Regence fined $100K for denying coverage for removal of birth control

Today, Washington’s Insurance Commissioner, Mike Kreidler, announced a $100,000 fine levied against Regence for its failure to pay for procedures to remove IUDs. Regence paid for the insertion of the device, as long as it was prescribed by a doctor. However, the problem arose when women wanted the devices removed — in that case Regence refused to pay for the procedure unless it was “medically necessary.” So if a woman decided she was ready to have kids and wanted the device taken out, Regence refused to cover the procedure unless she could prove that procedure was medically necessary to her health. In other words, really easy to get the implantation of the device covered, really hard to get the removal of the device covered.

So women were forced to either pay for the procedure themselves out-of-pocket, or forgo having it removed if they couldn’t afford the procedure.

Kind of outrageous.

Regence ended up denying 984 claims to remove IUDs between 2002 and today. And it wasn’t until one woman called the Office of the Insurance Commissioner in April 2010, that the OIC began an investigation resulting in the fine. Regence has now reprocessed all the claims and paid them, totaling about $149,000. Regence also must pay 8% interest to all policyholders whose claims were denied.

The Insurance Commissioner’s Order details how Regence violated the law. WAC 284-43-822 regulates the unfair practices relating to health care.

Section (1) prohibits any health carrier from restricting, excluding, or reducing “coverage or benefits under any health plan on the basis of sex.”

Section (2)(a) requires all carriers who provide comprehensive prescription coverage to not “exclude prescription contraceptives or cover prescription contraceptives on a less favorable basis than other covered prescription drugs and prescription devices.”

And finally, Section (2)(b) prohibits carriers from placing limitations or restrictions on “prescription contraceptives that are not required or imposed on other covered prescription drugs and prescription devices.”

By making it much harder to get coverage for the removal of IUDs, Regence violated all three provisions, and they are paying the price. Kudos to Mike Kreidler and the rest of his team at OIC for sticking up for the rights of women in this state.

The sad part is that most women who had coverage denied didn’t do anything about it. Only 3 of 984 women even bothered to appeal the denial of coverage. And it wasn’t until April 2010 — 8 years after Regence began denying coverage — that one of the women called of the Insurance Commissioner’s Office to complain.

I think the lesson here is that just because your insurance company denies your claim doesn’t mean that the denial was right under the policy or under the law. So if you feel that coverage has been unfairly denied, stick up for your rights — appeal the denial and file a complaint with the Insurance Commissioner.

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