Employer not covering contraception d/t bioethics and not fully disclosing it??

[kit789]

TLDR: 1. Yes im looking at new jobs
2. Yes im privileged to be able to afford this but if anything goes wrong, or I need more followup, would be a larger financial hit to my wallet that I dont need in this economy
3. HR said they would likely cover this bill then went on this long chase and then said no worry we can’t
4. HR also said they texted me a link to a copay card 2 years ago and I dont recall getting a link and I wasnt even using the service at the time. Weird and then they wouldnt discuss much bc the language goes against bioethics. The copay card says “prescription and services related to contraception” which I assumed included IUD followup Eep. What are some facts about insurance coverage and shady disclosure of covering or not covering womens health resources?

Story:
I work for a religious intuition and I am employed in a state that requires contraceptive coverage for people however, obviously religious institutions are exempt to a certain degree. I was told that that ACA basically covers for contraceptive prescriptions only however, the insurance company does not cover it and we all basically just get a contraceptive prescription card that’s removed from the health insurance?? so in the event that someone needs an actual doctors visit to discuss birth control or termination, or anything regarding that then you would need to pay fully out of pocket and then if you switch birth control or have a termination and need follow up then you would also pay fully out-of-pocket for that visit, even if the provider is in network, because The service is not covered. I swear this was never discussed with me. I talked to HR and they said they are not allowed to use those words d/t bioethics of the place (pathetic). Allegedly two years ago they sent out a mass text message to notify us about the contraceptive prescription agreement but obviously I don’t have that because I wasn’t using it back then, so I guess they are legally covered because they notified me once?? Also, I’ve been employed here for years, but I was on my family plan which covered everything no problem and then I switched to a very comprehensive PPO plan once I turned 26 and was on a OCP which was covered by the copay card (also, had minimal issues on it and did followup in the form of med reconciliation at a PCP or routine well womens visit so it was never billed as contraceptive counseling). When I switched to an IUD, I was billed 1800$ for it and then they re-ran under my contraceptive card and it was covered but no services around it even though the card states + services. I think there was some secondary billing code to justify the insertion but the followup, I was billed full OOP for an in network provider. Total BS. Fortunately, I was able to afford it but realize this isnt chill moving forward in the event that I have other problems/require more followup. I asked HR to look into this and they re ran 3x which was nice and the third time, they said it was denied bc its a service that isnt covered even though the paperwork sent to me from the contraceptive card says “prescription and related services” on it multiple times. The HR benefits person even said it should have been covered when I initially asked. Weird how they state “and services”but literally didnt cover a service. Sucks for other women and those who cannot afford a 200$ bill for a 15 min convo with an in network provider. Thankfully im doing okay but I realize that I literally cannot afford ANY blunders. Do I just go to planned parenthood from now on?? Free no cost clinics? Total BS for a NURSE like me who fights insurance on the daily / pays $$$$$ for full PPO plan.

Plan is new job but also lawyer up? Report? Ask for a re run? Appeal?

TY

 

[foreverthankful]

@kit789 Religious exemption to contraceptives trumps ACA. They don't even have to offer you an alternative like a rebate card.

You don't have a case here.

Pay out of pocket, find a low/no cost clinic or find a new employer are the options here.

 

[kit789]

@foreverthankful It was weird bc they said the ACA gave me the prescription card. But horrible to think about it as a nurse and as a female. I get how I dont have a case. They dont pay for any termination no matter what (obviously… ick) and any followup. So if you go to the Dr saying you have bleeding and wanna learn about brith control… bam they bill as contraceptive counseling and no coverage. If i brought it up as a convo during annual, then no bill. If you have bad birth control side effects, cant cover bc its a related service. So odd! I get free retinol and low cost therapy (huge plus) but no womens health protections beyond like routine test/annual and general OB care

 

[aletia]

@kit789 Did you call the insurance company? It sounds like your employer objected to the coverage on moral/religious grounds and took advantage of the option to provide accommodation, meaning those services are covered by the insurance company (or TPA) completely outside of the employer's plan. They should at least be able to tell you why the follow-up wasn't covered, my guess would be billing code error.

This mess is 100% courtesy of your employer. It's also worth noting that the insurance company isn't required to provide those benefits separately. They could leave you with zero contraceptive coverage, and it would be perfectly legal. All that is to say that reporting or getting a lawyer may be wasted energy on your part.

 

[kit789]

@aletia Yesss called on and off for weeks. It was odd. at first the rep I spoke to was shocked and apologetic and said there should be coverage (im sure it is this way for a non religious place) and it was probably a billing error so they would fix it. Then claim was redone, re-rejected. Then the doctors office billing also said wow this is so weird and told me to wait it out and then they re initiated and then the insurance told them no it was charged bc I hadn’t met deductible. Then I called HR benefits and they re-ran and got back to me and had no explanation but said you have to pay and it doesnt count toward deductible. Then the HR lady said she has never seen this before and the commercial insurance would have “paid for it on the back end” which obviously is not the case. Then she did the whole “sorry this isnt favorable” talk and cut it off. The whole thing was weird AND the cost of my bill went down every time! First was 200 then down to 110 then down to 87 then down to 67 so clearly SOMETHING was wrong however if it wasnt for the religious thing it would have been a standard 20$ copay (which I did pay copay of 20$ for the IUD and insertion combined on the same insurance). Whole thing is super odd.

Basically, I need a new job if I want my rights protected haha. They also dont pay for any medical termination (bc the pope said so) in the event of ANYTHING which is so scary. Wild how they do this to nurses. Im literally a nurse coordinator and I work with insurance on the daily so I was shocked. Thank you for your input though

 

[luisjordanb]

@kit789 There's nothing shocking about this. That's what happens when people are allowed to refuse other people healthcare because of 'sincerely held religious beliefs'. Thanks, Hobby Lobby.

 

[kit789]

@luisjordanb Yep! It’s so crazy.HR lady then said that if I chose any of the OTHER plans offered, it would have been covered which is definitely a lie bc seems like its a bioethical issue

 

[luisjordanb]

@kit789 Definitely BS, but you can ask to see the other plans and have someone else look at them.

 

[kit789]

@luisjordanb I did, she said other plans dont have that issue and dismissed me and said its “simply not covered” such BS. Bc I have a full time job, even the PP or womens health clinic / low cost clinic still makes me bleed a decent amount of money. Im fortunate to be employed etc but its wild how there’s no affordable option