CVS came under fire last year for inappropriately charging 11,000 women a co-pay for their birth control, which is supposed to be covered with no cost-sharing under the Affordable Care Act. A new report suggests that this kind of problem may be widespread.
The report from the Kaiser Family Foundation finds that insurers are not providing consistent coverage for non-pill birth control methods like the vaginal ring, intrauterine device (IUD), implant, and hormonal patch.
It can be fiendishly difficult to find information about which methods are covered by different plans, and women may not have access to an adequate appeals process if they feel they are being unfairly charged.
All Food and Drug Administration-approved methods of birth control are supposed to be covered without cost sharing, and government agencies like the Centers for Disease Control and Prevention have clearly stated that contraceptive choice is important to reduce the risk of unplanned pregnancy.
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Most insurance carriers comply with the spirit of this requirement, the report finds, but there are significant and worrisome exceptions.
The report surveyed 20 insurance carriers in five states: California, Georgia, Michigan, New Jersey, and Texas.
The information about these carriers wasn’t easy to come by, the authors noted. Out of 24 companies contacted, only nine agreed to interviews, and many of those officials interviewed didn’t have complete information.
The rest of the information came from publicly available documents. Many of these documents, however, did not have clear information about how various contraceptive methods were covered.
“This makes it extremely difficult, if not impossible for policyholders to ascertain their current plan’s contraceptive coverage policies,” the report says.
Five of the 20 insurance carriers studied required co-pays for the NuvaRing, the only FDA-approved vaginal ring, and one plan doesn’t cover it at all. Two carriers don’t cover any kind of contraceptive implant, and one doesn’t cover the ParaGard, the only available non-hormonal IUD.
Only half of the 20 providers cover all three FDA-approved IUDs with no limitations, and only 11 fully cover the emergency contraceptive pill ella, which has a longer window of effectiveness than Plan B and is more effective for women over a certain weight.
Some of these limitations may run afoul of the law, while others may be a result of poor communication or misinterpretation of guidelines.
Frequently, methods aren’t covered because insurers are exercising “reasonable medical management,” which is supposed to reduce costs. Some insurers argue that because methods like the ring or the patch have the same hormonal formulation as the pill but are more expensive, it’s reasonable to cover the pill but require a co-pay for other methods. A patient may also be required to try out the pill first before covering those methods.
The Obama administration hasn’t given concrete guidance about how reasonable medical management should apply to contraceptive care. It does, however, say that insurers should have a waiver process in place for women who have a medical need for a certain method that isn’t covered.
The report’s authors noted that none of the carriers they interviewed had a formal waiver process for women who want to contest being charged for contraceptives.
All of the companies claimed that their usual appeals process was sufficient, but the report’s authors said that the timing of those processes “may be problematic and lead to delays which are not in the best interest of standards for quality contraceptive care.”
That problem is especially acute for emergency contraception, the authors noted.
Of concern, none of the carriers interviewed had an expedited waiver or appeal processes for emergency contraceptives other than the expedited appeal process required for all other benefits, which may not be timely enough for women seeking emergency contraceptives.
A spokesperson for the Department of Health and Human Services told Vox that the administration plans to release more guidance “soon” to address the confusion.