When the Affordable Care Act was passed in 2010, supporters celebrated new tenants that would require insurance companies to provide broader healthcare benefits to women. Contraception overage and preventative care including mammograms, prenatal care and general maternity care would be free to policyholders under the new law. But now, three new studies suggest that many health insurers are simply ignoring these requirements. According to reports from the National Women’s Law Center, many insurers are charging women for coverage that is not supposed to cost them.
In writing the report, the group considered plans in 15 states from more than 120 insurance companies by examining certificates of coverage. Breaches of the law ranged from matters concerning maternity care and birth control, all the way to charging women for genetic testing, prescription drug coverage and certain pre-existing conditions. “In every state, there were violations of the law,” said Karen Davenport, director of health policy at the women’s center. “In some cases, it was charging cost-sharing [fees] for services that should be free, and in other cases it was not covering something at all.” Davenport said she is the most concerned about health plans that don’t cover maternity care for women under the age of 26 who are included on their parents’ plans.
“So if you are a 20-year-old woman on your parents’ policy and you become pregnant, your pregnancy wouldn’t be covered,” she said.
Though women can file an appeal with the insurance commissioner in their state, Davenport wants to go further in correcting these violations. “When the health plans apply to sell policies on the exchanges, at that point, in most states, the state reviews that application,” Davenport said. “And then the feds also, if they’re in the federally facilitated marketplace, need to sign off on that too.
“There are really two levels of review in most states that these plans go through, but that’s clearly not doing the job.” The perceived violations were not specific to geographic region, and the group believes the problems could be widespread. Health industry trade group America’s Health Insurance Plans rejects the report’s findings; however, saying researchers distorted the truth.
“Health plans provide access to care for millions of women each day and receive high marks in customer satisfaction surveys,” said AHIP President and CEO Karen Ignani. “To use highly selective anecdotes to draw sweeping conclusions about consumers’ coverage does nothing to improve the quality, accessibility or affordability of healthcare for individuals and families.”
Any insurers that are found to be violating ACA mandates can be subject to fines by the federal government.