How much leeway do employers and insurers have in deciding whether they’ll cover contraceptives without charge and in determining which methods make the cut?
Not much, as it turns out, but that hasn’t stopped some from trying.
Kaiser Health News readers still write in regularly describing battles they’re waging to get the birth control coverage they’re 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, according to Planned Parenthood.
Under the health law, health plans have to cover the full range of FDA-approved birth control methods without any cost sharing by women, unless the plan falls into a limited number of categories that are excluded, either because it’s grandfathered under the law or it’s for is a religious employer or house of worship. Following the recent Supreme Court decision 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 to use “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.
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 clearly states 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, “we’ve 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.
–Michelle Andrews, Kaiser Health News
OMG says
So tell me why the Insurers need to follow the law when the President does not and changes it whenever he pleases. Especially for his special interest groups!
Michael Randazzo says
1. Why does the left consider a pregnancy a sickness? It is as natural as the birds and the bees.
2. What is the baby’s choice in this? How about men keep it in their pants and woman keep their legs closed?
3. The “ACA”/ Obamacare is an unconstitutional law and as far as I am concerned should be struck down completely.
4. If you can show me in the Constitution where it is lawful for the Government to take my money to fix your screw up (and I do mean screw up) I will gladly fork over my hard earned money to pay for your slutty (female) and dirtbag (male) irresponsible behavior.
Thank you for listening.
Bunnell Resident says
Since the President picks and chooses which laws he will follow or enforce including knowingly and willingly breaking his own law under Obamacare, there should be no surprise that employers/ insurers may be tempted to pick and choose also. The President has set a poor example which has caused a decreased respect for the law. Is anyone surprised? When leaders lead followers will follow, when leaders fail to lead, followers do whatever the hell they choose.
OMG says
See what I mean. Obama just changed the Law again… http://www.foxnews.com/politics/2014/08/22/administration-offers-new-accommodations-on-birth-control-after-obamacare/
A.S.F. says
I notice whenever birth control options are excluded for any reason, by any group, it is always the options open to women that are targeted. Why are vasectomies never excluded, either by name or with such gusto? If sexual mores and behavior are the issue for so many of the upright Christian soldiers among us, why do I hear no such protestations mentioned for Viagra and Cialys prescriptions for men? I mean, if the Lord WANTED you to be able to have an erection…(fill in the blank.)
Sherry Epley says
I agree completely ASF! I love the way you worded your comment! Also what about vasectomies?
Also, not to confuse the loyal FOX lovers with actual facts, it is actually the Republican packed Supreme court that is changing the rules for the ACA!
What about them? says
Vasectomies are considered an elective procedure, and I know of NO insurance plans that cover them. If you’re so up-in-arms about having choices, it seems to me you would WANT vasectomies to be fully covered. That way more women could “choose” to NOT use birth control.
Also, can you point out some insurance plans that cover ED prescriptions at no cost? I’m sure there are thousands of men that would like to sign up for it!
Sherry Epley says
Apparently good ole’ (NOT!) Hobby Lobby’s insurance still provides some coverage for vasectomies and ED drugs. I’ll bet they even have job openings IF you are the “RIGHT” gender and believe in the “RIGHT” God!
This from the DailyElite:
Hobby Lobby may no longer allow its female employees to pay for IUDs and Plan B pills with their health insurance, but men are more than able to pay for Viagra and their vasectomy procedures with Hobby Lobby’s current insurance offerings.
If Hobby Lobby believes that IUDs, which actually prevent pregnancy in the first place, cause abortion, it’s interesting (and suspiciously convenient) that they don’t similarly hold that vasectomies don’t interfere with the creation of life as God intended.
This revelation has also brought into question that the five all-male Supreme Court justices who comprised the majority opinion in Hobby Lobby’s favor might have ruled differently if it were their own reproductive rights and medical procedure payment options at stake.