Multiple New York health plans found to be misinforming customers about contraception coverage

My Patient Rights | Stay Informed | Multiple New York health plans found to be misinforming customers about contraception coverage

Multiple New York health plans found to be misinforming customers about contraception coverage

Following an undercover sting, the New York Department of Financial Services announced last week the results of an investigation into health insurers’ coverage of contraception.

Out of 15 companies called statewide by the department masquerading as customers, 11 provided inaccurate or misleading information about contraceptive costs and coverage, and as such could be considered non-compliant with state law.

Under state law, all health plans are required to fully cover all contraceptives drugs and devices without co-pays, coinsurance or deductibles. Insurers are legally required to inform customers that these drugs and devices are covered with no out-of-pocket expense, and of the requirements for such coverage.

“New York law mandates that contraceptive coverage must be available with no co-payments, deductibles or any out-of-pocket costs, and also requires that insureds are provided accurate information about their rights to this coverage,” Financial Services Superintendent Maria T. Vullo said in a public statement. “Any insurer that is not providing full and accurate information about coverage requirements will be met with swift action to ensure full compliance with this important coverage protection.”

As part of the investigation, the DFS says it will take “all necessary action to ensure that all health insurers in New York cover the full range of FDA-approved contraceptive delivery methods at no cost-sharing,” and will request insurer documentation, specifically contraceptive claims and pay-outs, and customer complaints and appeals.

Bolton’s Pharmacy President and Owner Patricia V. Signor said birth control prescriptions are “always 100 percent covered with zero co-pays” at her pharmacy, sometimes at her own expense.

While she hasn’t run directly into any issues with insurers misinforming or “cost-sharing” the burden onto clients, Mrs. Signor said she has been on the receiving end of insurance companies’ reluctance to pay on as much as 40 percent of the scripts she fills. Mrs. Signor names United Healthcare as paying below cost on most prescriptions — whether it be contraception or treatment for schizophrenia.

“It’s not just that they don’t pay the gross costs,” Mrs. Signor said. “They don’t cover what it costs me to simply bring it in the back door and sell it.”

During the sting, callers asked the health plans for information on coverage and cost-sharing of birth control pills, the contraceptive patch, vaginal ring, injection, emergency contraceptive pills, intrauterine devices, and the contraceptive implant.

Only three plans fully and correctly answered the callers’ questions, and one other answered mostly correctly.

Of the remaining 11 health plans, six provided multiple inaccurate responses, three refused to provide some or all information, and seven incorrectly stated that contraceptive costs would be shared with customers.

The DFS is not identifying the 11 insurers at this time.

By JEN JACKSON

February 28, 2017

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