By JoNel Aleccia The Seattle Times.
Women in Washington state seeking birth-control coverage through the health-benefit exchange created under the Affordable Care Act are receiving false or misleading information from their insurance carriers, who are bound by the federal law to provide no-cost access to approved methods.
That's according to a report released Thursday by legal-access and women's-rights advocates, who conducted a "secret shopper" survey of insurers' responses to would-be consumer questions about contraceptive coverage last year.
"We were surprised. Some of it was fairly shocking," said Janet Varon, executive director of Northwest Health Law Advocates, or NoHLA, which conducted the survey in conjunction with NARAL Pro-Choice Washington. "There was wide variation in each plan."
Representatives for all eight insurers selling Qualified Health Plans (QHPs) under the state exchange provided inaccurate information to the would-be consumers, with many struggling to answer questions about coverage for specific birth-control methods, brands, costs and co-payments. Other customer-service personnel seemed unaware that the 2010 federal law mandates no-cost coverage of all birth-control methods approved by the U.S. Food and Drug Administration.
"Because there are new and more expanded rules from the Affordable Care Act that assure access to coverage, all of us are interested in seeing how health carriers are covering them," Varon said.
About 158,000 people have enrolled in the state exchange plans, including about 85,000 females, according to state figures. About 40 percent are of reproductive age, between ages 18 and 44, which means inaccurate information could affect some 34,000 Washington women during their childbearing years.
NARAL organizers used 11 volunteers who contacted each of the eight exchange insurers five times between July and November 2014. The insurers include Community Health Plan of Washington, Molina Healthcare of Washington Inc., BridgeSpan Health, Kaiser Foundation Health Plan of the Northwest, Premera Blue Cross, LifeWise Health Plan of Washington, Coordinated Care Corporation and Group Health Cooperative.
Representatives from multiple carriers wrongly told callers there were co-payments for various methods of contraception, including birth-control pills, birth-control patches, vaginal rings, implants and injections. According to filings with the state Office of the Insurance Commissioner, all carriers cover medically necessary methods at no cost to patients.
"I was clearly surprised," said Commissioner Mike Kreidler. "I really thought the information they would be disseminating would have been much better thought-out so that they would have the facts."
Kreidler met with the insurers in March, and they all agreed to revamp the training and information their customer-service representatives receive and to make sure that their formularies, or lists of available drugs, accurately reflect available contraceptive options.
"The report surfaced both a need and an opportunity to make contraceptive coverage more easily accessible for members, and in this case, nonmembers, alike," Jackson Holtz, a spokesman for Group Health, said in a statement.
Lisa Hart, a spokeswoman for Molina HealthCare, said the firm's plans are in compliance with state and federal regulations.
"Molina covers all required contraceptive methods for members without cost-sharing as specified in the law," she wrote in a statement. Melanie Coon, a spokeswoman for Premera, noted that the report focused on initial queries, not the final benefits.
"While accurate information is critical, we are confident that we are processing benefit claims correctly and members are receiving the contraceptive benefits they're entitled to in accordance with the Affordable Care Act."
Responses from all of the eight insurers are included in the new report. Varon said the insurers are expected to meet with Kreidler in October to update progress on the issue.
The Washington survey was released the same day as a Kaiser Family Foundation report conducted in conjunction with the Lewin Group, which reviewed contraceptive coverage information from insurers in five states, California, Georgia, Michigan, New Jersey and Texas.
That report also finds that there is "wide variation in how the contraceptive coverage provision is being interpreted and implemented by health plans."
Many plans place limits on coverage of the vaginal ring, birth-control implants and patches, the report found.
Several women filed complaints with Kreidler's office in 2014, citing problems obtaining coverage for birth-control methods.
One 31-year-old Tacoma woman who asked to remain anonymous said her insurer required co-payments totaling nearly $400 for the NuvaRing device prescribed by her doctor last year, but then agreed to cover it fully starting in 2015.