Report: Women In CT Denied Some Mandated Health Benefits

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Women in Connecticut have been denied health insurance benefits in violation of the federal Affordable Care Act, according to a study by the National Women’s Law Center.

Connecticut is one of 15 states included in the study, which analyzed the 2014 and 2015 health plans of companies that provide coverage under the ACA in state marketplaces. It found violations in all 15 states and concluded that they are likely occurring nationwide.

According to the report, Connecticut women have been denied coverage for the following: breastfeeding counseling and education after two months following delivery, infertility treatments after the age of 40, sterilization procedures, emergency birth control, and maintenance care for such things as lupus, HIV, and hormones after breast cancer treatment. Coverage was also denied for transgender transitions.

Some of the violations found in Connecticut have been corrected. The companies that participate in the state health marketplace, Access Health CT, are: Anthem Health Plans, ConnectiCare Benefits Inc., HealthyCT and UnitedHealth Group.

Karen Davenport, the law center’s director of health policy, said it takes all violations “seriously,” but added Connecticut didn’t have “really shocking problems” such as a Colorado insurer’s one-year waiting period for organ transplants, and a Tennessee insurer’s refusal to pay for labor and delivery costs for policyholders’ dependents.

The state's Insurance Department informed insurers that coverage of  breastfeeding counseling is required "during pregnancy and/or the postpartum period."

The state’s Insurance Department informed insurers that coverage of breastfeeding counseling is required “during pregnancy and/or the postpartum period.”

The severity of a violation “depends on the woman and her circumstances,” Davenport said. “Where women aren’t able to get the services that the law guarantees them, depending on where you sit, any one of them could be egregious,” she said.

Some of the Connecticut violations were corrected in insurance plans after the state issued bulletins clarifying that transgender transitions, sterilization for women, and contraception should be fully covered without a co-pay or deductible.

The remaining problems with Connecticut plans mainly concern the duration for which breastfeeding counseling is covered and a lack of coverage for infertility treatments for women age 40 and older.

On breastfeeding counseling, the state’s Insurance Department informed insurers to provide coverage for an undefined postpartum period, according to spokeswoman Donna Tommelleo. The department used a federal guideline that stipulates coverage is required “during pregnancy and/or the postpartum period,” Tommelleo said.

But when asked for clarification, the U.S. Department of Health and Human Services (HHS) responded that health plans must cover breastfeeding counseling “for the duration of breastfeeding.”

The Insurance Department is now reviewing the infertility coverage issue and “collecting additional data,” Tommelleo said. All four companies in the state’s insurance marketplace limit infertility coverage to women younger than 40. But the law center report states, “many women over 40 still have reproductive capacity.”

Davenport, of the law center, explained that because Connecticut mandates coverage of infertility services in its benchmark plan for Essential Health Benefits, it must be covered under the ACA. “If Connecticut chose a benchmark plan that did not cover infertility, such as a plan offered under the Federal Employees Health Benefit Program, infertility would not be part of Connecticut’s Essential Health Benefits,” she said.

The state must also adhere to an ACA prohibition against age discrimination, Davenport said.

Meanwhile, the report praises the state’s Insurance Department for clarifying coverage requirements for contraception and transgender-related care. It calls the state’s birth control bulletin “an important step toward ensuring that issuers clearly understand the requirements of the law and are not inappropriately charging women cost-sharing.”

Susan Lloyd Yolen, vice president of public policy and advocacy for Planned Parenthood of Southern New England, said her organization joined the law center in approaching the Insurance Department, which was “eager to correct inconsistencies and violations.”

In May, the HHS informed insurers that all forms of contraception identified by the FDA should be fully covered. This followed a letter from 39 U.S. senators, including Connecticut Democrats Richard Blumenthal and Chris Murphy, who complained about inconsistent contraception coverage.

“We take reports of non-compliance very seriously,” said Katie Hill, an HHS spokesperson.

After the state told insurers that failure to provide transgender transition coverage violates state discrimination law, all insurers in the state’s marketplace included it in their 2015 plans. None covered it in their 2014 plans, according to the law center report.

HealthyCT’s Chief Executive Officer Ken Lalime said when his company “became aware that policies were out of compliance, we immediately rectified the situation.” Its plan now includes coverage for lactation education through the duration of breastfeeding, and full coverage of female sterilization services and routine maternity care.

“As a brand new insurance company, HealthyCT had to write an entire Certificate of Coverage from scratch under new laws at the state and federal level,” he said, adding that “it’s unfortunate” that the law center didn’t acknowledge his company’s amended plan when it published its report.

ConnectiCare said it has been covering sterilization services for women without co-pays or deductibles since 2012 and disputed the law center’s contention that it hasn’t.

An Anthem spokesperson, Sarah Yeager, said in an email, “Our products are approved by the Connecticut Insurance Department.”

United, cited for the age limit in its infertility coverage, didn’t respond to a request for comment.

Davenport said the center does not know how many women were affected by the violations. The state Insurance Department does not know how many Connecticut women have coverage under ACA, said Tommelleo. The report states that nearly 6.3 million women nationally bought insurance during the 2015 open enrollment period.

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