Insurers Face Widely Differing Reproductive Health Coverage Rules – InsuranceNewsNet

“Across the country, strong monitoring and oversight continues to be needed to ensure that insurers, both in the private context and in Medicaid-managed care, are complying with the requirements of the law, often in all areas of health care, including reproductive and reproductive services. sexual health,” said Amy Chen, senior attorney in the Los Angeles office of the National Health Law Program, a health care advocacy group.

Free means free

Passed by the Oregon Legislature in 2017, RHEA covers annual wellness visits, birth control, abortions, cancer and sexually transmitted disease screenings, breastfeeding support, and other services. Business insurance and Medicare are exempt from its mandates.

State regulators found that each of the 12 insurers was not paying all eligible claims under RHEA requirements. They applied copays, coinsurance and deductibles, which are prohibited under RHEA for reproductive health and preventive care. In some cases, insurers have erroneously rejected claims for covered services.

In addition, the reports revealed that three insurers — Aetna, BridgeSpan and Regence BlueCross BlueShield — failed to cover certain types of contraceptives or placed improper restrictions on the amount or time a member could refill a prescription.

Other insurers mentioned were Cigna Health and Life Insurance Co., HealthNet Health Plan of Oregon, Kaiser Foundation Health Plan of the Northwest, Moda Health Plan, PacificSource Health Plans, Providence Health Plan, Samaritan Health Plans, UnitedHealthcare Insurance Co. and UnitedHealthcare of Oregon.

All insurers, with the exception of Moda Health, have filed responses with the state as of the publication of this article.

Three insurers accepted the audit findings: PacificSource, Kaiser and UnitedHealthcare of Oregon. Other insurers disputed Oregon’s report in whole or in part. Aetna, in particular, objected to how regulators handled her responses to the evidence before and after a Dec. 16 hearing.

“Aetna continues to dispute the remaining factual findings and legal conclusions contained therein,” wrote Kenneth G. Kubes, executive director and senior counsel for Aetna. “Instead of giving specific examples of claims that Aetna processed during the study period in violation of RHEA, the final report instead makes general statements and draws conclusions from hypothetical scenarios that are not supported by the data Aetna actually submitted. ”

A pair of insurers, Regence and BridgeSpan, suggested that Oregon regulators issue a rule explaining the law’s requirements.

“We support the intent and spirit of this important law to provide Oregonians with access to reproductive health services and contraceptives,” wrote Christopher G. Blanton, senior vice president of health plan operations for Regence. “The results of the market-wide study indicate inconsistency with how the RHEA Statute has been interpreted and implemented.”

Disputes over contraceptive coverage with insurers aren’t new, says Laurie Sobel, deputy director, women’s health policy for the Kaiser Family Foundation.

She pointed to “problems around what is considered reasonable medical management of insurance companies” who want to be able to set parameters around personalized birth control plans.

“Adoption of these changes will reduce barriers and expand access to comprehensive reproductive health care…”New Jersey Insurance Commissioner Marlene Caride

“Insurance companies are used to being able to set parameters, even if there is some kind of mandate,” she explained.

The Colorado Division of Insurance recently reminded insurers to know their obligations. Colorado law ensures that anyone seeking birth control, including tubal ligation surgery, can obtain services at no cost to the insured member.

“The division has recently become aware of cases where individuals have been misinformed that they may be responsible for a portion of the cost of a surgical sterilization procedure,” said Colorado Insurance Commissioner Michael Conway.

Abortion fight

The debate over coverage of reproductive health services, such as birth control, has largely made headlines in the decade since the ACA became law. That all changed when word leaked that the Supreme Court would overturn abortion.

Policy battles quickly mounted and state legislators took sides. According to the Guttmacher Institute, one of several groups charting the abortion debate, eight states are requiring abortion coverage in private health insurance.

On the other hand, eleven states have laws in effect that limit abortion insurance coverage in all private insurance plans written in the state, including those offered through health insurance exchanges established under the ACA.

“As some anti-abortion lawmakers scramble to ban abortion, we’ve seen bold, proactive action from states like California, Massachusetts, New Jersey, New York and Oregon, allocating state funds to help people with the financial costs of an abortion. ,” said Morgan Hopkins, president of All Above All, an abortion rights group in Washington, DC. “So were many cities, including Atlanta, Chicago, and St. Louis.”

New Jersey is a typical example of the blue-state approach to expanding health care coverage for reproductive rights and abortion. The state Department of Banking and Insurance spent 2022 studying the issues for a 13-page report submitted to Governor Phil Murphy in November.

Insurance Commissioner Marlene Caride cited the report’s findings in announcing new requirements for expanded abortion coverage among insurers in the individual and small employer markets, which took effect before the start of the 2023 plan year on Jan. 1.

As part of the report, carriers in New Jersey’s individual and small employer markets were asked to list the impact of covering abortion without exception as part of their 2023 rate statements. Carriers estimate a range from zero impact to 0.1% of the premium.

“The adoption of these changes will reduce barriers and expand access to comprehensive reproductive health care in the new year,” Caride said.

InsuranceNewsNet senior editor John Hilton has covered business and other matters daily in journalism for more than 20 years. Jan can be reached at [email protected]. Follow him on Twitter @INNJohnH.

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Insurers Face Widely Differing Reproductive Health Coverage Rules – InsuranceNewsNet

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