Lack of consumer awareness over contraceptive coverage ‘unacceptable’

At a time when more information is coming to light over misinformation provided to the public about contraceptive coverage, U.S. Senator Patty Murray (D-Wash), finding the misinformation “unacceptable,” sent a letter to eight health insurance companies currently offering coverage on the Health Insurance Exchange in Washington. In the letter, she expressed her concern that the insurers were failing to cover forms of contraception approved by the FDA and failing to provide women with accurate information about the services available to them under the Patient Protection and Affordable Care Act (ACA) (P.L. 111-148). At the same time, the National Women’s Law Center released two companion reports identifying “violations” of the ACA’s contraceptive coverage requirements.

Senator Murray’s letter

Murray’s letter mirrored that of Congresswoman Suzan DelBene (D-Wash) who also sent a letter cautioning that while ACA provisions are intended to guarantee access to FDA approved “oral contraceptives, the ring, the patch, the shot, implants, intrauterine devices (IUDs), emergency contraception, and subdermal implants,” those reforms only have their intended effect if women have access to accurate coverage information about those benefits (see The misconceptions with contraception, Congresswoman’s letter questions insurers over misinformation, Health Reform WK-EDGE, April 29, 2015).

The letters focused on the findings of a Northwest Health Law Advocates and NARAL Pro-Choice Washington survey, which discovered that insurance company “representatives routinely told callers that certain forms of contraception are available at no cost but that others are only available with cost-sharing, and no single carrier consistently told callers that all FDA-approved methods are available without cost-sharing—the precise level of coverage required by the ACA.” According to the survey, certain contraceptive methods are also “frequently left off carriers’ formularies or listed in formulary tiers that require cost-sharing.”

Urging insurers to be proactive, Murray said, “I write to express strong concern about these developments and urge you to come into compliance with the law immediately… A lack of consumer awareness and transparency about what is covered for women is unacceptable. A benefit that’s hidden from consumers is the same as having no benefit at all. Insurers must do their part to provide accurate information to all Washingtonians.”

In her letter, Murray asked that insurance companies be sure to:

  • Ensure that all sales and customer service representatives receive training on all benefits, including contraception benefits;
  • Update formularies regularly, making sure that they are accurate and compliant with the ACA requirements on contraception coverage;
  • Make sure that formularies accurately list all medical methods of contraception and that consumers can find information on methods easily; and
  • Help provide consumers with greater access to medical information about contraception methods to support informed decision-making and full range of choice.

Additionally, Murray stated that carriers should consider providing emergency contraception without cost-sharing regardless of whether a woman has obtained a prescription, as it is both a beneficial and cost-effective option for women and carriers alike.

National Women’s Law Center reports

What is categorized as misinformation by some may be considered violations of the ACA by others. Two reports released by the National Women’s Law Center (NWLC) reveal what the NWLC calls insurance company violations of the ACA. The studies reviewed issues in 15 states, but the NWLC notes that the same issues are likely to exist nationwide. Included in the report are concerns related to maternity care, birth control, breast-feeding support and supplies, genetic testing, well-woman visits, prescription drug coverage, care related to gender transition for transgender individuals, chronic pain treatment, and certain pre-existing conditions. The NWLC’s initial report provides examples of discriminatory practices, such as denying maternity coverage to daughters of subscribers. In a companion report, NWLC found that insurance plans across the country are violating the ACA’s birth control coverage requirements.

“Insurance companies are breaking the law by denying women coverage to which they are entitled,” said NWLC Vice President for Health and Reproductive Rights Gretchen Borchelt. “The Affordable Care Act has made dramatic improvements in women’s health coverage, but insurers’ failure to comply with its requirements has serious consequences that affect women every day. Insurance companies must comply with the law, and regulators should do a better job enforcing it. Otherwise, women will again be at the mercy of insurers whose previous discriminatory practices drove the need for reform in the first place.”

States reviewed include Alabama, California, Colorado, Connecticut, Florida, Maine, Maryland, Minnesota, Nevada, Ohio, Rhode Island, South Dakota, Tennessee, Washington, and Wisconsin. The states included in both reports are meant to “reflect a diverse sample in terms of geography, political environment, and use of a federal or state Marketplace.”