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Planned Parenthood volunteers help bring the fight for health insurance reform to the Ohio Statehouse in Columbus. June, 2009
The major achilles heel of Obamacare working as healthcare reform policy is that it keeps insurance companies largely in control of the health care people can access. That's compounded by the reliance on state insurance regulators to do the heavy lifting when it comes to making sure that insurers comply with all the provisions of the federal law. Some states have a great insurance regulatory system, many do not. Historically, insurers have exploited every opportunity lax oversight has given them, and even with the Affordable Care Act, they're still trying to push that line. Typically, they're still trying to screw women by trying to skirt the rules mandating they cover contraceptives without a patient copay.
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.

That's not supposed to be how it works under the new law. There are some exemptions from the coverage—plans that are still grandfathered under the law, and those for religious employers or houses of worship and the new, SCOTUS-approved Hobby Lobby case. But insurers have to provide for all the different methods of birth control. They can require a substitution of a generic birth control pill for a brand-name one, but they can't tell a patient prescribed one method of hormonal birth control that she will either have to pay for it or use a different method. The government has made that clear to insurers in the rules it has provided, but some insurers are still trying to skirt the law.
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."
They likely think they can get away with it because fighting back is a hassle. Women who encounter this refusal by their insurance company have to appeal the decision with the insurer, and they also have to get their state insurance department involved. The companies are likely betting that their customers are confused enough about the new law to not know that they're getting screwed or that they just won't have the time or energy to press their case.

Now that insurance companies can't get their profits by refusing to cover treatments and procedures for the really expensive conditions, it looks like some of them have decided to profit by nickel-and-diming their female customers on the medicine they have to use every day. Because that's what they do. It's one more reason that health care reform isn't finished. As long as insurers think they can save money by getting around providing some treatment, they'll do it.

Originally posted to Joan McCarter on Tue Aug 26, 2014 at 10:39 AM PDT.

Also republished by Daily Kos.

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Comment Preferences

  •  Tip Jar (16+ / 0-)

    "The NSA’s capability at any time could be turned around on the American people, and no American would have any privacy left, such is the capability to monitor everything. [...] There would be no place to hide."--Frank Church

    by Joan McCarter on Tue Aug 26, 2014 at 10:39:22 AM PDT

  •  Side note: NuvaRing is bad news. My daughter (3+ / 0-)
    Recommended by:
    Catte Nappe, enhydra lutris, whaddaya

    used to use one until she had a serious DVT. It turns out that blood levels of hormones with NuvaRing are several-fold higher than were originally reported and it is associated with an elevated risk of clots and strokes.

    Not trying to derail your diary, but I thought it was important to get this out there.

    Is it true? Is it kind? Is it necessary? . . . and respect the dignity of every human being.

    by Wee Mama on Tue Aug 26, 2014 at 10:57:21 AM PDT

    •  That is one of the many reasons it is good to (1+ / 0-)
      Recommended by:
      Wee Mama

      talk to an obgyn about all the different side effects, issues, and problems of all contraceptives prescribed. I hope patients are reporting these issues to their doctors so doctors will be aware of any and all problems and side effects of what they prescribe. With all these TV ads about asking your doctor about......some doctors just prescribe whatever we ask for...and that is upsetting too. For instance, I studied the side effects of Lyrica as my sister and friends were nagging me constantly about getting on that for relief from nerve pain. But I am prone to breakouts, skin infections, rashes, I never did ask my doctor about it.  

      Keystone Liberals on Twitter @ KeystoneLibs , Join PA Liberals at

      by wishingwell on Thu Aug 28, 2014 at 04:08:40 PM PDT

      [ Parent ]

    •  Thanks Wee Mama for this info so we can tell (1+ / 0-)
      Recommended by:
      Wee Mama

      our friends and relatives about this so they can talk to their doctor about this being a problem.  As I find often I need to study my medications as the doctors often just prescribe and do not study or warn of the side effects. And pharmacists often are so busy , that we pick up our scripts and do not have time to wait around to ask questions about side effects, or what they have heard. etc.

      Keystone Liberals on Twitter @ KeystoneLibs , Join PA Liberals at

      by wishingwell on Thu Aug 28, 2014 at 04:10:57 PM PDT

      [ Parent ]

  •  They've always done this (0+ / 0-)

    And not just with BC or with women's health. They will always try to push for the less expensive option for meds, or any other treatments and procedures.

    “Texas is a so-called red state, but you’ve got 10 million Democrats here in Texas. And …, there are a whole lot of people here in Texas who need us, and who need us to fight for them.” President Obama

    by Catte Nappe on Tue Aug 26, 2014 at 11:20:16 AM PDT

    •  Yes they would not cover my medication for a (1+ / 0-)
      Recommended by:
      Catte Nappe

      fungal infection, insisting the OTC medication had to be used first ..even when my doctor told them they tried it and it did not cure my fungal infection and he wanted to try oral medication, insurance company said No. And my insurance company is quite liberal with covering medication and costs usually.

      Keystone Liberals on Twitter @ KeystoneLibs , Join PA Liberals at

      by wishingwell on Thu Aug 28, 2014 at 04:13:12 PM PDT

      [ Parent ]

  •  And if you don't have insurance it is expensive (1+ / 0-)
    Recommended by:

    My company offers insurance but the employee portion is unaffordable for many employees. Because the company offers insurance they are not eligible for subsidies or to buy on the exchange.

    We need single payer now

    "Pulling together is the aim of despotism and tyranny. Free men pull in all kinds of directions.” --Lord Vetinari

    by voracious on Thu Aug 28, 2014 at 03:35:28 PM PDT

    •  The insurance they offer must be affordable (2+ / 0-)
      Recommended by:
      hbk, wishingwell

      and it must be comparable to at least a silver plan, as I recall. If it is not affordable you can use the exchange. See a navigator.

      •  I don't know how that works. It is affordable (0+ / 0-)

        for some but not others. I think it might meet the affordability requirements but they dont want to spend $200 a month

        "Pulling together is the aim of despotism and tyranny. Free men pull in all kinds of directions.” --Lord Vetinari

        by voracious on Thu Aug 28, 2014 at 04:06:14 PM PDT

        [ Parent ]

    •  My husband works for a major retail chain and (0+ / 0-)

      they sent a letter to employees last fall where they gave the employee the option to seek insurance through the exchanges or they could continue with the company insurance plans being offered. I just assumed most companies were doing that with their employees, apparently not

      Keystone Liberals on Twitter @ KeystoneLibs , Join PA Liberals at

      by wishingwell on Thu Aug 28, 2014 at 04:15:18 PM PDT

      [ Parent ]

  •  OK, Joan. Go to the board and write 100 times: (0+ / 0-)
    The major achilles heel of Obamacare working as healthcare reform policy is that it keeps insurance companies largely in control of the health care people can access.
    And if you want to include continued reliance on employers to provide health insurance, you will get a gold star.

    LG: You know what? You got spunk. MR: Well, Yes... LG: I hate spunk!

    by dinotrac on Thu Aug 28, 2014 at 03:45:47 PM PDT

  •  FUCK the anti birth control monsters; (1+ / 0-)
    Recommended by:
    skye in Ore

    He'll is too good for them.

    I voted Tuesday, May 6, 2014 because it is my right, my responsibility and because my parents moved from Alabama to Ohio to vote. Unfortunately, the republicons want to turn Ohio into Alabama.

    by a2nite on Thu Aug 28, 2014 at 04:05:37 PM PDT

  •  Aetna told me I couldn't get coverage for heparin (0+ / 0-)

    and that they wanted me on Lovenox. They wouldn't pay for the heparin at all. The Lovenox would have cost me $4000, plus whatever 20% is on top of that. ($5493 total for 9 months during my pregnancy.) Sure, it's not birth control, but insurers do this crap all the time - deny, deny, deny.

    I see you drivin' 'round town with the girl I love / And I'm like / Please proceed, Governor. - Dave Itzkoff

    by Jensequitur on Thu Aug 28, 2014 at 04:12:17 PM PDT

    •  Lovenix( long acting heparin) is very expensive... (0+ / 0-)

      Lovenix( long acting heparin) is very expensive but much much better in pregnancy because of the higher metabolic clearance of regular heparin

      Also regular heparin has had problems being available and causes much more side affects such as heparin induced thrombocytopenia.

  •  This is the dark side of portability of coverage, (0+ / 0-)

    and of the use of the insurance company model instead of single payer.

    Birth control is a preventative measure, and prevention typically saves money for whomever picks up the check for the consequences.  Vaccines save the cost of the disease, birth control saves the cost of the delivery of a baby.  In single payer, the payer would be EAGER to cover birth control because the payer would be saving the cost of a pregnancy, delivery, and care of a newborn.

    In our model, though, the insurance company has an incentive to get rid of "risky" policyholders, and get them to go to someone else.  A woman who wants birth control is more risky to an insurance company, not because birth control is expensive, but because birth control isn't perfect.  Better to get her really annoyed so that she changes insurers.  

    One more reason we need single payer.  

  •  Would someone please (0+ / 0-)

    remind me how single payer wasn't even discussed when Big Pharma and Big Insurance were handed the keys to the castle?  Because I seem to remember that Obama promised to at least consider it when he campaigned...didn't he?

  •  As someone who once worked for an insurance (0+ / 0-)


    Never, ever take a refusal to pay as valid.  Call, ask why, ask for the code (mis-coding, deliberate or accidental is a big reason for denials and overcharges.)  Ask for a detailed bill, Question everything.  I once took my daughter in for an emergency @ noon, and was charged for 'after hours'.

    If you know you are correct, contact the state insurance department.  Get a name and let the insurance company know that you are working with the state.  

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