Be it Pill, Patch, Shot, Ring
May 3, 2015 4:53 PM   Subscribe

Health insurance companies are illegally charging for birth control, according to studies conducted by the National Women's Law Center.

Jezebel reports further on the matter:

"The issue isn’t just birth control: the report found that health insurers are also illegally excluding transition-related medical care for transgender people from their plans and illegally charging women for preventative services like 'well woman' exams. The insurers claim they’re using 'reasonable management techniques,' which they’re entitled to do under the law. It’ll probably take years of scoldings from a variety of federal agencies before they cut it out."
posted by ourt (51 comments total) 26 users marked this as a favorite
 
Go on, tell us again about how the market works things out to the benefit of consumers in the absence of governmental regulation. I fucking dare you.
posted by Etrigan at 4:59 PM on May 3, 2015 [113 favorites]


what are you talking about, the market works great, it's punishing the right people

that'll teach them to be women or trans
posted by Kutsuwamushi at 5:02 PM on May 3, 2015 [18 favorites]


How does it even make actuarial sense to charge more for birth control? Pregnancies aren't exactly cheap.
posted by indubitable at 5:05 PM on May 3, 2015 [12 favorites]


Yeah, it's like

We won't comply
Maybe no one will notice -- if so, profit!
If they do notice, maybe they won't do anything -- if so, profit!
If they complain, maybe no one will take heed -- if so, profit!
If they do take heed, explain that it's just not possible; they might buy it -- if so, profit!
If they make us comply, then we do a shitty job and drag our feet for decades -- in the meantime, profit!
posted by GenjiandProust at 5:07 PM on May 3, 2015 [44 favorites]


How does it even make actuarial sense to charge more for birth control? Pregnancies aren't exactly cheap.

Because women who don't want to be pregnant really don't want to be pregnant and are typically willing to spend their own money on birth control in order to prevent it. I'd guess the money saved by not paying for birth control is more than the cost of the unplanned pregnancies.
posted by jeather at 5:08 PM on May 3, 2015 [12 favorites]


I was going to say what indubitable just said. Insurance companies could probably pay customers to use birth control and still come out ahead.
posted by zsazsa at 5:09 PM on May 3, 2015 [1 favorite]


My insurance provides "wellness" mammograms for free, on the theory that prevention is cheaper than cancer treatment.

My wife has had three of them. Every single time the procedure has been "accidentally" miscoded as diagnostic instead of preventative, and we've gotten a bill. Every single time it's taken weeks and multiple physical mailings and phone calls to sort out.

I realize this is almost certainly the fault of the hospital and not the insurance company, probably because they get paid less for those wellness checkups. But fuck that shit. Just fuck it.

Single payer that shit ASAP.
posted by localroger at 5:15 PM on May 3, 2015 [63 favorites]


the report found that health insurers are also illegally excluding transition-related medical care for transgender people from their plans

AFAIK, it's actually super murky what the ACA did for trans people. They can't refuse you coverage because you're trans, but, while the idea persists that they're required to provide coverage for transition-related care, it doesn't seem to be the case. Some states (e.g. California) are requiring it, but the requirement only covers plans the insurance commissioner has power over, meaning it doesn't apply to what are called 'self-funded' plans.

I can tell you that my insurance company has artfully written their policy so as to absolve them of the responsibility for actually providing transition-related care while claiming they do. They'll pay for therapy (supposedly). They'll pay for hormones, but they won't pay for estrogen pills, they won't pay for self-injected medication (across the board, there's some exclusion to the exclusion for insulin I think), so that leaves... topical testosterone, I guess. Except the formulary excludes all the 'modern' topicals that aren't somewhere in the range between 'pain in the ass to use' and 'inevitably you react to it'. Surgery is excluded entirely, they're not even making a pretense of paying for it (though you can effectively exclude it by conveniently having no in-network surgeons or very low coverage caps).
posted by hoyland at 5:17 PM on May 3, 2015 [7 favorites]


"It’ll probably take years of scoldings from a variety of federal agencies before they cut it out."

Or, the electing of a Republican President. I guarantee this problem will disappear after that. So will the law.
posted by Thorzdad at 5:20 PM on May 3, 2015


From reading the linked articles from Jezebel, it seems that a lot of the issue is that the insurers are trying to pay only for the generic/cheapest version of any given form of birth control. Not to give insurers any kind of pass, but I wonder how much this is impacted by the staggeringly high cost of prescription drugs in the US, especially newer drugs. Someone is really going to have to tackle drug pricing in the US for the insurance coverage models to have a chance of working properly.
posted by frumiousb at 5:23 PM on May 3, 2015 [3 favorites]


This is why healthcare for profit is always going to be a conflict of interest. If there's no way to provide birth control for free and make a profit then something's gotta give. And I think providing birth control for free is going to be in society's best interest far greater than profits for a few corporations. So. Let's get on this...
posted by bleep at 5:38 PM on May 3, 2015 [11 favorites]


*could cause pain, suffering, loss of time and energy. If your insurance provider is causing hives, rash, head/ wallet trauma, bleeding from the eye or ears seek litagation immediately. If overcharged, blurry vision, recital discomfort occurres, remember the law. If your health provider gives you diarrhea, headaches, swelling of the liver seek advice from a qualified professional. Erections lasting more then 4 hours should be a comforting thought but seek medical advice.
Ask us if health is right for you.
Not valid in all 50 states, taxes, fees, and gratuity not included.
posted by clavdivs at 5:40 PM on May 3, 2015 [4 favorites]


I had a surgery once, right there on the bill was 2 charges from the anesthesia guy.
posted by clavdivs at 5:42 PM on May 3, 2015 [1 favorite]




From EmpressCallypgos' link LOL: "Ask Jeeves" (picture of 404 screen)
posted by localroger at 5:59 PM on May 3, 2015


From reading the linked articles from Jezebel, it seems that a lot of the issue is that the insurers are trying to pay only for the generic/cheapest version of any given form of birth control. Not to give insurers any kind of pass, but I wonder how much this is impacted by the staggeringly high cost of prescription drugs in the US, especially newer drugs. Someone is really going to have to tackle drug pricing in the US for the insurance coverage models to have a chance of working properly.


I'm generally OK for insurance companies only covering generic when its available (as long as they're bioequivalent, and incidentally, as someone on thyroid meds, there's a whole nother story there...), as I understood the Jezebel article, this is a bit different, as the insurance companies are basically saying "We'll cover these two pills and these two pills only". Which, as anybody has gone through trying to find a hormonal birth control that works for them knows, is BS. I switched around three times before I found a good one for me, and if someone told me that only pill #2 (which turned me into a weepy mess for three months) would be covered, there would be Issues.
posted by damayanti at 6:00 PM on May 3, 2015 [12 favorites]


Funny/sad, indeed.
posted by [insert clever name here] at 6:02 PM on May 3, 2015 [1 favorite]


My insurance provides "wellness" mammograms for free, on the theory that prevention is cheaper than cancer treatment.

My wife has had three of them. Every single time the procedure has been "accidentally" miscoded as diagnostic instead of preventative, and we've gotten a bill.


My ACA provider set up an aggressive program to get everyone to have an annual wellness exam. They said to tell your physician to use these codes for these procedures (including mammograms) and then take a short online survey, and they'd send you a gift card for $100 cash. So I did. I got a gift card for $100.

A few months later, the State Attorney General declared the insurance company insolvent, put them in receivership, and cancelled all their active policies.
posted by charlie don't surf at 6:10 PM on May 3, 2015 [1 favorite]


I can sympathize with localroger, we're probably going to have to pay over $2K because someone carelessly coded something as "diagnostic" when it should have been "preventative" and no one is all that interested in fixing it.
posted by maxwelton at 6:31 PM on May 3, 2015 [1 favorite]


Best birth control I ever had was cocaine. Paranoid and impotent, give me more of that!
posted by I love you more when I eat paint chips at 6:34 PM on May 3, 2015 [5 favorites]


"insurance" because the words "horrible" and "fuck" were already taken.
posted by Fizz at 6:50 PM on May 3, 2015 [3 favorites]


and no one is all that interested in fixing it.

Please do not let them get away with it. We have never quite gotten to the point of having to hire a lawyer but we would have over a bill more than a couple of hundred dollars. Send letters to everyone, certified and return receipt requested, explaining the situation. If anyone refuses delivery you have nailed them, send the next round to all the same recipients plus cc to the state Attorney General or whoever it is in your state who regulates the insurance industry. That will get their attention.
posted by localroger at 6:55 PM on May 3, 2015 [18 favorites]


Send letters to everyone, certified and return receipt requested, explaining the situation. If anyone refuses delivery you have nailed them, send the next round to all the same recipients plus cc to the state Attorney General or whoever it is in your state who regulates the insurance industry. That will get their attention.

The mere fact that such measures are routinely necessary makes me just so disgusted. I hate literally every single facet of the corrupt, slimy piece of shit American "health" industry.
posted by Steely-eyed Missile Man at 7:06 PM on May 3, 2015 [19 favorites]


Every so often I ask the world "how fucking hard is it to be a goddamn empathetic human being?" ive learned not to expect any sort of meaningful answer.
posted by triage_lazarus at 7:17 PM on May 3, 2015 [10 favorites]


Naturally. Naturally this is a thing that is happening. Let's add it to the list of things. What page are we on now?
posted by turbid dahlia at 7:20 PM on May 3, 2015 [1 favorite]


My insurance company somehow misrecorded my second son as a girl, and then denied a penis-related doctor visit as some phrasing like, "PROCEDURE NOT POSSIBLE FOR GENDER."

It took me longer to get the insurance company to fix their error than it took me to gestate the child in question. Meanwhile they just kept denying all my bills because the doctor's billing codes didn't match their incorrect data.

I also found it sort of Kafka-esque when they sent me a form letter that said "you have permission to go forward with your procedure GIVING BIRTH VAGINALLY." Uh, guys, I don't know if you know this, but birth "goes forward" with or without your permission letter.

Ugggggh single payer now please.
posted by Eyebrows McGee at 7:25 PM on May 3, 2015 [54 favorites]


My insurance company somehow misrecorded my second son as a girl, and then denied a penis-related doctor visit as some phrasing like, "PROCEDURE NOT POSSIBLE FOR GENDER."

This is on the list of reasons why I still have an M on my driver's license — I've heard horror stories about trans people getting denied appropriate care for the bits they've actually got due to this sort of ZOMG WHAT IS GENDER DOES NOT COMPUTE bullshit. My sense is that most of us don't ever have to deal with it, but I'm still not sure I want to tempt fate.
posted by nebulawindphone at 7:30 PM on May 3, 2015


As someone that works in heath insurance let me clear up a few things.

First, the provider (the doctor or facility) is not going to make any more money by using a routine vs. diagnostic code. All that matters is how much you are going to pay vs. how much the insurance company is going to pay.

Second, if it's a mistake (and it often is) the provider can change the claim. For something like a mammogram it starts with the referring doctor (the one who ordered the test) the radiologist and the imaging facility will use whatever diagnostic code is on the paperwork they receive. They can't change it. The insurance company can't change it. This is by law.

Birth control. Coverage varies by plan. Insurance company A might cover drug B if you work for company C but not if you work for company D. This was a decision made by company D. All plans must cover birth control at no cost (religious exceptions not withstanding) but sometimes mistakes happen and things get coded wrong in computers. When this happens my company works as quickly as possible to fix it but we might be an outlier I have no way of knowing. It is true that not all brands are covered but again, this is a decision made by the company buying the plan. We cover what your company pays for.
posted by Bonzai at 7:36 PM on May 3, 2015 [2 favorites]


" My sense is that most of us don't ever have to deal with it, but I'm still not sure I want to tempt fate."

The totally frustrating part isn't so much the denial, which eventually got straightened out, but that there was NO ONE responsible for fixing fundamental errors in underlying records. This would have been a three-minute problem if the first customer service drone was like, "Well, your daughter ..." "No, my SON. I have a boy." "Okay let me transfer you to data error repair, they may want you to fax a copy of the birth certificate, but they'll get it straightened right out."

(I'm going through this with my water company where the computer panicked when. I paid both on time and late by paying on leap day and keeps triggering late fees, penalties, refunds, etc. I finally overpaid by $80 so it could just draw down for a while , but it didn't help. The water company thinks it may be easier to delete my account and start me fresh so the computer can stop its rage cascade.

There really needs to be a person with the power to override the computer when dealing with utilities, health care, the government, etc.
posted by Eyebrows McGee at 7:53 PM on May 3, 2015 [21 favorites]


We cover what your company pays for.

This is exactly why y'all should be out of business.
posted by waitingtoderail at 8:13 PM on May 3, 2015 [29 favorites]


It's obviously a manifestation of a broken system, but hopefully the fact that it is directly running into the ACA language mandating coverage will force some slight improvements.

At heart, all we are doing is spray painting a turd -- there is no escaping that the overall approach is wrong, which makes the tweaks and improvements ineffective.
posted by Dip Flash at 8:20 PM on May 3, 2015 [4 favorites]


This absolutely happened to me. My insurance company kept charging me a $50 copay for each pack of birth control pills, even though it was supposed to be covered at no copay. I called them REPEATEDLY about it only to be told that the Affordable Care Act hadn't taken effect yet. I was told this by three different people. I finally asked the guy why I was then looking at a press release from the DHHS saying that the provision regarding birth control HAD taken effect. He didn't have an answer and transferred me to someone else. That person told me that my employer must not be participating with the ACA. Um, no. Then someone else condescendingly lectured me on the difference between an act and a law. This was after I told him that they were breaking federal law. (I hung up on that guy.) Most of the phone calls ended with the person saying they didn't know why my birth control wasn't being covered and they would research it and call me back. (No one ever, ever called me back.) It extra pissed me off because I wondered how many people just went, "Oh, okay" and either didn't use birth control or paid cash for it because their insurance company kept telling them firmly that it wasn't covered.

It took five months and I finally had to get the benefits representative from my work (which embarrassed me but FUCK THOSE GUYS) involved before my birth control pills were covered. And then not long after, I got married and started trying to get pregnant, HAVE FUN PAYING FOR THAT, INSURANCE COMPANY. BET THAT ORTHO TRI-CYCLEN LO IS LOOKING PRETTY COST-EFFECTIVE NOW, ISN'T IT?!?!?!
posted by Aquifer at 8:41 PM on May 3, 2015 [45 favorites]


Near as I can guess, seeing as how they still exist, the ACA did not outlaw drug formularies, which is how your insurance company decides which drugs are covered, and at which rates, for which plans.

I take lo-estrogen seasonique. While I still had my HDHP, it was about $240 every 3 months. When I switched to the highest tier PPO, it became $30 every 3 months. I ain't gonna gripe about saving $210, thanks, but you know: why is my form of birth control not free? I have no idea.

That said: I still don't like the idea of contraception for women being free: if someone else is footing that bill completely, then they have control over me. Uh, no. Just no.
posted by gsh at 8:50 PM on May 3, 2015


We cover what your company pays for.

And sometimes you work for the insurance company and they decide not to cover your NuvaRing.
posted by Burn.Don't.Freeze at 8:50 PM on May 3, 2015 [4 favorites]


I have the closest possible thing to single payer that the current system allows: my insurance comes through a nonprofit company owned by our city's public hospitals system.

They charged me a copay for both my annual physical as well as my well-woman visit (I managed to contest the second charge, but the billing mixups it created still haven't been sorted out). Bonus: I'm currently in the middle of a six-month wait for psych care.

Do we need a single-payer system? Yes. Absolutely. Will establishing one solve all of the biases and inefficiencies involved in seeking medical care? Almost certainly not. The good news is that we can start working on the latter long before we're granted the former.
posted by evidenceofabsence at 9:12 PM on May 3, 2015 [2 favorites]


I have been on hormones for about three years. I would not be alive without them. Last year, my doctor was fighting cancer, and for one of my checkups he was out of state getting chemo. I had to see another doctor in the same practice who didn't know anything about trans people. She refreshed my prescriptions for another six months, and I made my next appointment with my actual doctor. A month or so before I was supposed to see him again, he died, and my appointment disappeared from the system - no automatic rescheduling, no call from the office, no nothing.

When I ran out of refills that month, I had the pharmacy request them from the office. I went in to pick them up and was told that my request had been denied. I called the nurse of the doctor I had seen six months prior and asked what was going on, and she said the doctor wouldn't write me any more prescriptions until she saw me. I asked if she would at least give me two weeks or something while we worked out a new appointment, and she snidely told me no. This left me stranded without prescriptions for the first time since I'd started, and I felt really vulnerable and desperate. There was this realization that I had been sort of taking my prescriptions for granted, and for the rest of my life I'm going to be subject to the whims of cis doctors who know absolutely nothing about trans people and don't particularly care anyway. I knew more than my original doctor, sure, but at least he was consistent with my medication, and I figured that as long as I had that base covered I could worry about bloodwork results etc. myself. But without those prescriptions, I'm completely screwed.

Thankfully, I had some extra hormones from online pharmacies, because I had always been worried about losing access during a hurricane or something. So this wasn't actually a huge emergency for me, aside from how it made me feel. I set up an appointment, at which the doctor told me she had been "reading up" on treating trans people, since she'd gotten all of my old doctor's trans patients. She asked me all sorts of questions that were medically unnecessary - the usual stuff I expect from clueless random people but not from the doctor seeing me. She was completely unfamiliar with one of the drugs I'm taking (that is not uncommon in the treatment of trans women), and I watched her look it up on her computer, read the page, and then tell me she didn't know why I was taking it and thought I shouldn't. (It blocks dihydrotestosterone, is why.) She proudly told me a couple of facts that she had learned - did I know that after I have bottom surgery, I won't need to take testosterone-blocking medication any longer? Did I know that in fifteen years or so I should start getting regular mammograms? Some truly high-level stuff extremely relevant to my current visit.

I did that thing trans people are used to where you just nod and kiss ass, and left with new prescriptions. No insurance I've had in the last three years has paid a single cent for my treatment aside from my physical last year (and I was surprised to see that), because I'm trans, and they don't have to. The ACA supposedly says we can't be excluded services covered for cis people anymore (like hormone replacement therapy and regular-ass checkups), and maybe it will wind up that way eventually as these things work their way through courts, but right now in Louisiana there is not a single silver or bronze plan on the individual marketplace that doesn't have an explicit trans exclusion. (I assume all of the nice plans have them too, I just didn't check through them because I couldn't afford them anyway.)

I got the bill for this visit last week. It is $350. My pharmacist friend tells me it's not unusual for doctors to require patient visits to renew prescriptions every six months, but it still feels a lot like I was being extorted.

And, I mean, I'm in a good situation. I have access to a doctor willing to see trans patients at all. I have access to a doctor who is at least willing to write HRT prescriptions in general. I can afford that bullshit charge. I can afford my medication out of pocket. I am able to make and attend an appointment on short notice. I am able to maintain a small backup supply.

This whole thing is just such a fucked up racket and it ought to be burned to the ground.
posted by Corinth at 9:21 PM on May 3, 2015 [48 favorites]


This is why I stay with Kaiser, even when I've had other options from my company. Yeah, if some emergency comes up and I have to do any really cutting edge treatments there may be issues, but that's a small possibility and in the meantime I never, ever had to deal with an insurance company.
posted by tavella at 9:33 PM on May 3, 2015 [2 favorites]


Not exactly related to the article, but I am utterly mystified why insurance companies can't just send eligible women a 1 year supply of birth control pills. There is NO REASON tens of millions of women should have to stand in line at the pharmacy every single month. It's a hardship in some circumstances, but also just a pointless waste of time. And the insurance companies should want to do this -- they're ultimately paying the (extremely generous) pharmacists' salaries, to do nothing other than put a plastic container into a paper bag.

On a lighter note... Ask if birth control is right for you.
posted by miyabo at 9:34 PM on May 3, 2015 [10 favorites]


Up here in single payer Canada, I am certain my wife paid for her BC. When she had employer insurance some part of that may have been refunded — but I'm pretty sure we've always been out of pocket to the tune of $40/month or so.
posted by five fresh fish at 10:03 PM on May 3, 2015


Oh, I have a topper BC story!

Although I have never had PIV sex, I had a Mirena IUD implanted to suppress my periods, about three insurance changes ago. (If you want surreal, try looking like a gay male biker announcing to the GYN front desk I'm in for my IUD appointment) It appears in all my health records, probably because it also shows in most of my abdominal imaging. of which I have a lot due to tracking other health problems.

I can't get my current coverage to pay for a GYN visit OR removing the IUD, now that it's at the end of its five-year hormonal-release lifespan. They are denying coverage because... I haven't had a period/must be menopausal and so don't need a GYN or BC any more. Umm, perhaps I am menopausal (in which case I don't need the expired Mirena and it should be removed, and I should have my GYN annual too, do they think my parts will self-maintain now that I can't have the babies?), perhaps not (in which contrary case I need the expired Mirena removed and a new one inserted. Ugh.)

However, my current insurance is happy to pay for a hysterectomy/ovarectomy so I can't have any more fibroids and no ovarian cancer risk (but sure and sudden menopause. Yeah, that sounds fun). The fibroids that stopped being a problem because of the IUD. Will the current insurance cover hormone replacement therapy if the surgery causes menopausal symptoms? Of course not! Why? Because according to the insurance, but not my body experience or doctors, I'm all ready no-symptom menopausal! Aaaaaaaagh!

Oh, and can I get insurance-covered testosterone to deal with gender dysphoria? No! Why? Because I have a progesterone-releasing IUD!
posted by Dreidl at 10:24 PM on May 3, 2015 [11 favorites]


Uh, yeah. They're charging for birth control because they're charging for everything. The law was written assuming most medical expenses were covered and that is actually not how things are working out. Even the best plans you can get your hands on have a hand out trying to get ever larger pieces because, heh, why not?
posted by effugas at 1:13 AM on May 4, 2015


I'm sure the sterilization thing is just old-fashioned stupid paternalism. But with the drugs, it does concern me a little that this is being turned into the insurer's responsibility alone. Last few years, I've known a lot of people who've started on their first antidepressant and been given much more expensive drugs than I ever was. Quite possibly because someone in sales had been counseling their doctor about how to make patient treatment decisions. This isn't purely an insurer/patient conflict.

With birth control, it winds up like this, turned up with a little Googling. That's a woman who doesn't realize she's been prescribed a new birth control that's still under patent. She really likes it--but no mention of a medical reason why she needs Generess Fe specifically. After the sticker shock, she seems to have gone back to her doctor, who had no trouble giving her a less-expensive alternative. She eventually switched back and seems to think whatever she's paying as of the last update was worth it. Great! But I'm not actually sure the system anticipated those cost increases without regard to outcomes.

At which point, I'm torn. I do want all of this to be more accessible, but if Generess Fe is free as a first-line prescription, does that really help women--or does it help Actavis? Insurers are still clearly being idiots about this, but I don't think we can just leave these things to be a personal decision between a woman, her doctor, and a pharmaceutical company's multi-billion-dollar marketing budget.
posted by Sequence at 2:49 AM on May 4, 2015 [1 favorite]


Getting a prescription for birth control pills should be the same process as any other maintenance Rx - because sometimes medical needs change or side effects escalate. If this isn't the case, some people with the time need to file cases with their local civil rights commission citing adverse impact after listing personal travails with the current process.k
posted by childofTethys at 4:17 AM on May 4, 2015 [1 favorite]


How does it even make actuarial sense to charge more for birth control?

It almost certainly doesn't; that analysis has been done over and over and it's not controversial anymore. There's no reason to assume this is rational behavior, though. Within an organization as big as an insurance company there are many people, each of whom have their own agenda and goals, some of which can be well-served by doing things contrary to what would appear to be in the company's best interest in the long term. And that presumes that the company's leadership really even cares about the long term, and not just banging the stock price as high as they can get it to go for a couple of quarters and bailing out.

Also, because people can and do switch insurance companies all the time, the companies themselves are not necessarily incentivized to care about long-term costs. If they can keep you from spending $300 this year, the fact that it might cause you to spend $10,000 next year might not be their problem if you're on somebody else's insurance by then. My guess is that the companies can probably predict which customers are most likely to not be in it for the long haul (based on jobs, type of plan, demographics, etc.) and I wouldn't put it past them to deny preventative care services to someone they figure won't be their problem in six months. You could easily do that with the data they have available and it would be hard to detect.
posted by Kadin2048 at 6:10 AM on May 4, 2015 [7 favorites]


I still don't like the idea of contraception for women being free: if someone else is footing that bill completely, then they have control over me. Uh, no. Just no.

Your sense of freedom in this matter is utterly illusory.
posted by Steely-eyed Missile Man at 6:37 AM on May 4, 2015 [11 favorites]


I'm jumping through hoops right now with my insurance company for the IUD I got installed at the beginning of this year. Before I even made my doctor's appointment, I double-checked to make sure my insurance would cover it.

January: Appoinment made. IUD inserted, no problems.
February: I get two bills, one for the Mirena device, the other is for "Pharmacy, Surgical Care & Clinic". They total over $200. I ask my doctor and the hospital WTF, but no one can give me a clear answer, so I just pay it.
March: A friend tells me that her IUD was completely covered by insurance and that I should double check to see WTF is going . I call, and they tell me I was charged because I used an out-of-network doctor. Except I didn't use an out-of-network doctor, a fact that they confirm with me over the phone. They say they will conduct a review and get back to me.
April: A month later, I've heard nothing from this "review". I follow up and 45 minutes of hold time and phone transfers later, I found out that the review did go through, and my money was reimbursed. Sort of. Instead of paying my money back to me, my insurance company paid the two billing companies, so now I have to contact each of them separately to go through the process of getting my money back. Oh, and I used an HSA account, so I'm sure that will complicate things even more.

This is a relatively mild case, but it's definitely annoying. I consider myself a pretty savvy and assertive person. If a woman didn't know how to advocate for herself, I can see many insurance companies ripping them off. WTF indeed.
posted by chara at 6:53 AM on May 4, 2015 [6 favorites]


Up here in single payer Canada, I am certain my wife paid for her BC. When she had employer insurance some part of that may have been refunded — but I'm pretty sure we've always been out of pocket to the tune of $40/month or so.

This isn't birth control specific, however. Prescription drugs administered outside of hospitals aren't covered at all under the Canada Health Act. Some provinces provide public coverage for drugs, but this is usually by population group, not by drug (i.e. for seniors or low-income individuals). Some national or provincial agencies with independent charitable arms do provide funding for drugs needed for specific conditions, like cancer treatment, but these are exceptions. For the most part, it's just a matter of more or less no prescription drugs being covered under the public health insurance plans in Canada.

(Although access to transitioning treatments in Canada is inequitably borked.)
posted by northernish at 7:06 AM on May 4, 2015


I still don't like the idea of contraception for women being free: if someone else is footing that bill completely, then they have control over me. Uh, no. Just no.

This is actually kind of the complete opposite of how reality works?

Unless I guess your reality is that you're rich enough to pay for literally any medication or procedure you might want, at any time, and assume that every single other human being on the planet is the same. Spoiler alert: they're not.
posted by We put our faith in Blast Hardcheese at 12:07 PM on May 4, 2015 [8 favorites]


I actually got an IUD because my insurer wasn't covering my birth control pills (or they were, and then suddenly weren't), and I had no idea why. I thought maybe I had misunderstood my prescription costs or deductable, until I got a few different prescriptions and only had to pay the co-pay for them. Now I have the IUD and I'm iffy about it, but it was covered and the pills weren't, so I didn't have much choice. I'm pretty angry about how confusing all this has been. Not to mention the fact that I didn't even like my pill, because it was a random pill I was switched to when my provider was out of stock of the BC pill that worked for me with no side effects. Fucking, fucking birth control.
posted by easter queen at 11:31 AM on May 11, 2015


"New HHS clarification on ACA contraceptive coverage requirement specifies that insurance plans must cover at no cost to women at least one of the 18 contraceptive methods approved by the FDA. If a provider recommends a specific option or product, plans must cover it at no cost as well."

Disclaimer as usual: I work there, but not on the policy side.
posted by rtha at 4:05 PM on May 11, 2015


From the same administration clarification:
Health insurers cannot limit preventive services based on a person's birth gender, gender identity or recorded gender, the Obama administration said Tuesday, addressing claims of discrimination against transgender people.

The clarification was included among other guidelines that the Health and Human Services Department released in response to confusion among insurers and consumers. It said issuers should cover the preventative services an individual's provider deems appropriate.
posted by Corinth at 5:58 PM on May 11, 2015


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