Press Releases

Congresswoman Suzan DelBene (WA-01) today wrote to insurance carriers with plans on the Washington state healthcare exchange, demanding clarity for women who inquire about what contraceptives are covered at no-cost under their healthcare plans.

“I am writing to express my serious concern with recent reports that consumers are receiving inaccurate information regarding the coverage and cost of contraceptive services,” DelBene wrote. “I was troubled to learn that enrollees in Washington may be receiving misinformation from their carriers about birth-control coverage, and I urge you to take swift action to address this critical issue for women across our state.”

According to a recent report, every insurer selling Qualified Health Plans (QHPs) on the state exchange failed to provide consistent, accurate answers to women’s questions about birth-control coverage. Under the Affordable Care Act (ACA), insurance carriers are now required to provide no-cost access to all FDA-approved forms of birth control, but some women who inquired were wrongly told they’d have a copay.

Nearly 34,000 Washington women of reproductive ages are enrolled in state exchange plans. It is estimated that 99 percent of women use birth control at some point in their lives.

Full text on the letter follows:

April 21, 2015

Chris Blanton, President                                             Lance Hunsinger, CEO

BridgeSpan Health Company                                     Community Health Plan of Washington

Jay Fathi, M.D., CEO                                                 Scott Armstrong, President and CEO

Coordinated Care                                                       Group Health Cooperative

Andrew McCulloch, President                                   Jim Havens, President

Kaiser Permanente Northwest                                    LifeWise Health Plan of Washington

Peter Adler, President                                                 Jeff Roe, President and CEO

Molina Healthcare of Washington                              Premera Blue Cross

To Health Insurance Carriers with Plans on the Washington Healthplanfinder:

I am writing to express my serious concern with recent reports that consumers are receiving inaccurate information regarding the coverage and cost of contraceptive services. While the Affordable Care Act (ACA) requires issuers of qualified health plans (QHPs) to cover all FDA-approved contraceptive methods without cost-sharing, this guarantee is not realized if women cannot access clear, consistent, and accurate information from their carriers about their health insurance plans, medical benefits, and cost-sharing responsibilities. Consequently, I was troubled to learn that QHP enrollees in Washington may be receiving misinformation from their carriers about birth-control coverage, and I urge you to take swift action to address this critical issue for women across our state.

As you know, the ACA’s contraceptive coverage requirements represented an important step toward improving women’s health and reducing inequality in our healthcare system. For the 99 percent of women who use birth control at some point in their lives, whether for family planning or other medical reasons, these reforms help to ensure that being a woman is no longer treated like a pre-existing condition. I also welcomed federal guidance in 2013 clarifying that carriers must cover branded contraception at no cost when generics are medically inappropriate, and that carriers must provide access to the full range of FDA-approved contraceptive methods — including oral contraceptives, the ring, the patch, the shot, implants, intrauterine devices (IUDs), emergency contraception, and subdermal implants. However, in order for these reforms to have a meaningful effect on women’s health, enrollees must also have access to consistent, accurate information about their contraceptive benefits.

That is why I am concerned about the results of a recent study conducted by Northwest Health Law Advocates and NARAL Pro-Choice Washington, highlighted by the Seattle Times on April 16, 2015 (“Women getting bad info on birth-control coverage from ACA insurers”), indicating that sales and customer service representatives are providing false, incomplete, or inconsistent information to consumers regarding the coverage of contraceptive benefits. According to the study, representatives routinely told callers that certain forms of contraception are available at no cost but that others are only available with cost-sharing, and no single carrier consistently told callers that all FDA-approved methods are available without cost-sharing – the precise level of coverage required by the ACA. In addition, the study found that certain contraceptive methods are frequently left off carriers’ formularies or listed in formulary tiers that require cost-sharing.

I recognize that the study’s findings differ among carriers, and I understand that many of you have already committed to taking action in coordination with Insurance Commissioner Kreidler to ensure consumers are receiving accurate information about the coverage and cost of contraceptive services. As you review these findings, I expect you to continue working closely with the Commissioner’s office and I respectfully request you address the following questions:

1. Are all FDA-approved contraceptive methods currently listed in your formulary and available without cost-sharing? If not, which methods are not included or are included as available only with cost-sharing?

2. Are each of the covered contraceptive methods listed in the formulary individually, or are they listed collectively (e.g., “FDA-approved methods”)? If listed collectively, have you provided a more detailed list of contraceptive methods to your customer service representatives to ensure consumers are receiving accurate, detailed information?

3. Is your formulary, or another form of documentation outlining coverage of contraceptive services, currently available online and easily accessible to consumers?

4. To ensure consumers are receiving accurate information regarding the availability of contraceptive methods, have you provided, or are you planning to provide, training to your sales and customer service representatives on the contraceptive benefits you cover?

5. Through what process do you currently ensure that consumers may obtain branded or non-preferred contraceptive services at no cost when generics are unavailable or deemed to be medically inappropriate by a provider? Has this process been made clear to your customers and the medical providers in your network?

I appreciate your prompt attention to this matter and I look forward to hearing from you. Together, we can ensure consumers across Washington state are receiving clear, consistent, and accurate information on their contraceptive benefits — which is essential to ensuring every woman can make the right medical decisions for her and her family.

Sincerely,

Suzan K. DelBene

Member of Congress

Cc: Insurance Commissioner Mike Kreidler