Birth Control Covered by Blue Cross Blue Shield Health Select
Q: Under the Affordable Care Act, I qualify for contraceptive services as part of my health plan at no extra cost. My health insurance provider Blue Cross Blue Shield has confirmed that fact to me. Yet Express Scripts, a separate company my Blue plan uses for prescription coverage, insists that my Blue plan doesn't offer a zero co-pay for me. What's going on? I've called and called and called. Where can I file a complaint against Express Scripts?
A: You're definitely right in principle. Under Obamacare, women have been entitled to a range of preventive services for more than a year, including birth control products and services, all at no additional costs. Your health plan premiums cover those costs in full.
"Starting a year ago, women of all walks of life began to get both birth control and important well-women checkups at no cost for the first time," said Cecile Richards, president of Planned Parenthood, recently. "This is the big story of the Affordable Care Act—the steady, historic progress for women."
Related: Lucy Hale on Why Getting an IUD Was a 'No-Brainer'
However, not every particular contraceptive is covered under the law. The Affordable Care Act requires just one form or brand of each of the 15 or so birth control methods—pills, rings, IUDs, implants, patch, injections and so on—to be covered.
So it seems to me that you have a simple problem. The particular form or brand of birth control you are using is not on your Blue Cross plan's approved list. For example, your brand-name pill—or even your specific generic—may not be included.
As straightforward as that problem sounds, you're learning how tricky the solution can be.
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In a rational world, you'd think you could call Express Scripts and find out what specific pill or other form of birth control is covered.
Related: Study Finds Link Between Birth Control and Breast Cancer
However, generally third-party providers like Express Scripts are set up to do is tell you whether the exact pill or form you're asking about pops up as approved on its computer screen. If it does, great! You're covered; Express Scripts fills your prescription at no extra cost. But when it does not—as in your case—Express Scripts just tells you that you're out of luck.
Before you look for a lawyer, go back to Blue Cross and get a supervisor to give you the full list of the contraceptive products and services your health plan covers, including brand names and dosages if applicable. Blue Cross should help sort this out for you.
Then talk to your doctor. Ask whether there is an approved product or service that would be safe and effective for you. Chances are, you'll have several options, at no extra cost. And if you have special medical needs, your doctor should want to help you seek a waiver for your particular contraceptive from Blue Cross.
https://parade.com/37364/jmarquez/21-should-birth-control-pills-be-sold-over-the-counter/
If you're still having trouble, go to the National Women's Law Center website at nwlc.org. That non-profit women's advocacy group has an excellent "toolkit" for women who are denied the preventive services they deserve, including form letters for formal appeals and waivers.
Studies done before the ACA became law have documented that birth control has been costly for women—and the nation. Half of all women of reproductive age said they didn't use birth control because of the costs, which can climb to $1,000 or more a year for IUDs and implants, the most effective forms of contraception. And the high costs, in turn, contribute to the nation's 1.6 million unintended pregnancies a year at an estimated cost of $12.5 billion in public assistance.
Over time, the ACA's birth control benefits should reduce the number of unintended pregnancies and the drain on the national budget.
Source: https://parade.com/219546/franklalli/does-my-health-plan-cover-contraceptives-or-not/
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