Health insurers not following Oregon law requiring free reproductive health care, state audit says – Oregon Capital Chronicle

The Oregon Governor, legislators, and state agency officials have often described the state’s Reproductive Rights Act as one of the most comprehensive and equitable laws in the country.

But there’s a catch: Many insurance companies that provide coverage to more than one million Oregon residents don’t follow the regulations.

This is one of the results of a review ordered by the state’s Department of Consumer and Business Services, which regulates the insurance industry. The report, released Tuesday, said investigators found widespread evidence of violations of the Reproductive Health Equality Act, passed by the legislature in 2017 and effective in 2019. The law requires insurance companies to provide free coverage for reproductive health care, including check-ups. Abortion and contraception – even for undocumented immigrants.

The abuses meant that Oregonians were paying, at least in part, for reproductive services that were supposed to be free. The report did not say how many Oregonians were affected.

The law applies to commercial insurance companies, including individual, large and small group plans. The only exceptions to the law are religious insurers, such as the Providence Health Plan, that are exempt from the law.

The audit examined the claims from January 1, 2019 through December 31, 2020. The department began the audit when its work in a legislative report in June 2020 found that the requirements were not being fully followed.

The report said the agency found “differences in coverage and indications of a widespread potential for non-compliance with the law,” specifically a failure to pay in full for certain services.

Reproductive rights advocates were outraged, but not shocked by the report.

“It’s incredibly disappointing and incredibly unsurprising,” Senator Elizabeth Steiner Hayward, M.D., at Oregon Health & Science University, told the Capital Chronicle. While acknowledging that it is “difficult to renew when the new requirements are applied,” she said insurers have nearly three years to adjust to the law.

“What baffles me is this: All of these things ultimately save insurance companies money,” said Steiner Hayward. “Providing contraception is cheaper than taking care of someone when you’re pregnant. It’s also smarter because women who get pregnant while planning are more likely to have healthy babies.”

By law, insurance companies must cover abortions, screening for anemia, contraception, pregnancy screening, sterilization, and screening for sexually transmitted diseases free of charge. The law also requires coverage for undocumented immigrants.

Abortion ban could be coming

The report comes as reproductive rights activists and anti-abortion groups – along with the public – await a US Supreme Court decision that could overturn the Roe v. Wade case, which was decided in 1973, and a later decision – Planned Parenthood v. Casey. – which endorsed Rowe in 1992.

The department prepares reports on the violations of each company. Mark Peterson, acting director of communications for the Department of Consumer and Business Services, said he’s received few complaints about coverage from consumers.

The report did not mention the insurers, but Peterson told the Capital Chronicle that they are: Aetna, Inc., Cigna, Health Net Health Plan of Oregon, Kaiser Foundation Health Plan of the Northwest, Moda Health Plan, Inc., PacificSource Health Plans and Providence Health Plan and Regence BlueCross BlueShield of Oregon and Samaritan Health Plans, Inc. and UnitedHealthcare Insurance Co. and UnitedHealthcare of Oregon, Inc. And BridgeSpan Health Co. Their commercial health plans cover 1,042,661 Oregonians — a quarter of the population.

“Not every violation was found in every insurance company,” the ministry said.

The agency said that details of each insurer’s violations will be revealed after the companies have an opportunity to review them.

set of violations

The review found that insurers did not pay for services they were required to cover for free claims that were mishandled and applied inaccurate provisions for cost-sharing between patients and insurers.

“Some insurers have failed to provide coverage for some benefits until 2020 or beyond, including preventive services covered by the Affordable Care Act,” the report said. The ACA covers annual wellness exams and other preventive services, including mammograms, cervical cancer screenings, and prenatal care.

In some cases, the report said, insurance companies required at least a partial payment for abortions, anemia screening, contraception, pregnancy testing, sterilization and screening for sexually transmitted diseases.

Ann Doe, executive director of Planned Parenthood Advocates of Oregon, said the report was an important first step.

“It is more important now than ever that we elect officials and agencies who stand up to insurance companies and hold companies accountable for wrongdoing,” Doe said in a statement to the Capital Chronicle. “Every Oregon citizen who has been forced to pay out of pocket for sexual and reproductive health services – in violation of state law – deserves to be paid, and insurance companies should take responsibility.

State lawmakers also welcomed the report.

State Representative Dan Rayfield, de Corvallis and speaker of the House of Representatives, told the Capital Chronicle that insurance companies must comply with the law.

“It is unacceptable for any Oregon citizen to have paid out of pocket for these critical health care services or been adversely affected in any other way to access health care. I appreciate the work DCBS is doing on enforcement and hope they continue to use their full power to protect the services of Reproductive health for all Oregonians,” he said.

“This screening is vital in light of what we know is coming in terms of reproductive health and abortion services in the United States to protect Oregonians,” said Representative Rob Noss, the newly appointed chair of the House Health Care Committee.

Lawmakers and human rights advocates said they are eagerly awaiting the company’s reports, which management is finalizing.

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