverage for her contraceptive method of choice, she was not fully aware of her rights as a patient, the legal obligations of insurance companies or recourse options that she and other patients have. “Patient education can go a long way,” she said. “I now know well the hurdles you have to jump through, but I worry about women who may not be, who don’t know they can challenge an insurance company’s denial and could be exploited.”

Kristan F. Talley