Repressive Insurance Policies?

[betterbebalboa.livejournal.com]

Has anyone here ever had an issue with getting their HBC script filled due to a religious-based insurance policy?

A friend of mine is working for a Catholic organization, and unbeknownst to her (it was not on her contract, or clearly on her insurance policy), her employers' insurance policy forbids birth control coverage for the purpose of contraception. When she called her OBGYN to ask if she could have the script made out for a different purpose (a.k.a. any of the other medically sound reasons that she ALSO uses HBC, and would continue to use it even if not sexually active), they told her they couldn't do that - they said if she uses it for contraception at all, she would be committing insurance fraud.

What to do? Is there a way for her to have affordable HBC coverage under such a repressive policy? Is there a way she can contest this without fear of losing her job?

Comments

[archangelbeth]

Is the company self-insured, or is it buying packages from an insurance company? If the latter, she can probably talk to the insurance company about this restriction and see if it can be quietly overturned. If the company is self-insured -- they pay the bills, though they may have an established insurance company to collect bills and deal with paperwork (my spouse's business did that) -- then she's probably of out of luck unless she can get a different doctor to make out the scrip.

Perhaps she could get enough together to get a copper IUD on her own dime, and then she's not using the pills as contraception? (Assuming that she is indeed wanting HBC for both contraceptive and the non-contraceptive methods.) Or her doctor could prescribe something she could get inexpensively as a generic with her own cash?

I can't think of anything else -- getting a lawyer regarding the lack of clarity in the policy, leaking this to the press, etc. -- that wouldn't risk her losing her job.

Luck to her.

[knittinggoddess.livejournal.com]

This to the copper IUD idea. There's also a patient assistance program (http://community.livejournal.com/iud_divas/1065966.html) for the Paragard. Additionally, the Mirena IUD would offer both contraceptive and non-contraceptive benefits, though it's only effective for five years. Still, it's way less expensive in the long run than many hbc pills.

[mollyanomaly.livejournal.com]

Some pharmacies offer discounted generics, some even include birth control pills. I know that Hannaford (grocery store w/ its own pharmacy, New England based) offers 2 different generic pills, one triphasic, one monophasic, for only $10/pack. Your friend wouldn't even need to give them her insurance information at all, just ask the doctor if either of the generics are acceptable for her to take and get a RX for them. Have your friend check out pharmacies near her to see if any offer similar things!

[sekaijuuni.livejournal.com]

When I first studied abroad in Japan, my gyno was more than happy to write (or maybe sign? I forget) a letter saying that my HBC was for acne and regulating my periods, which to some extent it was.

Is it possible for her to get a prescription from another doctor or does it have to be that one gyno? I feel like Planned Parenthood or something might be more understanding.

[sekaijuuni.livejournal.com]

Also, many clinics like that charge for HBC on a sliding scale according to the patient's income, so it's possible that they'd adjust the price knowing that her insurance won't cover it.

[karalianne.livejournal.com]

I can't answer the question, but I thought I'd point out that this happens with non-religious employers as well. HBC is often considered to be an optional medication - i.e., something that is not necessary to one's health - so insurance companies don't cover it.

We thought my husband's work coverage might not cover my HBC because it's so common to deny it, but apparently his work is just that awesome. (Seriously, his work insurance is amazing for what it covers and how flexible it is. My two-years'-overdue crown is even being covered, not two months after I had an emergency root canal and crown put in. Pretty sure that's a pre-existing condition.)

[misspaigeb.livejournal.com]

It's just sad that an insurance policy that actually fucking covers emergency, important matters of health and birth control even has to be considered "that awesome." I wish America would get its shit together when it comes to health care.

[karalianne.livejournal.com]

I'm Canadian.

And currently live in Saskatchewan, the most socialist province in the country.

I can see doctors for free for most things (I think including emergency care), but I have to pay for prescriptions and the dentist and eye doctors are never free.

I think dental and eye checkups should be covered by provincial health care, to be honest. Same with prescriptions, which should include corrective lenses - maybe not frames (some of them can cost way more than they ought), but the lenses themselves should be covered provincially. Even my amazing health insurance only covers new glasses/contacts once every two years, and even then only $250 of them. I am currently wearing $600 on my face, and I got the frames that were under $200, and my eyes are currently changing every year. So, you know, there's definitely room for improvement.

[paraxeni.livejournal.com]

I live in the UK. All medical care is free, contraceptives are free of charge, any other prescription medication is a flat price of £7.50. I pay £10 per month for a prepayment card that covers every prescription I get, so I save a fortune.

Although we do pay for dental and eye care no NHS dentist can charge more than £200 per course of treatment, and most opticians charge about £15 for eye tests (some large chains don't charge) and glasses, including lenses, cost from £10 a pair. Our local supermarket did my gf's last test and prescription lenses for a total of £15. Those specs have lasted her 2 years.

[misspaigeb.livejournal.com]

The thing I really wish I had more coverage on is prescriptions. My old insurance made me pay a copay of $35 for my birth control, but with the new one, I have to pay for $200 worth of any prescription before they'll even start covering PART of it. And since NuvaRing costs around $80 per ring, that just seems like the biggest waste of money ever. I'd have to buy 3 rings full price and then I will pay $35. Once 2010 is over I will have to start all over again with the $200. Ugh.

Plus, living in a super conservative state does not help because the Planned Parenthood here gets shit for funding. But the fact that they can even CHARGE $80 for 3 weeks of birth control is... unreal to me. How many women want to be on NuvaRing for whatever reason but can't because it's too expensive? It's sad.

[frolicnaked.livejournal.com]

How many women want to be on NuvaRing for whatever reason but can't because it's too expensive?

Very true. I'll admit that I didn't have a particularly good experience with Nuva Ring when I was trying it. (My first 3 rings were samples from my doc.) But it was price -- $52 per ring then, none covered by my insurance -- that was the deciding factor for me. And I'm fortunate in that I don't have a problem with more "daily user involved" methods (pills, FAM, etc.) -- but I know that's not the case for a fair number of folk.

[misspaigeb.livejournal.com]

For my anxiety, it's a godsend because I'm not worrying about "Did I take my pill on time? Did I puke my pill up? Did I poop it out?" also because of my IBS. I am on the fence about an IUD but if I ever do get one, it will probably be more because of cost than anything. The fact that I've spent nearly $420 on my birth control alone (covered by insurance!) in the past year is kind of disturbing.

[mintytrina.livejournal.com]

I feel ya on that. When I gave NuvaRing a shot, I was delighted to have finally found a BC that didn't make me totally crazy and I didn't have to pop a pill for (because I ALWAYS forget).

Then I found out it's crazy expensive. I've stayed on it but with my husband's new insurance it's $40 a ring :-/

I have now taken to buying mine from Northwest Pharmacy online.

[misspaigeb.livejournal.com]

Are you in the U.S.? Did you just have your doctor call your prescription in? I just called my doctor's office and the nurse said they "don't usually like to do that" and would have to ask the doctor about it because it "might not be the same medication." That seems like a load of shit to me.

By the way I'm sorry for highjacking this post, OP!

[mintytrina.livejournal.com]

Yes, I'm in the U.S. I just took my written prescription and scanned it in and emailed it to the pharmacy. I figured that trying to get my doctor to call it in would be frowned upon.

[misspaigeb.livejournal.com]

Well apparently it is!

[mintytrina.livejournal.com]

I did get a call from my bank when my card was charged through them though....apparently my bank saw it as "strange charges to my account." I told them it was fine, I authorized it, but it was weird.

[misspaigeb.livejournal.com]

Ah, sorry for my mistake! I honestly didn't know that Canada used insurance. I have a copay for prescriptions, doctor's appointments, everything. Depends how expensive the prescription is, and I think they cover like %80 of doctor's visits. I have to pay for $200 worth of any prescription before they'll start covering part of it, and that's every year. So... I'm hoping to order my birth control (NuvaRing, about $80 per ring without insurance in the U.S.) through a Canadian pharmacy, because I just can't be paying EIGHTY DOLLARS for my birth control. Ridiculous.

I don't have dental insurance or eye coverage either because my dad owns his own business, and I'm on his insurance, so he has to pay everything out of pocket instead of getting it through his employer, and dental and eye is too much for him to pay. I am so with you on wishing I had coverage for eyeglasses! I have a pair of prescription glasses, a pair of prescription sunglasses and each cost around $200 for frames and lenses. My eyes are also getting worse, so I'll probably have to get new ones pretty soon.

It just makes me sad that I have insurance and all of these things are still a problem. So I can't imagine someone who doesn't have any insurance. :(

[paraxeni.livejournal.com]

Eighty dollars? That's fucking ridiculous. P'raps only well-off people deserve to have sex without fear, eh?

*hugs*

Every time someone slags the NHS off I want to direct them to a VPer, I really do.

[misspaigeb.livejournal.com]

Yeah, everyone tells me I should just switch to some cheap pills or something. But I don't want to, and I think people should at least have some kind of choice! NuvaRing's patent doesn't go up til like 2018 or something like that, so the price is likely to keep going up.

Planned Parenthood is trying to argue that the "all preventative care %100 covered" clause in Obama's bill should include contraceptives, which would be so awesome if it would. So many people in this country are against any health reform that resembles socialized medicine and I honestly just don't understand why. Maybe I'm naive but something has to change.

[paraxeni.livejournal.com]

I don't understand that mindset either. I'd be completely screwed if it wasn't for socialised medicine.

[mintytrina.livejournal.com]

It really is so frustrating. Birth control aside, I have asthma and thanks to someone deciding that generic inhalers were "bad for the environment" companies had to make new ones and thus they are no longer generics for a few years. So ALL my asthma meds are non-generic and expensive. :( I spend ~$120/month on asthma meds alone. WITH insurance. And these are not optional, I need them or I die/visit the ER regularly.

I fucking hate health insurance companies. They seriously need a complete overhaul because everything they do is profit driven only, they don't give a crap if you're suffering or not. I don't think my health should be in the hands of people who are only worried about how much money they are making off me, not my health.

[paraxeni.livejournal.com]

You're so right. Coming from a place where all contraception is free, even condoms and female condoms if you go to a clinic, VP can make for depressing reading. Being able to control reproduction is a basic human right, not a privilege. Here we've got our shit together in the last few years so that even abortion services have improved, with something like 80% taking place before 8 weeks.

[zombie-attaackk.livejournal.com]

def she should see another dr....one that would be a little more understanding to work with her.

[donnajuanita.livejournal.com]

I know lots of manufacturers have coupons or programs on their websites for discounted prescriptions... Neither my husband nor I have insurance (yah childcare!) but we get my Yaz for something like $25/mo because of the program we signed up for on their website. I don't think it's income-based, which is cool Basically (as I understand it - my husband handles the HBC thing for me :) you just give your name/email/birthday or something, and you print out a paper to take to the pharmacy.
HTH!

[opaloctober.livejournal.com]

THIS.


Maybe she can talk to her local Planned Parenthood and possibly get her BC from them, instead?

[mydocuments.livejournal.com]

She may want to contact her local Health Department. They may offer low cost/no cost birth control as part of a women's health program or sexual health program. My health department in my hometown offers free paps/birth control (Nuva Ring, OTC-Low, and Depo) no questions asked. It's wonderful.

Other than that, she may want to see another doctor and have them prescribe the birth control pills on the chart as being for dysmenorrhea or amenorrhea.

Good luck to her!

[loonquawl.livejournal.com]

Sprintec and TriSprintec are on Target's $4 generic and Walmart's $9 generic lists. I don't think those programs require insurance. But if she is on a specific one for whatever reason, that may not quite be an option.

[jennifer0246.livejournal.com]

If she has problems with periods, hormones, acne, or a medical reason to take hormonal medication like bcp, then her doctor can write a note stating that. However, if she has no history of this, she can't simply invent it in order to circumvent the insurance company - the dr's office is absolutely correct in stating that's insurance fraud.

That said, the insurance co policy is super crappy and unfair, because I bet they cover prenatal care! And maybe even viagra. Sigh.

[eunicemcgee.livejournal.com]

It sounds like in your post that she does indeed have a history of other reasons for her taking HBC? If that's the case, I'd just try calling again, because it sounds like the office misunderstood her the first time. The policy sounds very clear in that that she's allowed to take HBC for non-contraceptive purposes (as opposed to anything with a contraceptive side-effect being banned). She could phrase it like "my insurance needs to verify that I have a non-contraceptive reason for taking HBC. I need it confirmed that I've discussed my problems with heavy periods/irregular periods/acne/whatever with my doctor." This doesn't preclude the not-wanting-to-get pregnant part, but will satisfy the insurance policy.

[misspaigeb.livejournal.com]

This is what I was thinking.

[acharmedlife.livejournal.com]

Not related - but I didn't even know that there were plans that cover HBC. I'm in Canada and it isn't covered by my govt insurance or my private insurance. It's pretty painful to have to pay $30 every month in addition to my other meds, but returning to life with horrible, debilitating, painful, LONG, heavy periods is a worse thought.

[lexicalcrap.livejournal.com]

Between the several insurers my parents have been covered by, and the ones I've encountered through either school or co-op terms, I've yet to find an private insurance plan that doesn't at least cover some HBC pills -- and this includes insurers with otherwise limited formularies.

[paraxeni.livejournal.com]

I'm in the UK, but plenty of my USian friends have insurance plans that do not cover BC. Apparently 49% of group plans do not cover BC, and only 155 cover LARCs (long acting reversible contraceptives) like Implanon, Mirena IUS, IUDs, Depo-Provera etc.

http://www.healthinsurancerates.com/56-birth-control-and-health-insurance.html

[lexicalcrap.livejournal.com]

I meant Canada, though, and specifically Ontario; I should have clarified that. I'd suspect that Canadian employers might, as a whole, be less likely to opt out of HBC coverage for moral reasons than US employers. There's definitely a financial incentive to not covering birth control, but I suspect that the social climate plays a role in that, too.

[misspaigeb.livejournal.com]

I'm in the U.S. and most insurance covers birth control but you'll have a copay depending how much it costs without insurance, or they have some condition under which it's covered. Like only the generic if it's available, or something. My birth control was $80 and I had to pay a $35 copay.. so, you're still paying less than I am, with insurance. :P